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Open Access 29-01-2025 | Lung Ultrasound | Invited review

ESR Essentials: imaging of common paediatric pulmonary diseases—practice recommendations by the European Society of Paediatric Radiology

Authors: Jovan Lovrenski, Maria Raissaki, Domen Plut, Efthymia Alexopoulou, Süreyya Burcu Görkem, H. Nursun Ozcan, Julia Geiger, Daniel Gräfe, Chiara Sileo, Pablo Caro-Dominguez, Pierluigi Ciet

Published in: European Radiology

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Abstract

Chest imaging in children presents unique challenges due to varying requirements across age groups. For chest radiographs, achieving optimal images often involves careful positioning and immobilisation techniques. Antero-posterior projections are easier to obtain in younger children, while lateral decubitus radiographs are sometimes used when expiratory images are difficult to obtain and for free air exclusion. Chest CT protocols should be age-dependent to minimise radiation exposure and motion artefacts. MRI is primarily used in specialised centres to reduce radiation exposure, requiring specific expertise and sedation in younger children. Respiratory distress syndrome is a leading cause of morbidity in preterm neonates, diagnosed through characteristic radiographic findings and a history of prematurity. Bronchopulmonary dysplasia is the most common complication of extreme preterm birth and chronic oxygen therapy; imaging is used for predicting outcomes for the assessment of severe cases. Transient tachypnoea of the newborn and meconium aspiration syndrome are common in term infants, with specific imaging characteristics aiding in their differentiation. Congenital lung malformations present diagnostic and management challenges, with imaging playing a crucial role in diagnosis and surgical planning. Finally, imaging is essential in detecting complications from pneumonia in children, such as empyema and necrotic pneumonia, or in identifying foreign object aspiration.

Clinical relevance statement

This review summarises current radiology practice of paediatric chest pathologies, aiding in the accurate diagnosis and management of neonatal and congenital pulmonary conditions and pneumonia complications, ultimately improving patient outcomes through precise imaging interpretation and targeted clinical intervention.

Key Points

  • Chest radiographs should be systematically assessed for pathology.
  • Ensure accurate differential diagnosis of neonatal lung diseases by collecting information on gestational age, method of delivery, presenting symptoms, ventilation type, and fetal ultrasound findings.
  • Radiographs and ultrasound are initial diagnostic tools for paediatric pulmonary disease; CT should be reserved for complex cases. Referral to paediatric hospital should be considered when the use of chest MRI is indicated.
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Metadata
Title
ESR Essentials: imaging of common paediatric pulmonary diseases—practice recommendations by the European Society of Paediatric Radiology
Authors
Jovan Lovrenski
Maria Raissaki
Domen Plut
Efthymia Alexopoulou
Süreyya Burcu Görkem
H. Nursun Ozcan
Julia Geiger
Daniel Gräfe
Chiara Sileo
Pablo Caro-Dominguez
Pierluigi Ciet
Publication date
29-01-2025
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-11268-4