Notes: Treat with azole antifungal. For severe or invasive cases with amphotericin.
Question: Which organism causes these findings?
Aspiration Pneumonia
Category: generalpediatrics-Pulmonology
Findings: history of neurological disease or dysphagia, diffuse infiltrates on CXR, fever, tachypnea, cyanosis
Notes: Treat anaerobic and gram-negative organisms with antibiotics such as ampicillin-sulbactam or a combination of metronidazole and amoxicillin. You may use clindamycin in patients with penicillin allergy.
Bacterial Tracheitis
Category: generalpediatrics-Pulmonology
Findings: high fever, cough, stridor, unresponsive to treatments for croup
Notes: Unlike epiglottitis, there is no drooling, and there is a cough.
Blastomycosis
Category: generalpediatrics-Pulmonology
Findings: cough and hemoptypsis, weight loss, chest pain, verrucous skin lesions and microabscesses, upper lobe infiltrates and cavitary lesion, fever, exposure to spores from soil
Notes: Seen often in Arkansas, Illinois, Mississippi, and Wisconsin
Question: What fits these findings?
Bronchiectasis
Category: generalpediatrics-Pulmonology
Findings: cough worse with positional changes, hemoptysis, associated with cystic fibrosis and autoimmune disorders, airway widening
Notes: Caused by damage and widening of bronchi
Question: What fits these findings?
Choanal Atresia
Category: generalpediatrics-Pulmonology
Findings: stridorous loud breathing since birth, tachypnea, cyanosis, worse at rest and better when crying
Notes: Also known as Valley Fever. Seen commonly in Arizona, California, Nevada, and New Mexico.
Congenital Diaphragmatic Hernia
Category: generalpediatrics-Pulmonology
Findings: respiratory distress in newborn, pulmonary hypertension, decreased breath sounds on the left side, flat or scaphoid abdomen
Notes: Treat with gastric decompression with NG tube, gentle ventilation, and management of pulmonary hypertension. When stable, obtain echocardiogram to check for commonly associated congenital heart diseases.
Findings: focal infiltrates on CXR, hilar adenopathy, mild fever and cough, exposure to farm animals
Notes: Seen with bat and chicken droppings, and found commonly in the Ohio and Mississippi river valleys.
Idiopathic Pulmonary Hemosiderosis
Category: generalpediatrics-Pulmonology
Findings: cough with hemoptysis, iron deficiency anemia, fatigue, worsening dyspnea, sputum with hemosiderin-laden alveolar macrophages
Laryngomalacia
Category: generalpediatrics-Pulmonology
Findings: inspiratory stridor in 3 month old infant worse when supine or agitated, no fever or signs of infection
Notes: Due to prolapse of epiglottis or tissue or cartilage near epiglottis. Obtain ENT consult for flexible laryngoscopy. Unlike croup, this is not caused by an infection, usually viral.
Question: Which disease is associated with these findings?
Laryngomalacia
Category: generalpediatrics-Pulmonology
Findings: inspiratory stridor in infant, worse when child is supine or upset, retractions, floppy larynx cartilage
Notes: Most cases will self-resolve by one to two years of age. Severe cases may require supraglottoplasty to keep airway open above vocal cords.
Question: What fits these findings?
Mycoplasma Pneumoniae
Category: generalpediatrics-Pulmonology
Findings: cough and wheezing in adolescent, fever, joint pain, splenomegaly, erythema multiforme, pharyngitis, confusion, multifocal diffuse infiltrates or lobar consolidation
Question: What organism causes these findings?
Pulmonary hemosiderosis
Category: generalpediatrics-Pulmonology
Findings: anemia, cough, crackles on exam, potential milk protein intolerance, hemosiderin laden alveolar macrophages
Notes: Alveolar hemorrhage leaded to recurrent respiratory symptoms. May be caused by granulomatosis with polyangitis, Goodpasture, SLE, and milk protein intolerance among other conditions. May treat with steroids and immunosuppressants.
Pulmonary Sequestration
Category: generalpediatrics-Pulmonology
Findings: recurrent pneumonia on same side, chronic cough
Notes: Lung tissue disconnected from trachea and has its own blood supply
Spasmodic Croup
Category: generalpediatrics-Pulmonology
Findings: croup and mild stridor at night, asymptomatic during day, treated with gastric reflux and allergy medications
Subglottic Stenosis
Category: generalpediatrics-Pulmonology
Findings: inspiratory and expiratory stridor, history of intubation, dyspnea, may be congenital or due to trauma
Question: What fits these findings?
Toxocara Canis
Category: generalpediatrics-Pulmonology
Findings: wheezing, abdominal pain, leukocytosis, eosinophilia, lung infiltrates, multiple systems affected, pet dog
Notes: Causes visceral larva migrans. Treat with albendazole.
Question: Which organism causes these findings?
Tracheomalacia
Category: generalpediatrics-Pulmonology
Findings: expiratory stridor worsened with agitation, usually resolves by 6 to 12 months
Notes: Due to collapsing tracheal wall. Unlike laryngomalacia, is expiratory instead of inspiratory.
Question: What fits these findings?
Tracheomalacia
Category: generalpediatrics-Pulmonology
Findings: expiratory stridor in infant, frequent respiratory infections
Notes: Due to obstruction in lower trachea
Vascular Ring
Category: generalpediatrics-Pulmonology
Findings: trouble feeding in infant, gastroesophageal reflux, expiratory stridor since birth, evaluated with barium swallow, sometimes caused by double aortic arch
Notes: Perform CT angiography or MRA for further workup
Question: What fits these findings?
Vocal Cord Dysfunction
Category: generalpediatrics-Pulmonology
Findings: wheezing, chest tightness, shortness of breath or feeling of suffocation, unresponsive to albuterol
Notes: Vocal cords close instead of open when breathing.
Question: What fits these findings?
Vocal Cord Paralysis
Category: generalpediatrics-Pulmonology
Findings: hoarse or weak cry in infant, inspiratory high-pitched stridor