Cavitary necrosis complicating pneumonia in children: sequential findings on chest radiography.

OBJECTIVE: The objective of this study was to describe the sequential clinical and radiographic findings of cavitary necrosis complicating pneumonia in childhood.
MATERIALS AND METHODS: A study group of 17 children (mean age, 6 years) was identified by reviewing CT examinations of all patients who underwent CT of the chest to evaluate possible complications of pneumonia over a 3-year period. Children included in the study group were those who met the criteria for cavitary necrosis: loss of lung architecture, decreased enhancement, and multiple cavities with thin, nonenhancing walls. In the 17 identified cases, sequential chest radiographs were reviewed for visibility of a lung cavity. Long-term follow-up radiographs were evaluated for persistent abnormalities.
RESULTS: Ten of the 17 cases of cavitary necrosis seen on CT showed cavities at some time on radiography: one cavity was visible at the time of diagnosis on CT and nine were visible only later. All three cavities that were predominantly air-filled on CT were revealed by radiography, whereas 50% (7/14) of predominantly fluid-filled cavities were revealed by radiography. Eleven children underwent follow-up radiography more than 40 days after the diagnosis of cavitary necrosis. Radiographs of those 11 children showed clear lungs without pulmonary sequelae.
CONCLUSION: In children, cavitary necrosis is associated with severe illness; however, cases usually resolve without surgical intervention, and long-term follow-up radiography shows clear lungs without pulmonary sequelae. Evidence of cavitary necrosis complicating pneumonia is often seen on CT before or in the absence of findings on chest radiography.