تشخیص

Causes of Hemoptysis in Children

Infection

Tracheobronchitis

Pneumonia
  Bacterial
  Tuberculous
  Fungal (e.g., aspergillosis)
  Parasitic (e.g., echinococcosis)

Tracheostomy-related

Bronchiectasis
  Cystic fibrosis
  Ciliary dyskinesia
  Immunodeficiency

Foreign body

Congenital heart disease (mainly with pulmonary vascular obstructive diseases )

Pulmonary arteriovenous malformations

Trauma

Alveolar hemorrhage syndromes

   Connective tissue disease/vasculitis

                (e.g., Goodpasture syndrome, Wegener granuloma)
  Primary pulmonary hemosiderosis

            (e.g., idiopathic, Heiner syndrome)

Pulmonary thromboembolism

Tumor
 
  Bronchial adenoma
  Metastatic

CAUSES OF PULMONARY HEMORRHAGE AND MASSIVE HEMOPTYSIS IN PEDIATRIC PATIENTS

Differential Diagnosis of mediastinal Calcification

Pulmonary Inflammatory Pseudotumour

Posterior mediastinal masses ganglioneuroblastoma

Posterior Mediastinal Schwannoma

Alveolar Rhabdomyosarcoma

Histoplasmosis

Lobar Consolidation,
Hilar Adenopathy,elevated ESR

Tuberculous

lymphoma

Hamartom

benign and malignant lymphoproliferative lung disorders

 reactive pulmonary lymphoproliferative disease

primary and secondary pulmonary lymphomas

Wegener's Granulomatosis

Lobar Consolidation,
Hilar Adenopathy,elevated ESR

Mycoplasma pneumoniae (LLL)

Pulmonary Sarcoidosis (LLL)

Esophageal tuberculosis (vomiting, cough, low-grade fever and anorexia / positive mantoux / history of contact to Tuberculosis/ Upper Gl scopy / an irregular ulcer / consolidation left lower lobe / hilar and mediastinal adenopathy. )

Lymphomatoid granulomatosis (elevated ESR and LDH) 

Bronchoscopy & Biopsy
Imaging
…

Tuberculous

tuberculous lymphadenitis

Esophageal tuberculosis

Lymphoma

germ cell tumor

Pulmonary Inflammatory Pseudotumour

Hamartom

 Wegener's Granulomatosis / Goodpasture syndrome

Treatment

The patient treated with the diagnosis of pneumonia (Ceftriaxon and Erythromycin ) for 10 days. 

No improvement was observed in clinical and radiological findings.

Diagnostic plan was performed.
 

Bacterial causes of pneumonia

Immunocompetent                 Immunocompromised

-   S. pneumoniae                              -Pseudomona

-   H. influenza                                   - Enterobacter

Staphylococcus. A                          - Legionella

Bordotella pertussis                        - Nocardia

Moraxella. C                                    -  Anaerobic

Mycoplasma. P

Chlamydia. P

Pneumonia in Child over 6 year of age

Mycoplasma .P

( walking pneumonia or atypical pneumonia)

S. Pneumoniae

Chlamydia Pneumonia

(walking pneumonia or atypical pneumonia)

Causes of Hemoptysis

Bronchiectasis

CF

Bronchopulmonary aspergilosis

P.C.D

TB

Lung abscess

Neoplasm

Retained foreign body

Pulmonary sequestration

Vascular anomaly

Unusual pneumonias

Immunodeficencies ( Primary or AIDS )

Malignancy

Inflammatory Disease ( CTD )

Opportunistic organisms should be suspected.

( virus, fungi, bacteria, NTM )

Tissue diagnosis is needed

Mediastinal and hilar node enlargement

Infection

Bacterial

Fungal

TB

Malignancy

Leukemia

Lymphosarcoma

Sarcoidosis ( Bilateral )

Primary Mediastinal Masses in Infants and Children in NRITLD

A retrospective study was performed on 45 children with mediastinal mass in NRITLD.

60% were boys and 40% were girls with mean age of 8 year.

61% of the masses were malignancy in boys and 39% in girls.

Anterior mediastinal region was the most common site of involvement.(84/4%)

The most common diagnosis was malignancy (82/2%) and 67/3% were Hodgkin Lymphoma.

The second diagnosis was Lymphoblastic T cell Lymphoma.

Mediastinal Masses

Research in NRITLD                        Text book

Hodgkin Lymphoma (57.7%)                                    Neoplasm of thymus

Lymphoblastic Tcell Lymphoma (17%)                            Thymic cyst

Non Hodgkin Lymphoma (8.8%)                         Benign cystic teratomas

Bronchogenic cyst (6.6%)                                                Lymphoma

PPNET (4.4%)                                                     Teratoides (carcinoma)

Neuroblastoma (2.2%)                               Vascular lymphatic abnormalities

Shoanoma (2.2%)

Thymoma (2.2%)                                                  

Cardiac Tumor (2.2%)

Mesanchymal Hamartoma (2.2%)

Lymphangioma(2.2%)

Diagnosis performed by lymph node excetional biopsy

Final Diagnosis :

Hodgkin Lymphoma