Expert: Moshe Adler, MD - 7/15/2008

Question
I am hoping that you can help me understand what is going on with my 5 year old daughter.  She was diagnosed with pneumonia in November and had to be hospitalized.  After she kicked that, she came down with an upper respitatory infection.  At that point we were give a nebulizer with albuteral.

She was just diagnosed with pneumonia again last week. Our doctor said that they saw swollen lymph nodes in her chest on the x-ray.

The x-ray review states,minimal increased markings at the right upper lobe posterior segment which are possibly due to residual post-pneumonia fibrosis, but I can not rule out minimal infiltrate,  possible mild right hilar enlargement suggesting the possibilty of mild adenopathy. Also, possible minimal right perihilar infiltrate appearing since last exam.

Please translate this for me, is this something that could be serious.  We are going to follow up with whatever is necessary to get to the bottom of this.  My daughter is also very allergic to penicillin so she is limited in the medications she can take.

Thank you for your time.

Answer
Children can have repeated bouts of pneumonia for many reasons.  At her age, sometimes it's a foreign body that was put into the mouth and was accidently aspirated into the airway.  This causes either obstruction of the airway farther down, or irritation of the airway, which can lead to pneumonia that keeps coming back, or never really clears up.  Problems with the body's immune system can lead to repeated pneumonia, as can illnesses like asthma and cystic fibrosis.  The lymph nodes may be a reaction to the pneumonia, but they can also be a sign of other illnesses, like tuberculosis or even some type of tumor.  

Translation of the x-ray report:  "increased markings" means lines or haziness on the xray, which may be left-over damage from the pneumonia.  "can not rule out minimal infiltrate" means the radiologist thinks it's possible that there is a little pneumonia there, too.  The hilum is the middle of the chest, between the two lungs.  Hilar enlargement means it looks larger than it should, which may be due to "adenopathy" -- enlarged lymph nodes in the hilum.  "Right perihilar infiltrate" is an infiltrate -- haziness -- in the part of the lung to the right of the hilum.  This also could be a sign of pneumonia, but it's minimal, so the radiologist is not sure.  

I hope that helps.  She should have another x-ray done a few weeks after this bout of pneumonia is over, to see if everything is cleared up.  If not, or if she has another episode of pneumonia, she should have a CT or MRI of her chest.  If she has not seen a pediatric pulmonary specialist yet, that may be a good idea, too, if there is one in your area.  Ask her doctor for a referral.

If you have any more questions, or what I wrote is not clear, please write back.  

Moshe Adler, MD