Pediatric Pulmonary Hemorrhage

  • Etiology:
    — Cystic fibrosis from bronchial artery hypertrophy caused by infection as focal infection can erode into artery
    — Pulmonary hemosiderosis
    — Aspergilloma
    — Lymphangiomyomatosis
    — Can occur in divers after breath-holding due negative pressure
  • Imaging: Airspace opacification
  • DDX: Pulmonary edema, bacterial pneumonia
  • Complications:
  • Treatment: Embolization of bronchial artery in cystic fibrosis
  • Clinical: Present with hemoptysis

Radiology Cases of Pulmonary Hemorrhage

CXR and CT of pulmonary hemorrhage
CXR AP (above) shows bilateral diffuse asymmetrical airspace opacities which are more confluent in the right lung. There is a moderate in size right pleural effusion. Coronal CT with contrast of the chest (below) also shows right lower lobe atelectasis caused by the pleural effusion.

Radiology Cases of Pulmonary Hemorrhage in Cystic Fibrosis

CXR and angiogram of pulmonary hemorrhage in cystic fibrosis
CXR (left) shows chronic changes of cystic fibrosis. Bronchial artery angiogram (right) shows hypertrophy of the right-sided bronchial arteries.
CXR of pulmonary hemorrhage after cystic fibrosis
CXR AP and lateral show bilaterally hyperexpanded lungs with a coarse interstitial pattern, bronchial wall thickening and bilateral lower lobe bronchiectasis. The opacity in the medial aspect of the right lower lobe was new when compared to prior serial CXRs.

Radiology Cases of Pulmonary Hemorrhage in Pulmonary Hemosiderosis

CXR of pulmonary hemosiderosis
Initial CXR AP (left) shows diffuse alveolar infiltrates primarily in the upper lobes. CXR AP obtained a week later (right) shows resolution of the findings.