Pleural effusion or empyema, pneumothorax, lung abscess, bronchopleural fistula, and necrotizing pneumonia are rare complications of community-acquired pneumonia with an incidence rate above 13% in children hospitalized with pneumonia [9,13,14]. It is estimated that Reprint requests to: publications@acr.org Pneumonia in the Immunocompetent Child 1% of children with community-acquired pneumonia develop pleural effusions and effusions that are seen in 13% to 28% of hospitalized children [9,13,14]. Parapneumonic effusions often resolve with antibiotic therapy, but large effusions and empyemas may require percutaneous aspiration, fibrinolytics, surgical drainage, or thoracoscopy [4,15-18]. Bronchopleural fistula develops as a complication of pneumonia if lung necrosis extends to the pleura. Bronchopleural fistula is associated with higher morbidity [17,19] and can be diagnosed clinically by seeing air bubbles in the chest tube drainage [19]. Recurrent pneumonia is defined as at least two episodes of pneumonia in 1 year, or three episodes ever, with radiographic clearing of parenchymal opacities between episodes. Recurrent pneumonia occurs in 7.7% to 9% of children with community-acquired pneumonia [20]. Recurrent pneumonia can be nonlocalized (different location) or localized (same location). In the immunocompetent child, the differential considerations for nonlocalized pneumonia includes aspiration, asthma, bronchiectasis, underlying pulmonary parenchymal damage (eg, history of bronchopulmonary dysplasia), and mucociliary deficiency [13,21]. The role of imaging is to identify any underlying anatomic lung abnormality such as bronchiectasis.
Pneumonia in the Immunocompetent Child. Pleural effusion or empyema, pneumothorax, lung abscess, bronchopleural fistula, and necrotizing pneumonia are rare complications of community-acquired pneumonia with an incidence rate above 13% in children hospitalized with pneumonia [9,13,14]. It is estimated that Reprint requests to: publications@acr.org Pneumonia in the Immunocompetent Child 1% of children with community-acquired pneumonia develop pleural effusions and effusions that are seen in 13% to 28% of hospitalized children [9,13,14]. Parapneumonic effusions often resolve with antibiotic therapy, but large effusions and empyemas may require percutaneous aspiration, fibrinolytics, surgical drainage, or thoracoscopy [4,15-18]. Bronchopleural fistula develops as a complication of pneumonia if lung necrosis extends to the pleura. Bronchopleural fistula is associated with higher morbidity [17,19] and can be diagnosed clinically by seeing air bubbles in the chest tube drainage [19]. Recurrent pneumonia is defined as at least two episodes of pneumonia in 1 year, or three episodes ever, with radiographic clearing of parenchymal opacities between episodes. Recurrent pneumonia occurs in 7.7% to 9% of children with community-acquired pneumonia [20]. Recurrent pneumonia can be nonlocalized (different location) or localized (same location). In the immunocompetent child, the differential considerations for nonlocalized pneumonia includes aspiration, asthma, bronchiectasis, underlying pulmonary parenchymal damage (eg, history of bronchopulmonary dysplasia), and mucociliary deficiency [13,21]. The role of imaging is to identify any underlying anatomic lung abnormality such as bronchiectasis.