Differential diagnosis of pediatric chemical pneumonitis

Approach to the differential diagnosis of chemical pneumonitis:

  • The radiographic findings in chemical pneumonitis usually consist of nonspecific interstitial infiltrates and therefore the diagnosis is best made when correlated with the clinical history
    In the newborn, chemical pneumonitis is due to meconium aspiration syndrome which is suspected in the patient with meconium-stained amniotic fluid and confirmed when meconium is seen beneath the vocal cords
    In the older child, aspiration pneumonia should be suspected as the etiology of lung infiltrates in the child who has difficulty with feeding, has sustained intracranial injury, has gastroesophageal reflux, or has developed them while under anesthesia
    Lipoid pneumonia should be suspected in children with a witnessed ingestion of a hydrocarbon-based liquid