Variant 4: Acute respiratory illnesses in immunocompetent patients with pneumonia complicated by suspected parapneumonic effusion or abscess on initial chest radiograph. Next imaging study. Radiography Chest Chest radiographs are a useful initial imaging modality for complicated PNA, but they are inferior to other modalities for evaluating the pleura, for guiding interventions, or for assessing an opacity that has been refractory to therapy. CT Chest In severe cases of PNA, CT can demonstrate the overall extent of disease, which may provide important prognostic information [6]. CT can also demonstrate necrotizing PNA and abscess formation long before the findings become visible on a chest radiograph. The use of intravenous contrast can increase the conspicuity of empyemas and other pleural complications. CT can also serve as a guide for pleural drainage or localization of an appropriate site for biopsy [35]. CT is the modality of choice for evaluating a persistent opacity. Its superior contrast resolution allows it to detect obstructing masses, delineate lesions, such as sequestrations, and even characterize patterns of parenchymal disease, such that a particular etiology, such as organizing PNA or mycobacterial infection, can sometimes be suggested. US Chest US may be a useful adjunct for the evaluation of parapneumonic effusions as it is superior to chest radiographs for demonstrating pleural thickening and adhesions. US is superior to noncontrast CT for detecting septations in Acute Respiratory Illness in Immunocompetent Patients complex effusions. US can also be used to guide PNA-related interventions, such as biopsy, thoracentesis, and thoracostomy tube placement [36]. MRI Chest Our search failed to identify any studies evaluating the role of MRI in this clinical scenario. The study population examined by Syrjala et al [14] did not include any patients with parapneumonic effusion or empyema.
Acute Respiratory Illness in Immunocompetent Patients. Variant 4: Acute respiratory illnesses in immunocompetent patients with pneumonia complicated by suspected parapneumonic effusion or abscess on initial chest radiograph. Next imaging study. Radiography Chest Chest radiographs are a useful initial imaging modality for complicated PNA, but they are inferior to other modalities for evaluating the pleura, for guiding interventions, or for assessing an opacity that has been refractory to therapy. CT Chest In severe cases of PNA, CT can demonstrate the overall extent of disease, which may provide important prognostic information [6]. CT can also demonstrate necrotizing PNA and abscess formation long before the findings become visible on a chest radiograph. The use of intravenous contrast can increase the conspicuity of empyemas and other pleural complications. CT can also serve as a guide for pleural drainage or localization of an appropriate site for biopsy [35]. CT is the modality of choice for evaluating a persistent opacity. Its superior contrast resolution allows it to detect obstructing masses, delineate lesions, such as sequestrations, and even characterize patterns of parenchymal disease, such that a particular etiology, such as organizing PNA or mycobacterial infection, can sometimes be suggested. US Chest US may be a useful adjunct for the evaluation of parapneumonic effusions as it is superior to chest radiographs for demonstrating pleural thickening and adhesions. US is superior to noncontrast CT for detecting septations in Acute Respiratory Illness in Immunocompetent Patients complex effusions. US can also be used to guide PNA-related interventions, such as biopsy, thoracentesis, and thoracostomy tube placement [36]. MRI Chest Our search failed to identify any studies evaluating the role of MRI in this clinical scenario. The study population examined by Syrjala et al [14] did not include any patients with parapneumonic effusion or empyema.