1. Pneumonia in children including SARS Winnie Chu The Chinese University of Hong Kong Department of Diagnostic Radiology and Organ Imaging Prince of Wales Hospital

3. Role of imaging of pulmonary infection in children

4. Role of imaging in pneumonia Confirmation/ exclusion Underlying cause when failure to resolve or recur Acute complications Chronic sequelae Characterization and prediction of infectious agent

5. Follow up CXR Not a routine Post-obstructive pneumonia secondary to CA is not a concern reserved for: persistent symptoms recurrent symptoms immunodeficiency

6. Persistent/ recurrent pneumonia Developmental lung masses sequestration bronchogenic cyst cystic adenomatoid malformation reflux, aspiration, systemic disorders

7. Acute complications Parapneumonic effusion cavitary necrosis empyema lung abscess pneumothorax purulent pericarditis

8. Guiding management Placement of chest tubes loculated collection

9. Chronic sequelae Parenchymal scarring bronchial wall thickening bronchiectasis bronchiolitis obliterans Swyer-James syndrome

10. Typical pneumonia

11. SARS Severe Acute Respiratory Syndrome

12. Risk in children household contact healthcare setting contact

13. Presenting symptoms of SARS children 0 20 40 60 80 100 120 fever cough myalgia chills/ rigor runny nose dyspnoea sorethroat headache dizziness malaise febrile convulsion Percentage

14. Zonal distribution of air-space opacification Upper zone Middle zone Lower zone Upper & lower

15. Distribution of air-space opacification on CXR focal multi-focal bilateral

17. Radiological change Worst CXR appearance

18. Radiological changes Complete resolution of CXR

19. Role of HRCT in SARS Aid diagnosis in children with strong clinical suspicion of SARS but non- contributory CXR Assessment of treatment response in prolonged course of the disease

20. i.Ribavirin i.v. ii.Hydrocortisone i.v./ prednisolone p.o. iii.Cefotaxime i.v. iv.Clarithromycin p.o. Suspected paediatric SARS Mild symptoms Moderately severe symptoms + High swinging fever i.Cefotaxime i.v. ii.Clarithromycin i.v. iii.Ribavarin i.v. No improvement Persistent fever, Clinical deterioration + Prednisolone p.o. + Pulse Methylprednisolone i.v. No improvement + Pulse Methylprednisolone i.v.

21. Outcome Discharge: 16 Observation: 1 Mortality : 0

22. Conclusion Young children develop a milder form of the disease with a less aggressive clinical course and milder radiological changes

23. Conclusion Teenagers may simulate adult pattern, presenting with a more severe clinical disease and bizzare radiological finding

25. THANK YOU