Pediatric emergency medicine trisk 4094 4094
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CLINICAL PEARLS AND PITFALLS
Airway and lung lesions are uncommon in children, but can present
with common respiratory symptoms and signs.
Chest radiographs are the initial diagnostic modality of choice, and
should be obtained promptly in patients with respiratory distress when
such lesions are suspected.
Patients with large cystic lesions or hyperinflation may develop air
trapping and worsened respiratory compromise if positive-pressure
ventilation is applied.
Prompt surgical consultation may be needed in cases of respiratory
distress caused by a lung lesion.
Current Evidence
Most lung lesions in children are congenital, with the majority comprised of
CPAMs, bronchogenic cysts, bronchopulmonary sequestrations (BPSs), and
congenital lobar emphysema (CLE). Many lesions are discovered prenatally and
are asymptomatic after birth, while some cause clear early signs of respiratory
distress or circulatory impairment. Complications associated with the abovementioned lesions include compression of critical structures, infection,
pneumothorax, or rarely, malignant degeneration; therefore surgical intervention
is frequently warranted in the care of children with lung lesions.
Goal of Treatment
Since patients with lung lesions typically present with respiratory symptoms and
even distress, prompt evaluation and treatment is critical. Familiarity with normal
variations and potential pathologic abnormalities is necessary to arriving at a
prompt diagnosis and delivering the appropriate treatment, as patients with spaceoccupying lung lesions may require quite different management than patients
with more common respiratory illnesses.
Cystic Lung Disorders—CPAM and BPS
Cystic lesions of the lung are congenital processes that can present with
pulmonary infection, a mass or tension effect causing respiratory distress, or an
abnormal chest radiograph in an otherwise asymptomatic patient. CPAM lesions
are the result of an overgrowth of bronchioles (Fig. 124.7 ) and an increase in
terminal respiratory structures and mucous cells lining the cyst walls. These
lesions are generally supplied solely by the pulmonary arterial system, and are
