Purpose or Case Report: Asthma is a common childhood disorder characterized by chronic reversible hyperresponsiveness in the small airways, resulting in obstructive physiology. Asthma is diagnosed either clinically or with pulmonary function tests. Imaging is often unnecessary unless there is concern for superimposed pneumonia or a complication related to an acute asthma exacerbation. However, pediatricians must maintain a high degree of suspicion for non-asthma pathologies that present similarly to asthma and may require imaging to ensure an accurate diagnosis. This pediatric case series describes these pathologies and provides case examples from our institution of children that were initially misdiagnosed as having asthma until the proper imaging study was performed.
Methods & Materials: Infectious, inflammatory, congenital, neoplastic, and aspiration-related pathologies that can present similarly to asthma are identified and described in this educational poster, with a focus on key imaging features on chest radiography, computed tomography, and magnetic resonance imaging. Clinical presentations and relevant imaging from cases of non-asthma pathologies that were initially misdiagnosed as asthma at a single children’s hospital are presented. Relevant cases include children with vascular rings and slings, chronic foreign body aspiration, tracheal stenosis from tracheal rings, hypersensitivity pneumonitis, post-infectious bronchiolitis obliterans, atypical infections, leukemia, and other pathologies.
Results:
Conclusions: While common in the pediatric population, asthma can be challenging to diagnose given its heterogeneous clinical presentation that overlaps with multiple thoracic pathologies. Pediatricians must maintain a high suspicion for non-asthma pathologies and recognize when imaging evaluation should be performed, and pediatric radiologists should be familiar with the imaging findings of various pathologies that can present similarly to asthma.