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Symptomatology referable to the chest is one of the most common reasons for which pediatric patients present for clinical evaluation. Imaging plays a critical role in elucidation of differential considerations, provides valuable information in the evaluation of disease extent and associated abnormalities, impacts patient management decisions, and provides a detailed assessment of treatment response. Given the broad range of pathologies which affect the pediatric chest, anatomic localization is a useful classification approach and can be thought of in a three-compartment model, including primary processes of the lung parenchyma, abnormalities of the large airway, and pathology originating in the mediastinum. This practical approach can be applied to some of the most commonly encountered pediatric chest pathologies. This chapter also reviews the advantages and disadvantages of current imaging modalities and characteristic imaging findings of pediatric thoracic disorders encountered in daily clinical practice.

The ancient Egyptians laid the foundation for the development of the earliest recorded systems of medical treatment. Many specialties such as gynecology, neurosurgery, ophthalmology, and chest disorders were subject to diagnosis, which were followed by an appropriate treatment. Here, we elucidate the remarkable level of their knowledge and understanding of anatomy and physiology in the field of chest medicine. Furthermore, we look at how ancient Egyptian physicians came to a diagnosis and treatment based on the thoracic cases in the Edwin Smith papyrus.

The aim of this pictorial review is to introduce the radiologist to the differential diagnosis of a white hemithorax in children, to provide significant information on the diagnostic work-up, and to promote radiation-free techniques whenever possible. There are many causes of white hemithorax in children and it can be due to a variety of chest disorders. In most cases, plain chest radiographs and ultrasound will suffice. However, additional information provided by, e.g., CT or MRI is sometimes required.

Background Primary ciliary dyskinesia (PCD) is associated with pulmonary involvement that requires periodical assessment. Chest high-resolution computed tomography (HRCT) has become the method of choice to evaluate chronic lung disease, but entails exposure to ionizing radiation. Magnetic resonance imaging (MRI) has been proposed as a potential radiation-free technique in several chest disorders. Aim of our study is to evaluate whether high-field MRI is as effective as HRCT in identifying PCD pulmonary abnormalities. We also analyzed the relationships between the severity and extension of lung disease, and functional data. Methods Thirteen PCD patients (8 children/5 adults; median age, 15.2 yrs) underwent chest HRCT and high-field 3T MRI, spirometry, and deep throat or sputum culture. Images were scored using a modified version of the Helbich system. Results HRCT and MRI total scores were 12 (range, 6–20) and 12 (range, 5–17), respectively. Agreement between HRCT and MRI scores was good or excellent (r > 0.8). HRCT and MRI total scores were significantly related to forced vital capacity (r = -0.5, p = 0.05; and r = -0.7, p = 0.009, respectively) and forced expiratory volume at 1 second (r = -0.6, p = 0.03; and r = -0.7, p = 0.009, respectively). Conclusion Chest high-field 3T MRI appears to be as effective as HRCT in assessing the extent and severity of lung abnormalities in PCD. MRI scores might be used for longitudinal assessment and be an outcome surrogate in future studies.

Children are frightening. Frightening? In nearly all contexts this statement would be indefensible. In medicine, however, children are often frightening. For one thing, clinical evaluation in young children can be more difficult than with adults. In addition, in the acutely ill or injured child, reserve can be limited and appropriate assessment, including imaging evaluation, and subsequent care are critically important in improving outcome. Many care providers are not pediatric specialists by practice, and evaluation and treatment of children is less familiar than with adults. Moreover, the spectrum of disorders that affects the pediatric population can be quite different from disorders more easily recognized in adults. Often there is an extra layer of emotional concern, or anxiety, because a child is involved. Together, these issues reinforce the importance of resources which facilitate the diagnosis and care of the sick or injured child. This is especially relevant to chest disorders, because thoracic abnormalities are common in children, and is also relevant to radiologists, because imaging evaluation of the chest is frequently one of the first (or only) tools used after the clinical assessment. Presumably, you are reading this because you are an imager, or interested in imaging evaluation

Imaging of the respiratory system developed with exceptional rapidity in North America during the spring of 1896, after Roentgen's discovery of X-rays in November 1895, largely because of the efforts of a unique physicians, Francis H. Williams. With great zeal, this pioneer used fluoroscopy for early detection of tuberculosis and other life-threatening chest disorders. By the summer of 1896, he had accumulated more than 100 volumes containing tracings of clinical chest fluoroscopy. As a result of his extensive clinical experience, his dedication to patients' welfare, and his sense of scientific inquiry, several inventions and many landmark clinical observations were made in the first few years after the discovery of the X-ray. These included (1) the invention of a "densitometer" for standardized measurements of relative X-ray attenuation of the lung, (2) the invention of a "seehear" device to correlate auscultative findings and fluoroscopic observations, (3) the recognition that fluoroscopy was more accurate than percussion for estimating mediastinal displacement, (4) the discovery that clinically occult tuberculosis and congestive heart failure could be detected with fluoroscopy, (5) the documentation that unilateral chest disease caused decreased ipsilateral ventilatory compliance and increased contralateral ventilation, (6) the identification of the classical imaging characteristics of tuberculosis, pneumonia, pneumothorax, tension pneumothorax, pleural effusion, hydropneumothorax, emphysema, congestive heart failure, and air trapping. In April 1896, Dr. Williams described the "air bronchogram" in a radiograph of a patient with pneumonia.

A survey of the respiratory disorders in schoolchildren from rural areas showed no significant differences between the United Kingdom and Australia and New Zealand in loss of time from school owing to chest illness. Contrary to expectations the warmer the region the greater the prevalence of bronchitis, asthma, and hay fever. These results should encourage a critical appraisal of the respiratory benefits of warmer climates, and also suggest that the English climate should prove to be no more than a minor barrier to any future reduction of respiratory mortality in the U.K.

An assessment of energy expenditure has been made in 50 male textile workers and 30 male office cleaners. There was a statistically significant difference (P less than 0.001) in energy expenditure between textile workers and office cleaners amounting to 12 to 16%. While 33.3% of the textile group complained of chest disorders, none of the cleaners had such a complaint. FEV1 and FVC values of the textile workers were significantly lower (P less than 0.01) compared to those of the controls. There were no differences in body weight, lean body mass and socio-economic conditions of the two groups, however, the textile workers were younger and taller than the unexposed group. Exposure to cotton dust and respiratory and ventilatory impairments are suspected of causing a reduction in the energy expenditure of the textile workers.

Summary In 54 adult subjects (46 patients with chronic chest disorders and 8 normal individuals) the maximal midexpiratory flow-time (MMFT) was found to be closely related to the FEV1%. The MMFT can thus be used as an index for airflow obstruction, and an argument is made for including it in routine clinical spirometry. It is not well related to the FEV1, indicating that it does not test ventilatory capacity. The MMFR was more closely related to the FEV1 than to the FEV1%. It seems less satisfactory than the FEV1 and MMFT as a test of ventilatory function.

Pyogenic lung abscess with cavity formation is seldom mentioned in the literature dealing with chest disorders. Whether lung abscess occurs so infrequently that it is thought unimportant or whether it is considered too benign, self-limited, and responsive to antibiotics to require scientific study is not known. In 1957 Wolcott and Murphy1stated that the prognosis and management of lung abscess has changed dramatically in the past 15 years. They reported on 70 patients treated since 1941. In 19 patients treated between 1941 to 1944 with sulfonamide and routine bronchoscopy the mortality was 31.5%. From 1945 to 1951, 29 patients were treated with penicillin given both parenterally and in an aerosol form and supplemented with routine bronchoscopy; five persons, or 17%, died. The third group comprised 27 patients treated from 1951 to 1955. Bronchoscopy was now used only to secure cultural material and for sensitivity studies. The drug of choice

Objectives: Magnetic resonance imaging (MRI) has been proposed as a radiation-free alternative to high resolution computed tomography (HRCT) for the assessment and follow-up of chest disorders. Thus far, no study has compared the efficacy of high-field MRI and HRCT in children and adults with noncystic fibrosis (CF) chronic lung disease. The aims of our study were: (1) to assess whether chest high-field MRI is as effective as chest HRCT in identifying pulmonary abnormalities; and (2) to investigate the relationships between the severity and extent of lung disease, and functional data in patients with non-CF chronic lung disease. Materials and Methods: Forty-one subjects (median age, 13.8 years; range, 5.9-29.3 years; 30 children/11 adults) with primary ciliary dyskinesia (n = 14), primary immunodeficiency (n = 14), or recurrent pneumonia (n = 13) underwent pulmonary function tests, chest HRCT (120 kV, dose-modulated mAs) and high-field 3.0-T MRI (HASTE; transversal orientation; repetition time/echo time/flip angle/acquisition time, infinite/92 milliseconds/150°/approximately 90 seconds). HRCT and MRI images were scored in consensus by 2 raters using a modified version of the Helbich scoring system. The maximal score was 25. Results: HRCT and high-field MRI total scores were 11 (range: 1-20) and 11 (range: 1-17), respectively. There was good agreement between the 2 techniques for all scores (r > 0.8). HRCT and MRI total scores, and extent of bronchiectasis scores were significantly related to pulmonary function tests (r = -0.4, P < 0.05). The MRI mucous plugging score was significantly related to pulmonary function tests (r = -0.4, P < 0.05). Conclusions: Chest high-field 3.0-T MRI appears to be as effective as HRCT in assessing the extent and severity of lung abnormalities in non-CF chronic lung diseases, and might be a reliable radiation-free option to HRCT.