In one prospective study with 50 patients with noncystic fibrosis lung disease, MRI was equivalent to CT for grading central bronchiectasis and pulmonary consolidation but performed worse than CT for peripheral lung findings and for diagnosing emphysema and bullae [53]. There is no relevant literature regarding the use of contrast-enhanced MRI in this clinical scenario. Variant 8: Child. 3 months of age and older. Immunocompetent. Recurrent localized pneumonia by chest radiograph. Next imaging study. CT Chest CT chest without IV contrast can be used to diagnose anatomical abnormalities in the immunocompetent patient that could predispose children to recurrent localized infections, such as congenital lobar overinflation [54] or foreign bodies that could cause recurrent postobstructive pneumonia [13]. CT chest without IV contrast can also be used to evaluate underlying pulmonary disease like bronchopulmonary dysplasia [52]. Similar to CT chest without IV contrast, CT chest with IV contrast can be used to diagnose anatomical abnormalities in the immunocompetent patient that could predispose children to recurrent localized infections like congenital lobar overinflation [54], foreign bodies that could cause recurrent postobstructive pneumonia [13], and underlying pulmonary disease like bronchopulmonary dysplasia [52]. CT chest with IV contrast provides benefit over CT chest without IV contrast for diagnosing conditions such as bronchial tumors, congenital pulmonary airway malformation [54-58], pulmonary sequestration [21,54,55,59-63], and bronchopulmonary foregut malformations [54,55]. CTA Chest CTA chest with IV contrast is especially helpful for presurgical planning, identifying feeding and draining vessels in patients with suspected pulmonary sequestration, and assessing for a vascular ring that may lead to tracheal narrowing [59,63]. In most cases, CTA of the chest with IV contrast is preferred over CT chest with IV contrast.
Pneumonia in the Immunocompetent Child. In one prospective study with 50 patients with noncystic fibrosis lung disease, MRI was equivalent to CT for grading central bronchiectasis and pulmonary consolidation but performed worse than CT for peripheral lung findings and for diagnosing emphysema and bullae [53]. There is no relevant literature regarding the use of contrast-enhanced MRI in this clinical scenario. Variant 8: Child. 3 months of age and older. Immunocompetent. Recurrent localized pneumonia by chest radiograph. Next imaging study. CT Chest CT chest without IV contrast can be used to diagnose anatomical abnormalities in the immunocompetent patient that could predispose children to recurrent localized infections, such as congenital lobar overinflation [54] or foreign bodies that could cause recurrent postobstructive pneumonia [13]. CT chest without IV contrast can also be used to evaluate underlying pulmonary disease like bronchopulmonary dysplasia [52]. Similar to CT chest without IV contrast, CT chest with IV contrast can be used to diagnose anatomical abnormalities in the immunocompetent patient that could predispose children to recurrent localized infections like congenital lobar overinflation [54], foreign bodies that could cause recurrent postobstructive pneumonia [13], and underlying pulmonary disease like bronchopulmonary dysplasia [52]. CT chest with IV contrast provides benefit over CT chest without IV contrast for diagnosing conditions such as bronchial tumors, congenital pulmonary airway malformation [54-58], pulmonary sequestration [21,54,55,59-63], and bronchopulmonary foregut malformations [54,55]. CTA Chest CTA chest with IV contrast is especially helpful for presurgical planning, identifying feeding and draining vessels in patients with suspected pulmonary sequestration, and assessing for a vascular ring that may lead to tracheal narrowing [59,63]. In most cases, CTA of the chest with IV contrast is preferred over CT chest with IV contrast.