US is superior to chest CT for effusion characterization (eg, fibrin strands, septations, and complex fluid) [31,34-36,39]. Variant 5: Child. Immunocompetent. Pneumonia complicated by suspected bronchopleural fistula by chest radiograph. Next imaging study. CT Chest CT chest without IV contrast can detect bronchopleural fistulae [45]. A direct sign on CT of a bronchopleural fistula is a fistulous tract between the bronchus or lung and pleural space. An indirect sign of a bronchopleural fistula is the presence of air bubbles beneath the bronchial stump or suspected fistula [45]. CT chest with IV contrast can show the same findings as CT chest without IV contrast [45]. Additionally, CT chest with IV contrast can show important findings, such as necrotizing pneumonia, pulmonary abscess, and empyema that may be the underlying cause of the bronchopleural fistula [13,19,35,46-48]. There is no evidence directly comparing CT chest without IV contrast and CT chest with IV contrast in diagnosis of bronchopleural fistula. 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 supporting the use of MRI as the initial imaging study in this clinical scenario. Variant 6: Child. Immunocompetent. Pneumonia complicated by suspected lung abscess by chest radiograph. Next imaging study. CT Chest In the context of diagnosing necrotizing pneumonia or pulmonary abscess, contrast-enhanced CT is considered the gold standard for imaging [13,19,35,46,47]. CT chest with IV contrast can also differentiate between parenchymal and pleural processes [31]. There is no literature supporting the use of noncontrast CT in the evaluation of pulmonary abscess. US Chest There is no literature that investigates the diagnostic accuracy of US in the setting of lung abscess.
Pneumonia in the Immunocompetent Child. US is superior to chest CT for effusion characterization (eg, fibrin strands, septations, and complex fluid) [31,34-36,39]. Variant 5: Child. Immunocompetent. Pneumonia complicated by suspected bronchopleural fistula by chest radiograph. Next imaging study. CT Chest CT chest without IV contrast can detect bronchopleural fistulae [45]. A direct sign on CT of a bronchopleural fistula is a fistulous tract between the bronchus or lung and pleural space. An indirect sign of a bronchopleural fistula is the presence of air bubbles beneath the bronchial stump or suspected fistula [45]. CT chest with IV contrast can show the same findings as CT chest without IV contrast [45]. Additionally, CT chest with IV contrast can show important findings, such as necrotizing pneumonia, pulmonary abscess, and empyema that may be the underlying cause of the bronchopleural fistula [13,19,35,46-48]. There is no evidence directly comparing CT chest without IV contrast and CT chest with IV contrast in diagnosis of bronchopleural fistula. 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 supporting the use of MRI as the initial imaging study in this clinical scenario. Variant 6: Child. Immunocompetent. Pneumonia complicated by suspected lung abscess by chest radiograph. Next imaging study. CT Chest In the context of diagnosing necrotizing pneumonia or pulmonary abscess, contrast-enhanced CT is considered the gold standard for imaging [13,19,35,46,47]. CT chest with IV contrast can also differentiate between parenchymal and pleural processes [31]. There is no literature supporting the use of noncontrast CT in the evaluation of pulmonary abscess. US Chest There is no literature that investigates the diagnostic accuracy of US in the setting of lung abscess.