Respiratory manifestations of systemic disease

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Target exams

Red flags

• New fever, chest pain, and a fresh pulmonary infiltrate in a child with sickle cell disease is acute chest syndrome, the leading cause of death in this group — treat it aggressively before the picture completes rather than waiting for it to declare itself
• A child with a known systemic disease and new breathlessness, hypoxia, or a persistent infiltrate has a lung complication until proven otherwise — never write it off as a simple chest infection
• An anterior mediastinal mass, often lymphoma, can collapse the airway and great vessels under sedation or general anaesthesia — assess the airway and cardiovascular reserve and secure a tissue diagnosis by the safest route before any sedation
• Progressive exertional breathlessness, a dry cough, and clubbing in a child with juvenile dermatomyositis, scleroderma, or lupus point to interstitial lung disease that needs imaging and lung function before it becomes irreversible fibrosis
• Recurrent, severe, or unusual sinopulmonary infection, especially with bronchiectasis, may be the presenting sign of an inborn error of immunity and warrants an immune work-up rather than another antibiotic course
• In an immunocompromised or post-transplant child, a new infiltrate can be opportunistic infection, drug or radiation injury, or transplant-related lung disease, and early bronchoscopy often changes management

Life stages

Care settings

Clinical exam formats

Board mappings

• Respiratory Medicine
• General and Community Paediatrics
• The lung as a target organ of systemic disease
• Paediatric respiratory and sleep medicine competencies
• Recognition and management of secondary lung disease in systemic illness
• Interface of respiratory, haematology, rheumatology, immunology, and oncology
• Clinical Applications
• Systematic evaluation of the child with a systemic disease and new respiratory signs
• Long and Short Cases
• Respiratory long case: the child with multisystem disease and lung involvement
• 1. Good clinical care: Managing complexity and uncertainty
• Respiratory: Recognises and manages lung involvement in systemic disease
• Foundation of Practice (FOP)
• Applied Knowledge in Practice (AKP)
• Respiratory medicine and multisystem disease
• Clinical
• Respiratory assessment in the child with systemic disease
• History taking and management planning
• General Pediatrics Content Outline — Respiratory system
• Pulmonary manifestations of haematologic, rheumatologic, immunologic, and oncologic disease
• General Pediatrics EPA: Evaluate the child with respiratory distress in systemic illness
• Patient Care: Evaluation and management of secondary lung disease in systemic illness
• Medical Knowledge: Pulmonary manifestations of systemic disease in children
• Systems-Based Practice: coordinated multidisciplinary care across specialties
• Medical Expert
• Paediatric respiratory assessment in multisystem disease
• Pediatrics Core EPA — Assessing and managing lung involvement in systemic illness