Diagnosis : Round pneumonia
Differential diagnosis :
· Neuroblastoma
· Bronchogenic cyst
· CCAM ( congenital cystic adenomatoid malformation)
· Lung sequestration
· Round pneumonia
Clue for the diagnosis:
Round pneumonia
- Is a classic pediatric disease process characterized by a bacterial pneumonia that results in a sharply delineated, rounded appearance on radiographs, can simulate a mass.
- Results from the immature lung anatomy of children typically under the age of 8, in which the bacterial infection spreads via the Channels of Lambert and Pores of
Kohn, for this reason, it rarely occurs in older children and adults, with an average age of 5
- * (( before the age of 8, there is connection between the different segments of
the lobes via: Ø The pores of Kohn: openings in the alveolar walls connecting adjacent alveolar lumens.
Ø The canals of Lambert: connections between terminal bronchioles and adjacent alveoli.
------- These allow gas and fluid transfer between segments but no between lobes.
- Children with round pneumonia typically present with classic symptoms of pneumonia (i.e. cough + fever), but may also present with malaise and abdominal pain and can mimic appendicitis
- If the classic symptoms are present, underlying mass does not need to be excluded. However, in children over the age of 8, additional underlying pathology should be considered
- In terms of radiographic evaluation of Round Pneumonia, evaluation with PA and Lateral radiographs of the chest is the recommended approach, and remains the
only recommended imaging modality in patients with classic symptoms
- Cross-sectional imaging is not recommended unless there is a high index of suspicion for additional underlying pathology
- It has a lower lobe predominance, most commonly the superior segment and posterior location
- Recommend radiographic follow-up to resolution
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- A diagram that help you to accurate localization of the different segments of the lobes of the right lung on lateral chest X ray: ( above )