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Imaging in Pediatric Allergy
Saem Haque, Justin Stowell, MD, Brett Donegan, MD, Erin Opfer, MD, Lisa Lowe, MD
UMKC School of Medicine, Children’s Mercy Hospital
INTRODUCTION
Non- Respiratory
Respiratory
• Children might present with a constellation of
chronic, non-specific atopic symptoms, making the
clinical diagnosis of various allergic conditions
uncertain.
• This review discusses the role of imaging in the
diagnosis and management of various respiratory and
non-respiratory atopic conditions and their mimics as
they manifest in the pediatric patient population.
Chronic sinusitis
Acute sinusitis
In acute sinusitis,
mucosal thickening
often has a scalloped
appearance that may
vary from day to day.
Multiple sinus
involvement is common.
In contrast, chronic
sinusitis shows mucosal
thickening and bony
sinus wall sclerosis.
Differential Diagnosis
• The differential diagnosis for pediatric allergies can
be classified into respiratory vs non-respiratory
causes.
• Respiratory causes include sinonasal disease,
asthma, infection, hypersensitivity
pneumonitis (HP), allergic
bronchopulmonary aspergillosis (ABPA),
eosinophilic pneumonia and foreign body
aspiration.
• Non-respiratory causes can include
gastroesophageal reflux disease (GERD),
esophageal webs, eosinophilic esophagitis
and cow’s milk allergy.
Sinonasal Development
•
•
3 years
15 years
Allergic Bronchopulmonary
Aspergillosis (APBA) is a
hypersensitivity reaction
seen in patients with
longstanding asthma or
cystic fibrosis. Mucoid
impaction is commonly
seen and “finger-in-glove”
appearance (B) is
characteristic for ABPA.
Vascular
4
anomalies
such as
Vascular Rings
(C) and
TracheoEsophageal
Fistula (D) can
often mimic
respiratory
D
conditions.
2
A
Paranasal sinus development begins in utero.
Development begins from the ethmoid sinus and proceeds to
maxillary, sphenoid and frontal sinuses.
1 month
Juvenile Angiofibroma (above) almost always presents in adolescent males with
unilateral obstruction and epistaxis. It originates in the sphenopalatine formaen
and extends into posterior wall of the nasal cavity and the nasopharynx.
3
1
C
B
E
Eosinophilic Esophagitis (E) can present in kids with
signs of frequent vomiting, feeding intolerance,
asthma and acid reflux. “Trachealization” of the
esophagus is seen on esophagram.
Esophageal webs (F) can present
with progressive dysphagia and
vomiting. Rarely, regurgitation and
aspiration can occur in newborns.
Pathologically, a thin mucosal band
extends into the esophageal
F
lumen.
CONCLUSION
• Allergic rhinitis, asthma, chronic cough and
food allergies are among the most common
reasons for referral of patients to the pediatric
allergist, who often present in a very nonspecific way.
• Patients with congenital variants or
unexpected disease processes may present
with atopic-like symptoms. These diseases
may be detected through imaging.
• The radiologist and clinician can work together
through the use of imaging to help broaden
the differential diagnosis and detect various
infectious, inflammatory, developmental or
neoplastic conditions, which manifest with
atopic symptomatology.
CREDITS/DISCLOSURE/REFERENCES
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•
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1. Towbin R et al. Radiographics 1982;2:254.
2. Santiago Martinez et al. RadioGraphics 2008, 28, 1369-1382.
3. Yedururi S et al. Radiographics 2008;28:e29-e29.
4. Berrocal T et al. Radiographics 1999;19:855-872
5. All other images are property of Children’s Mercy Hospital and Clinics.