Ultrasonography Compared to Computed Tomography in Pediatric Complicated Pneumonia: Beyond Radiation

Introduction Some children with community-acquired pneumonia (CAP) experience progression to complicated community-acquired pneumonia (CCAP). It is characterized by local pulmonary or systemic complications such as para-pneumonic effusion, empyema, necrotizing pneumonia, and lung abscess. Imaging has an essential contribution to both the diagnosis and treatment of CCAP. While chest radiography and lung ultrasound (LUS) are commonly used for initial evaluation, chest computed tomography (CT), although valuable, raises concerns due to ionizing radiation exposure. Against the backdrop of increasing awareness regarding radiation risks in pediatric patients and the growing availability of bedside LUS, we conducted this study. Objective The aim of this study was to assess the agreement between LUS and contrast-enhanced chest CT in identifying specific findings in patients of complicated pneumonia, such as pleural effusion, pleural thickening, parenchymal consolidation, cavities, atelectasis, and hydropneumothorax. Methods We retrospectively compared CT and LUS images from 50 patients under 18 years of age admitted with clinical and radiological diagnosis of complicated pneumonia between January 2022 and June 2023, who underwent both imaging modalities within a seven-day interval. Images were assessed for pleural effusion, septations, pleural thickening, parenchymal consolidation, cavities, hydropneumothorax, and atelectasis. Results Pleural effusion without septations was found in 25 (50%) patients on chest CT, whereas it was noted in 20 (40%) patients on LUS. Pleural effusion with septations was found in 21 (42%) patients on chest CT, whereas it was noted in 27 (54%) patients on LUS. Pleural thickening was found in 19 (38%) patients on chest CT, whereas it was noted in 9 (18%) patients on LUS. Lung parenchymal consolidation was found in 30 (60%) patients on chest CT, whereas it was noted in 16 (32%) patients on LUS. Atelectasis was found in 25 (50%) patients on chest CT, whereas it was noted in 26 (52%) patients on LUS. Parenchymal cavities were found in six (12%) patients on chest CT, whereas it was noted in two (4%) patients on LUS. Hydropneumothorax was found in six (12%) patients on chest CT, whereas it was noted in one (2%) patients on LUS. Conclusions LUS can be used as an initial investigation in complicated pneumonia, while chest CT is reserved for cases with suspicion of specific complications of pneumonia.