CXR Patterns in Pediatric Pneumonia
Lobar Consolidation
- Appearance: Homogeneous opacity occupying one lobe; air bronchograms may be visible
- Distribution: Lobar / segmental; well-demarcated
- Organisms: Streptococcus pneumoniae (most common), Klebsiella
- Clinical correlation: Bronchial breathing, dullness on percussion, bronchophony
Classic: Right upper lobe consolidation in pneumococcal pneumonia
Bronchopneumonia Pattern
- Appearance: Patchy, bilateral, heterogeneous opacities scattered through lung fields
- Distribution: Peribronchial / peribronchovascular; both lungs
- Organisms: Staphylococcus, H. influenzae, Gram-negatives, mixed
- Notes: Most common CXR pattern in pediatric bacterial pneumonia overall
Interstitial / Perihilar Pattern
- Appearance: Perihilar and peribronchial infiltrates; poorly defined hazy/fluffy exudates radiating from hilar regions
- Distribution: Usually one lobe (often lower lobe) in Mycoplasma; bilateral in viral
- Organisms: Mycoplasma pneumoniae, RSV, parainfluenza, adenovirus, Streptococcus (interstitial form)
- Notes: X-ray findings more extensive than physical signs suggest (especially Mycoplasma)
- Hilar lymph node enlargement ± pleural effusion may occur in Mycoplasma
Staphylococcal Pneumonia — Classic CXR Features
| Feature | Description |
|---|
| Pneumatoceles | Thin-walled, air-filled cysts; pathognomonic of staphylococcal pneumonia |
| Consolidation | Both lung fields; dense bilateral opacities |
| Pyopneumothorax | Air-fluid level in pleural space |
| Empyema | Pleural opacity; mediastinal shift |
Empyema below 2 years of age is nearly always staphylococcal in etiology.
Round Pneumonia
- Appearance: Round / oval opacity mimicking a mass lesion
- Common in: Young children (5–10 years)
- Most common organism: Streptococcus pneumoniae
- Key point: Most resolve completely; must follow up to confirm resolution (rule out mass)
Pleural Effusion / Empyema
- Appearance: Blunting of costophrenic angle; mediastinal shift away from effusion (large)
- Associated organisms: Staphylococcus (<2 years), Streptococcus, H. influenzae, Pneumococcus
- Investigation: Pleural fluid analysis + culture essential
Gram-Negative Pneumonia CXR
| Organism | CXR Feature |
|---|
| E. coli / Klebsiella | Multiple consolidation areas; may have pneumatoceles |
| Pseudomonas | Bilateral patchy infiltrates; often in CF patients |
Mycoplasma Pneumonia CXR
- X-ray appearances far more dramatic than clinical signs
- Poorly defined hazy/fluffy exudates, predominantly one lobe (lower)
- Hilar lymphadenopathy
- Occasionally pleural effusion
- Difficult to distinguish radiologically from viral or rickettsial pneumonia
Viral Pneumonia CXR
- RSV / Parainfluenza: Hyperinflation + peribronchial infiltrates
- Adenovirus: Can cause severe interstitial pneumonia with extensive infiltrates
- Clinical signs of consolidation absent
Hydrocarbon (Kerosene) Aspiration CXR
- Ill-defined homogeneous or patchy opacities
- May resemble miliary mottling
- Predominantly lower zones (gravity-dependent aspiration)
Loeffler Syndrome CXR
- Pulmonary infiltrates of varying sizes
- Superficially resemble miliary tuberculosis
- Associated with eosinophilia
CXR Monitoring
| Situation | Action |
|---|
| Good clinical response | No repeat CXR routinely needed |
| Persistent fever / no improvement | Repeat CXR at 48–72 hours |
| Round pneumonia | Repeat at 4–6 weeks to confirm resolution |
| Suspected complication (effusion, pneumatocele) | Repeat CXR + ultrasound |
