VOCÊ SABERIA IDENTIFICAR BRONQUIOLITE VIRAL EM CRIANÇA?

Você Radiologista com João Paulo Queiroz

8 Jan 202105:52

Summary

TLDRThe transcript discusses a case of a one-year-old female infant presenting with productive cough, dyspnea, and tachypnea at 60 breaths per minute. Physical examination reveals crepitations and diffuse rhonchi. The radiographic findings are subtle, with possible infiltrates or reticulonodular opacities, leading to a challenging interpretation. The speaker carefully assesses the radiograph, considering various aspects such as tracheal and lung borders, and the heart's position and size. The consensus leans towards a diagnosis of viral bronchiolitis, a common respiratory infection in infants, often with normal or minimally abnormal radiographic findings. The diagnosis is primarily clinical, with radiography used to rule out other pathologies.

Takeaways

👶 The patient is a one-year-old female infant presenting with productive cough, dyspnea, and tachypnea at 60 breaths per minute.
🔍 On physical examination, the infant exhibits crepitations and diffuse expiratory wheezes.
📝 The script discusses the difficulty of performing a technically adequate X-ray, especially in a young patient.
🏥 The X-ray is described as possibly showing an indistinct infiltrate, with some disagreement on whether it's normal or abnormal.
💡 The script suggests that the clinical history is leading to a tendency to lean towards a specific diagnosis.
🧐 The heart is noted to be centrally located and not enlarged, which is important in the differential diagnosis.
👁 The diaphragm is also examined for any signs of hernia or abnormalities, with none found.
🦴 The skeletal and soft tissue structures, including the thoracic cage, are briefly mentioned to be normal.
🌟 The shadow of the heart is specifically checked for any abnormalities such as pulmonary vessels, with none noted.
🤒 The final diagnosis suggested by the script is viral bronchiolitis, which is often indicated by the clinical history rather than X-ray findings.
📈 The script emphasizes that in viral bronchiolitis, the X-ray is often normal or may show only subtle findings, and is more used to rule out other pathologies.

Q & A

What is the age and gender of the patient described in the script?
-The patient is a 1-year-old female.
What symptoms does the patient exhibit according to the script?
-The patient exhibits productive cough, dyspnea, and has a respiratory rate of 60 breaths per minute.
What findings were present on the physical examination of the patient?
-The patient had crepitations and diffuse rhonchi on physical examination.
What is the significance of the term 'crepitations' mentioned in the script?
-Crepitations refer to crackling sounds heard during auscultation of the lungs, often indicative of fluid or inflammation.
What is the term 'rhonchi' mentioned in the script and what does it suggest?
-Rhonchi are continuous, coarse, wheezing sounds heard during lung auscultation, suggesting airway obstruction or inflammation.
What is the patient's respiratory rate in comparison to normal values?
-The patient's respiratory rate is 60 breaths per minute, which is significantly higher than the normal range for a 1-year-old child.
What does the script suggest about the quality of the chest X-ray performed on the patient?
-The script suggests that the chest X-ray is of questionable quality, making it difficult to definitively interpret the findings.
What is the diagnosis suggested by the script based on the patient's clinical history and X-ray findings?
-The script suggests a diagnosis of viral bronchiolitis based on the patient's clinical history and the subtle findings on the chest X-ray.
What is the typical chest X-ray finding in viral bronchiolitis according to the script?
-The script indicates that in most cases, the chest X-ray in viral bronchiolitis is normal or may show minimal findings such as linear opacities or a slight nodular pattern.
What is the significance of the term 'peribronchial cuffing' mentioned in the script?
-Periorbronchial cuffing refers to the thickening of the bronchial walls, which can be seen on chest X-ray and may suggest inflammation or infection.
What are the limitations of using chest X-ray in diagnosing viral bronchiolitis as mentioned in the script?
-The script highlights that chest X-ray is more useful for ruling out other pathologies rather than confirming viral bronchiolitis, as the findings can be very subtle or even normal.
What other clinical signs or symptoms would support the diagnosis of viral bronchiolitis besides the chest X-ray?
-The script implies that a young patient's history of cough, physical examination findings such as crepitations and rhonchi, and the absence of significant X-ray findings support the diagnosis of viral bronchiolitis.

Outlines

00:00

😷 Viral Bronchiolitis in a One-Year-Old

The first paragraph discusses a one-year-old female patient presenting with productive cough, dyspnea, and crepitations and wheezes on physical examination. The patient's respiratory rate is 60 breaths per minute. The script mentions the difficulty in conducting a quality X-ray due to the patient's age and central position. It also covers the assessment of the patient's lung borders, the presence of peripheral nodules, and the transparency of the lung fields. The radiograph is described as potentially showing a slight reticulonodular pattern, septal lines, and a questionable infiltrate. The clinician suggests that the radiograph might be interpreted differently by various professionals, with some seeing it as normal and others as indicative of an infiltrate. The paragraph concludes with the diagnosis of viral bronchiolitis, noting that the radiograph is often normal in such cases, with only subtle findings like linear opacities or mild nodularity.

05:01

🔍 Clinical Diagnosis of Viral Bronchiolitis

The second paragraph focuses on the clinical diagnosis of viral bronchiolitis in infants, emphasizing that radiographic findings are often subtle or absent. The script highlights that a clinical history is crucial, especially in very young patients who typically present with a cough and may exhibit dyspnea and crackles on physical examination. It is mentioned that radiography is more useful for ruling out other pathologies rather than confirming viral bronchiolitis, as the condition often does not show significant changes on X-ray. The importance of clinical signs and symptoms in making a diagnosis is underscored, rather than relying solely on radiographic evidence.

Mindmap

Keywords

💡Bronchiolitis

Bronchiolitis is a common lower respiratory tract infection that primarily affects infants, causing inflammation of the bronchioles. In the video's context, it is the likely diagnosis for the one-year-old patient presenting with productive cough, dyspnea, and increased respiratory rate. The term is used to discuss the patient's symptoms and the clinical approach to diagnosis.

💡Productive cough

A productive cough is one that brings up mucus or phlegm from the respiratory tract. The script mentions the patient has a 'tosse produtiva,' which indicates that the cough is generating sputum. This is a key symptom in diagnosing respiratory conditions like bronchiolitis.

💡Dyspnea

Dyspnea refers to difficulty in breathing or shortness of breath. The video describes the patient experiencing 'dispneia,' which is a significant symptom that could point towards a respiratory issue requiring medical attention.

💡Respiratory rate

Respiratory rate is the number of breaths taken per minute. The script specifies that the patient has '60 incursões por minuto,' which translates to 60 breaths per minute, a rate that is elevated and could be indicative of respiratory distress.

💡Crepitus

Crepitus, or crackles, are abnormal lung sounds heard during auscultation, often indicating fluid in the lungs. The term 'creptos' is used in the script to describe sounds heard during the patient's physical examination, suggesting the presence of fluid or inflammation.

💡Sibilance

Sibilance refers to a high-pitched whistling sound heard during lung auscultation, often associated with airway obstruction. The script mentions 'sibilos,' which is a key finding that can help in diagnosing conditions like bronchiolitis.

💡Physical examination

Physical examination is the process by which a healthcare provider assesses the health of a patient through observation, palpation, and auscultation. In the script, the 'exame físico' is conducted to identify signs like crepitus and sibilance, which are crucial for the diagnosis.

💡Radiography

Radiography is the use of X-rays to produce images of the body's internal structures. The script discusses the patient's chest X-ray, which is an important diagnostic tool to look for signs of infection or other abnormalities in the lungs.

💡Viral infection

A viral infection is caused by a virus and can lead to various illnesses. The term is implied in the script when discussing bronchiolitis, which is often caused by a viral infection. The diagnosis of a viral etiology is made based on clinical history and the lack of significant findings on radiography.

💡Cardiothoracic ratio

The cardiothoracic ratio is a measurement on a chest X-ray that compares the width of the heart to the width of the thoracic cavity. The script mentions evaluating the 'índice cardiotorácico' to determine if the heart is enlarged, which can be a sign of various cardiac conditions.

💡Clinical history

Clinical history refers to the patient's medical background, symptoms, and other relevant information provided by the patient or caregiver. In the script, the 'história Clínica' is used to guide the diagnosis of bronchiolitis, as the patient's young age and symptoms align with the typical presentation of the condition.

Highlights

One-year-old female patient with productive cough, dyspnea, and tachypnea at 60 breaths per minute.

Physical examination revealed crepitations and diffuse rhonchi.

Increased respiratory frequency with crepitations and rhonchi.

Discussion of the difficulty in obtaining a technically adequate X-ray.

Centralization of the trachea and absence of significant findings.

Assessment of lung borders and the absence of peripheral nodules or masses.

Challenge in identifying any abnormalities in the lung fields on X-ray.

Mention of the possibility of a reticulonodular pattern or septal lines on X-ray.

The radiographic findings are described as questionable and subject to interpretation.

Normal heart size and position with no significant alterations.

Assessment of the diaphragm and the absence of diaphragmatic hernia or effusions.

Exclusion of any skeletal abnormalities or soft tissue issues.

Attention to the homogeneity of the cardiac shadow and the absence of any abnormal vessels.

Diagnosis of viral bronchiolitis based on clinical history and physical examination.

Radiography is often normal or shows minimal changes in viral bronchiolitis.

Radiography is used more for differential diagnosis rather than confirming viral bronchiolitis.

The importance of clinical history in diagnosing viral bronchiolitis in very young patients.