The value of early CT in complicated childhood pneumonia.
OBJECTIVE
To investigate the value of CT in complicated childhood pneumonia and its role in early intervention when chest radiography (CXR) is non-contributory.


METHODS
Forty-two immunocompetent children, aged 1-11 years, admitted for community-acquired pneumonia from October 1997 to September 1999, had 42 contrast-enhanced CT scans and frontal chest radiographs on the same day, which were assessed independently. CT was performed when the patient remained unwell and the CXR images showed failure of resolution despite 7-10 days of antibiotics and/or drainage with urokinase therapy.


RESULTS
Compared to CT, CXR revealed suboptimal accuracy rates of lobar involvement (84%), chest tube placement (73%), fluid loculation (42%), abscess formation (40%) and bronchopleural fistulae (33%). It could not assess parenchymal or pleural complications such as cavitary necrosis, early abscess formation, empyemas or pericardial effusions. On the basis of the CT findings and poor clinical progress, 16 patients underwent surgical intervention with the aid of video-assisted thorascopic surgery (VATS). The CT features correlated well with surgical findings. Ten cases required pleural decortication while six with destructive or necrotic lung lesions had surgical resection. Debridement was difficult when the pleura had become thick and fibrotic. Streptococcus pneumoniae was the offending organism in 81% of cases. The right side was affected in 67% of cases.


CONCLUSIONS
In complicated childhood pneumonia, CT is far superior to CXR in revealing pleural and parenchymal complications, which may require early surgical intervention.
Tan Kendrick
Anne P
AP
Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, 100 Buki Timah Road, 229899 Singapore. annetan@kkh.com.sg
Ling
Ho
H
Subramaniam
Ramnath
R
Joseph
Vijeyakaran T
VT
D002648:Child; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010994:Pleura / Q000000981:diagnostic imaging; D011014:Pneumonia / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed