دانلود کتاب رادیولوژی اورژانس اطفال

An adolescent with cough, shortness of breath, and wheezing has a differential that includes asthma, pneumothorax, pneumonia, achalasia, myocarditis, and congestive heart failure (HF). Patients with asthma, a chronic inflammatory disease of the airways, typically have recurrent episodes of airflow obstruction resulting from edema, bronchospasm, and increased mucus production in the airways. Children frequently have associated seasonal allergies (allergic rhinitis) and eczema (atopic dermatitis), with these three conditions forming what is known as the atopic triad. This patient does not have a history of allergic diseases or wheezing and on physical exam is not currently wheezing. Children have an increased risk of pneumothorax with a previous history of an emphysematous bleb, asthma (10%), and tobacco use (4%). An underlying congenital anomaly might also serve as a predisposing factor, particularly in a younger child. Young males with Marfan syndrome, the most common inherited disorder of connective tissue, are also more likely to have a spontaneous pneumothorax. Clinically, children usually present with the acute onset of pain at rest or during physical activity and, depending on the size of the pneumothorax, might have dyspnea and cough. Physical exam findings may reveal differences in air entry to the lungs; however, with a small pneumothorax, unequal breath sounds, hyperresonance with percussion, and asymmetric wall movements might be subtle or not yet present. This child does not have risk factors or findings associated with a pneumothorax.