CT Chest There is no relevant literature to support the use of CT as the initial imaging study in this clinical scenario. US Chest There is no relevant literature to support the use of US as the initial imaging study in this clinical scenario. MRI Chest There is no relevant literature to support the use of MRI as the initial imaging study in this clinical scenario. Variant 4: Child. Immunocompetent. Pneumonia complicated by suspected moderate or parapneumonic effusion by chest radiograph. Next imaging study. Radiography Chest Decubitus View Decubitus radiographs may be helpful to distinguish free-flowing pleural effusions from loculated collections [31]. However, radiographs can neither identify the type of fluid present nor be used to visualize the internal characteristics of the fluid [32]. In a study of adult patients, radiographs had a sensitivity of 39% and specificity of 85% compared with CT for presence of an effusion [33]. CT Chest There is limited evidence that a noncontrast chest CT is useful in this clinical scenario. Even with intravenous (IV) contrast, it may be difficult to distinguish consolidated lung from visceral pleural enhancement [34]. Contrast- enhanced CT can also be used to quantify the amount of pleural fluid and can also demonstrate pleural thickening Pneumonia in the Immunocompetent Child and enhancement that is suggestive of empyema. CT has limited ability to characterize the internal characteristics of parapneumonic effusions (eg, fibrin strands, septations, and complex fluid) [31,34-37]. US Chest US is the gold standard imaging for quantifying the size and identifying the internal characteristics of a pleural effusion. In a study of adult patients, US had a sensitivity of 92% and specificity of 93% compared with CT for presence of an effusion [33]. US can also be used to guide drainage of pleural fluid and complicated parapneumonic effusions [16,26,34,38].
Pneumonia in the Immunocompetent Child. CT Chest There is no relevant literature to support the use of CT as the initial imaging study in this clinical scenario. US Chest There is no relevant literature to support the use of US as the initial imaging study in this clinical scenario. MRI Chest There is no relevant literature to support the use of MRI as the initial imaging study in this clinical scenario. Variant 4: Child. Immunocompetent. Pneumonia complicated by suspected moderate or parapneumonic effusion by chest radiograph. Next imaging study. Radiography Chest Decubitus View Decubitus radiographs may be helpful to distinguish free-flowing pleural effusions from loculated collections [31]. However, radiographs can neither identify the type of fluid present nor be used to visualize the internal characteristics of the fluid [32]. In a study of adult patients, radiographs had a sensitivity of 39% and specificity of 85% compared with CT for presence of an effusion [33]. CT Chest There is limited evidence that a noncontrast chest CT is useful in this clinical scenario. Even with intravenous (IV) contrast, it may be difficult to distinguish consolidated lung from visceral pleural enhancement [34]. Contrast- enhanced CT can also be used to quantify the amount of pleural fluid and can also demonstrate pleural thickening Pneumonia in the Immunocompetent Child and enhancement that is suggestive of empyema. CT has limited ability to characterize the internal characteristics of parapneumonic effusions (eg, fibrin strands, septations, and complex fluid) [31,34-37]. US Chest US is the gold standard imaging for quantifying the size and identifying the internal characteristics of a pleural effusion. In a study of adult patients, US had a sensitivity of 92% and specificity of 93% compared with CT for presence of an effusion [33]. US can also be used to guide drainage of pleural fluid and complicated parapneumonic effusions [16,26,34,38].