The Role of Chest X-Ray in the Radiological Assessment of Pediatric Pneumonia in a Tertiary Care Setting: Chest X-Ray in the Radiological Assessment of Pediatric Pneumonia

Neha Tanveer; Arooj Ansar

doi:10.54393/pbmj.v7i11.1254

Authors

Neha Tanveer Department of Radiological Sciences and Medical Imaging Technology. The University of Lahore, Gujrat, Pakistan
Arooj Ansar Department of Medical Imaging Sciences, The University of Lahore, Gujrat, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v7i11.1254

Keywords:

Pneumonia, Children, Chest Infection, Respiratory

Abstract

Pneumonia is an infection of the lungs that is marked by a fever, respiratory symptoms, and changes seen on imaging. It is important to diagnose and evaluate the seriousness of an allergic disease in children as soon as possible for proper treatment. Objective: To analyze whether severe acute pneumonia in children can be predicted using chest X-rays. Patients with severe acute pneumonia had symptoms including difficulty in breathing, low oxygen levels, and findings on X-ray, such as lobar consolidation and interstitial involvement. Methods: A retrospective cross-sectional study was conducted in the Department of Radiology, Gujranwala, Pakistan, from December 2022 to March 2023. The study included 60 pediatric patients diagnosed with pneumonia. Patients with pneumothorax were excluded from the study. The study determined the sample size based on previous similar research. SPSS-22 was used for statistical analysis. Results: Most children in the research were less than 3 years old. The majority were boys, 41 (68.3%), while girls accounted for 19 (31.7%). The symptom that patients most usually reported was difficulty breathing, 25 (41.7%). The majority of the cases showed consolidation of a lobe, 25 (41.7%), followed by interstitial abnormalities, 14 (23.3%). Conclusions: It was concluded that lobar consolidation was the most common radiological finding in children with severe acute pneumonia, particularly in boys under the age of three. Chest X-rays played a crucial role in diagnosing and evaluating the severity of the disease. Regular training for radiologists and clinicians on pediatric pneumonia patterns can further improve diagnostic accuracy.

References

Ibrahim D, Bizri AR, El Amine MA, Halabi Z. Chest computed tomography and chest X-ray in the diagnosis of community-acquired pneumonia: a retrospective observational study. Journal of International Medical Research. 2021 Aug; 49(8): 03000605211039791. DOI: https://doi.org/10.1177/03000605211039791

Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM et al. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. Journal of Global Health. 2022 Dec; 12: 10013. DOI: https://doi.org/10.7189/jogh.12.10013

Aliberti S, Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. The Lancet. 2021 Sep; 398(10303): 906-19. DOI: https://doi.org/10.1016/S0140-6736(21)00630-9

Thareeb MK, Zghair MA, Hassan QA. Diagnostic Ability of Chest Ultrasound in Selective Paediatric Pneumonia: Alternative to CT Scan: A Single-Centre Comparative Observational Study. Journal of Nepal Pediatric Society. 2022 Dec; 42(3): 17-23.5. doi:10.3126/jnps.v42i3.45120. DOI: https://doi.org/10.3126/jnps.v42i3.45120

Ticona JH, Zaccone VM, McFarlane IM. Community-acquired pneumonia: A focused review. American Journal of Medical Case Reports. 2021 Nov; 9(1): 45-52. DOI: https://doi.org/10.12691/ajmcr-9-1-12

Niederman MS and Torres A. Severe community-acquired pneumonia. European Respiratory Review. 2022 Dec; 31(166). DOI: https://doi.org/10.1183/16000617.0123-2022

Yun KW. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and Experimental Pediatrics. 2023 Jun; 67(2): 80. DOI: https://doi.org/10.3345/cep.2022.01452

Gunaratnam LC, Robinson JL, Hawkes MT. Systematic review and meta-analysis of diagnostic biomarkers for pediatric pneumonia. Journal of the Pediatric Infectious Diseases Society. 2021 Sep; 10(9): 891-900. DOI: https://doi.org/10.1093/jpids/piab043

Rees CA, Kuppermann N, Florin TA. Community-acquired pneumonia in children. Pediatric Emergency Care. 2023 Dec; 39(12): 968-76. DOI: https://doi.org/10.1097/PEC.0000000000003070

Rueda ZV, Aguilar Y, Maya MA, López L, Restrepo A, Garcés C et al. Etiology and the Challenge of Diagnostic Testing Of Community-Acquired Pneumonia In Children And Adolescents. BioMed Central Pediatrics. 2022 Mar; 22(1): 169. DOI: https://doi.org/10.1186/s12887-022-03235-z

Van Aerde KJ. Investigating Innovative Techniques to Advance the Diagnosis and Management of Pediatric Respiratory Tract Infections (Doctoral Dissertation). 2025.

de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated Pneumonia in Children. The Lancet. 2020 Sep; 396(10253): 786-98. doi: 10.1016/S0140-6736(20)31550-6. DOI: https://doi.org/10.1016/S0140-6736(20)31550-6

O’Grady KA, Torzillo PJ, Frawley K, Chang AB. The Radiological Diagnosis of Pneumonia in Children. Pneumonia. 2014 Dec; 5: 38-51. doi: 10.15172/pneu.2014.5/482. DOI: https://doi.org/10.15172/pneu.2014.5/482

World Health Organization. Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children. In Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children/World Health Organization Pneumonia Vaccine Trial Investigators' Group. 2001.

Alexopoulou E, Prountzos S, Raissaki M, Mazioti A, Caro-Dominguez P, Hirsch FW et al. Imaging of acute complications of community-acquired pneumonia in the pediatric population—from chest radiography to MRI. Children. 2024 Jan; 11(1): 122. DOI: https://doi.org/10.3390/children11010122

Neuman MI, Lee EY, Bixby S, Diperna S, Hellinger J, Markowitz R et al. Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children. Journal of Hospital Medicine. 2012 Apr; 7(4): 294-8. doi: 10.1002/jhm.955. DOI: https://doi.org/10.1002/jhm.955

Elemraid MA, Muller M, Spencer DA, Rushton SP, Gorton R, Thomas MF et al. Accuracy of the interpretation of chest radiographs for the diagnosis of pediatric pneumonia. PLOS ONE. 2014 Aug; 9(8): e106051. doi: 10.1371/journal.pone.0106051. DOI: https://doi.org/10.1371/journal.pone.0106051

Ben Shimol S, Dagan R, Givon-Lavi N, Tal A, Aviram M, Bar-Ziv J, Zodicov V, Greenberg D. Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children. European Journal of Pediatrics. 2012 Feb; 171: 369-74. doi: 10.1007/s00431-011-1543-1. DOI: https://doi.org/10.1007/s00431-011-1543-1

Magree HC, Russell FM, Sa'Aga R, Greenwood P, Tikoduadua L, Pryor J et al. Chest X-ray-confirmed pneumonia in children in Fiji. Bulletin of the World Health Organization. 2005; 83: 427-33.

Yan C, Hui R, Lijuan Z, Zhou Y. Lung ultrasound vs. chest X-ray in children with suspected pneumonia confirmed by chest computed tomography: A retrospective cohort study. Experimental and Therapeutic Medicine. 2020 Feb; 19(2) :1363-9. doi: 10.3892/etm.2019.8333. DOI: https://doi.org/10.3892/etm.2019.8333

Awasthi S, Rastogi T, Mishra N, Chauhan A, Mohindra N, Shukla RC et al. Chest radiograph findings in children aged 2–59 months hospitalised with community-acquired pneumonia, prior to the introduction of pneumococcal conjugate vaccine in India: a prospective multisite observational study. British Medical Journal Open. 2020 May; 10(5): e034066. doi: 10.1136/bmjopen-2019-034066. DOI: https://doi.org/10.1136/bmjopen-2019-034066

Ayan E, Karabulut B, Ünver HM. Diagnosis of pediatric pneumonia with ensemble of deep convolutional neural networks in chest x-ray images. Arabian Journal for Science and Engineering. 2022 Feb; 47(2): 2123-39. doi: 10.1007/s13369-021-06127-z. DOI: https://doi.org/10.1007/s13369-021-06127-z

Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015 Apr; 135(4): 714-22. doi: 10.1542/peds.2014-2833. DOI: https://doi.org/10.1542/peds.2014-2833

Heuvelings CC, Bélard S, Andronikou S, Lederman H, Moodley H, Grobusch MP et al. Chest ultrasound compared to chest X‐ray for pediatric pulmonary tuberculosis. Pediatric Pulmonology. 2019 Dec; 54(12): 1914-20. doi: 10.1002/ppul.24500. DOI: https://doi.org/10.1002/ppul.24500

Gupta N, Sachdev A, Gupta S, Gupta D. High‐flow oxygen therapy in COVID times: Where affordability meets utility. Pediatric Pulmonology. 2021 Feb; 56(6): 1782. doi: 10.1002/ppul.25276. DOI: https://doi.org/10.1002/ppul.25276