In the immunocompetent child, the main differential for localized recurrent pneumonia is localized airway narrowing from intrinsic (eg, foreign body) or extrinsic cause (eg, mass, lymphadenopathy), focal bronchiectasis, underlying congenital lung abnormality (eg, congenital pulmonary airway malformation and sequestrations), underlying pulmonary parenchymal damage (eg, with history of bronchopulmonary dysplasia), and aspiration [13,21]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA; however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Discussion of Procedures by Variant Variant 1: Child. 3 months of age and older. Immunocompetent. Suspected uncomplicated community- acquired pneumonia in a well-appearing child who does not require hospitalization. Initial imaging. Radiography Chest Chest radiographs cannot reliably distinguish viral from bacterial community-acquired pneumonia and do not reliably distinguish among the various possible bacterial pathogens [4]. Chest radiographs performed in children with suspected acute lower respiratory tract infection lead to increased use of antibiotics in a clinic or emergency department setting; however, they have not been shown to affect hospitalization rates [23]. Some of the studies in this Cochran review have minor methodological flaws; however, this is the largest available systematic review and meta-analysis [23]. Therefore, the British Thoracic Society, the Pediatric Infectious Diseases Society, and the Infectious Diseases Society of America guidelines do not recommend routine radiographs for management of uncomplicated community-acquired pneumonia in nonhospitalized patients [3,4,24].
Pneumonia in the Immunocompetent Child. In the immunocompetent child, the main differential for localized recurrent pneumonia is localized airway narrowing from intrinsic (eg, foreign body) or extrinsic cause (eg, mass, lymphadenopathy), focal bronchiectasis, underlying congenital lung abnormality (eg, congenital pulmonary airway malformation and sequestrations), underlying pulmonary parenchymal damage (eg, with history of bronchopulmonary dysplasia), and aspiration [13,21]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA; however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Discussion of Procedures by Variant Variant 1: Child. 3 months of age and older. Immunocompetent. Suspected uncomplicated community- acquired pneumonia in a well-appearing child who does not require hospitalization. Initial imaging. Radiography Chest Chest radiographs cannot reliably distinguish viral from bacterial community-acquired pneumonia and do not reliably distinguish among the various possible bacterial pathogens [4]. Chest radiographs performed in children with suspected acute lower respiratory tract infection lead to increased use of antibiotics in a clinic or emergency department setting; however, they have not been shown to affect hospitalization rates [23]. Some of the studies in this Cochran review have minor methodological flaws; however, this is the largest available systematic review and meta-analysis [23]. Therefore, the British Thoracic Society, the Pediatric Infectious Diseases Society, and the Infectious Diseases Society of America guidelines do not recommend routine radiographs for management of uncomplicated community-acquired pneumonia in nonhospitalized patients [3,4,24].