Can X Ray Miss Pneumonia

Carole Stephens
• Wednesday, 18 November, 2020
• 7 min read

A new study, which looked at pneumonia cases that developed during the 2009 H1N1 influenza pandemic, suggests that this screening tool may not always be accurate enough, especially in detecting the early interstitial stage. Find out what the authors recommend when the initial radiograph looks normal, but symptoms suggest otherwise...

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Chest x -rays miss nearly half of early-stage pneumonia cases associated with influenza, according to a study recently published in Critical Care. Researchers initially looked at 98 consecutive patients with suspected 2009 pandemic (H1N1) infection who complained of ILL or severe acute respiratory illness at triage.

US also detected interstitial syndrome in 5 of 33 controls, which researchers suggest could be related to (H1N1) infection based on its prevalence in the community during the study period. Researchers reported that CAP patients with initially normal chest x -rays were more likely to have viral (H1N1) pneumonia compared to those with abnormal radiography and to be earlier in the disease progression.

As a result, bedside chest US could help emergency physicians rapidly identify patients who should start treatment for pneumonia. In particular, a US interstitial pattern with spared areas is strongly predictive of viral pneumonia.

For the new study, van UGT and her colleagues used information collected between October 2007 and April 2010 on 2,810 adult patients of doctors in 12 European countries. While catching only 29 percent of pneumonia cases seems alarming, Watkins said there may be differences between how doctors in Europe and the U.S. diagnose the infection.

“That's worse than flipping a coin,” said Dr. Richard R. Watkins, who was not involved with the new research but has studied how doctors diagnose pneumonia. People with pneumonia may have a cough, fever, nausea, vomiting, chills, or chest pain.

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The mucous in the chest could be allergy like asthma, bacterial pneumonia, viral (pneumonia) infection like a bad chest cold or flu, fungal infection, or even rarely cancer. And the radiologist does not know the patient, so he will call it pneumonia if there is very little congestion not wanting to miss it and get sued later.

No clinical, laboratory, or radiographic findings that would reliably differentiate viral from bacterial infection were identified. The chest roentgenograms of 128 consecutive ambulatory children with radiologic pneumonia were read independently and without clinical information by a faculty general pediatrician (PED), a pediatric radiologist (R-P) and a general radiologist (R-G).

Readings were compared with results of viral liters and bacterial cultures. The three observers agreed on a correct reading in only three children with viral and three with bacterial pneumonia.

Because of poor observer agreement and appreciable false-negative errors when viral and bacterial readings were compared to tier increases and positive bacterial cultures, respectively, we conclude that radiographic findings are poor indicators of etiology diagnosis in ambulatory childhood pneumonia and, of themselves, are an insufficient database for making therapeutic decisions. To evaluate the accuracy of World Health Organization (WHO) method of interpreting chest radiographs on identifying young children with bacterial pneumonia, and to compare its accuracy with other method.

Chest radiographs from children aged under 5 years old hospitalized for pneumonia, with microbiological evidence of bacterial or viral infection, were evaluated. Review of these films without knowledge of the previous interpretation and without clinical information disclosed variations regarding the roentgenographic confirmation of pneumonia in 24 percent of the cases and variations regarding the location of the lesion in about 50 percent of the cases.

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The need for follow-up roentgenograms documenting complete clearing of pulmonary infiltrates in the pediatric patient with acute pneumonia was studied prospectively. Seventy of 129 children enrolled in the study had a repeat roentgenogram within three to four weeks after initial diagnosis.

Of the two thirds of those who returned for a second follow-up roetgenogram, the infiltrates had cleared completely within three months. Routine repeat chest roentgenograms may not be necessary unless there is clinical evidence of persistent respiratory difficulty or failure to thrive.

This study assessed the clinical value of routine follow-up chest radiographs in hospitalized children with community-acquired pneumonia. …… In conclusion, routine follow-up chest radiographs are not needed in childhood community-acquired pneumonia if the child has a clinically uneventful recovery.

Such patients may have some benefit from control radiographs, but only in terms of detecting the chronic disease at an earlier stage, not in altering the clinical course. Such modest benefits must be weighed against the consequences of providing follow-up to many healthy children, and making lots of abnormal findings with no clinical significance.

Radiological Findings in Children with Acute Pneumonia : Age More Important Than Infectious Agent Purpose: To evaluate whether radiological findings and healing time in children with pneumonia are correlated to etiologic agent. A total of 346 children with radiologically verified acute pneumonia, and with accomplished serological tests for bacteria and viruses, were included in the study. The chest films of each etiological group were analyzed and the findings were correlated to the children's age.

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The Pediatric Infectious Diseases Society (AIDS) and the Infectious Diseases Society of America (IDEA) convened an expert panel to review the management of Community acquired Pneumonia (CAP). The expert panel included clinicians and investigators who represented community pediatrics, public health, critical care, emergency medicine, hospitalist medicine, infectious diseases, pulmonology, and surgery.

The first-ever guidelines on the diagnosis and treatment of CAP in infants and children, from AIDS and IDEA, emphasize the importance of immunizations (Prewar), including a yearly influenza vaccine, to protect children from life-threatening pneumonia. A 13-member panel, led by John S. Bradley, MD, with the Department of Pediatrics, University of California San Diego School of Medicine and Ready Children's Hospital of San Diego, in California, authored the new guidelines published online August 30 and to appear in the print October 1 issue of Clinical Infectious Diseases.

The document presents 92 specific recommendations in all, each with varying levels of evidence. Recommendations for Diagnosis “Diagnostic methods and treatments that work well in adults may be too risky and not have the desired result in children,” Regarding diagnosis, the guidelines state that blood cultures should not be routinely performed in nontoxic, fully immunized children with CAP treated in the outpatient setting.

“In these cases, there is no need to perform unnecessary medical interventions such as using x -rays (which expose the child to radiation needlessly) or prescribing antibiotics (which kill bacteria, not viruses, and may foster drug-resistant bacteria),” the written release states. The guidelines also recommend that infants 3 to 6 months old with suspected bacterial pneumonia be hospitalized.

We have discussed in previous articles about the chest viral cold with fever and cough at the beginning is usually viral and a recurrence of fever and lethargy after the fifth day is secondary bacterial infection. But many people are treated for pneumonia who have a viral chest cold or allergy.

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