The yield of CT of children who have complicated pneumonia and noncontributory chest radiography

OBJECTIVE. Our purpose was to investigate the usefulness of CT in evaluating children who do not respond appropriately to treatment for pneumonia, when chest radiography is noncontributory. MATERIALS AND METHODS. Fifty-six contrast-enhanced CT scans were compared with radiographs obtained on the same day in children with complicated pneumonia. CT scans were evaluated for clinically significant findings that were not revealed by radiography: lung parenchymal complications (cavitary necrosis, abscess, decreased enhancement, bronchopleural fistula, or cavity suspected on radiography but not seen on CT), pleural complications (loculation, malpositioned chest tube), inaccurate estimation of cause of chest opacity on radiography (pleural versus parenchymal), bronchial obstruction, or pericardial effusion. RESULTS. One hundred ten CT findings, not revealed by radiography, were seen on 56 CT scans (2.0 per CT scan): parenchymal complications (n = 40), pleural complications (n = 37), inaccurate estimation of cause of chest opacity on radiography (n = 20), pericardial effusion (n = 13). All CT scans showed at least one significant finding (100% yield) not seen on radiography. CONCLUSION. In the evaluation of children with complicated pneumonia, CT often reveals clinically significant findings not apparent on radiography.