Nontraumatic pediatric thoracic emergencies

The most common nontraumatic pediatric emergency is the patient with an acute pulmonary infection. In this regard, it is important to differentiate viral from bacterial infections, but a problem usually arises when one has to deal with atelectasis associated with viral infections. Asthma is the next most common nontraumatic thoracic emergency, and the problem usually is exacerbation of asthma with or without an associated pulmonary infection. In this regard, bacterial infections do not trigger asthma attacks, but viral infections do. After asthma, endobronchial foreign bodies are next most common; the key to their detection lies in the use of inspiratory-expiratory film sequences. Hydrocarbon aspiration also is common in childhood and manifests primarily in bilateral basilar infiltrates. Spontaneous pneumothorax is uncommon in childhood, but it is becoming increasingly apparent that one can encounter unexpected entities such as delayed congenital diaphragmatic hernia and delayed congenital lobar emphysema in older infants and children. Finally, among the more common causes of vascular congestion in childhood are acute glomerulonephritis and, less often, myocarditis.