Article Text

The value of repeat chest radiograph in a child with pneumonia
  1. H Bentur1,
  2. S Harave2
  1. 1Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  2. 2Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK


We report two interesting cases highlighting the value of repeat chest radiograph in a child presenting with pneumonia. First is a case of hereditary haemorrhagic telangiectasia in the chest presenting as pneumonia in 4 year old child. He presented to the children's hospital with cough and fever, and a chest radiograph showed rounded opacity in the left lower lobe, presumed to be a round pneumonia. He had persistent symptoms despite antibiotic treatment. A repeat chest x ray (figure 1) showed the rounded opacity to be persistent. A subsequent CT scan of the chest revealed a pulmonary arteriovenous malformation in left lower lobe for which he underwent percutaneous embolisation. Revisiting the family history revealed hereditary haemorrhagic telangiectasia on the paternal side.

Second is a case of anterior mediastinal cystic hygroma which became apparent on a repeat chest x ray. She presented with a similar history of cough and fever, and a chest radiograph (figure 2) showing bilateral pneumonia with minimal effusion on the left. A repeat chest radiograph (figure 3) after a course of antibiotics showed widened upper mediastinum with suspicion of a mass on the left side. A CT scan showed an abnormal left anterior mediastinal mass which was initially suspected to be teratoma. A percutaneous biopsy of the mass was inconclusive. She then underwent resection of the mass which revealed to be mediastinal cystic hygroma. She also had a history of cystic hygroma removed from the neck at the age of 2 years.

Pneumonia is one of the most common infections in children, with an annual incidence of 34 to 40 cases per 1,000 children. As per nice guidelines, follow-up radiography is not required in those who are previously healthy and who are recovering well, but should be considered in those with a round pneumonia, collapse or persisting symptoms. These two cases reinforce the value of repeat chest radiograph while treating children with pneumonia.

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