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Round Pneumonias Tend to Be Solitary With Sharp Margins

February 16, 2008
Written by: , Filed in: Chest Radiology, Pediatric Radiology
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Round pneumonia occurs in young children and is most commonly a solitary lesions found posteriorly in the lower lobe.

The objective of a recent study was to report radiographic and CT imaging results regarding the size, location, shape, margin, and associated findings of round pneumonia in children.

The study has concluded that round pneumonia occurs in young children and is most commonly a solitary lesions found posteriorly in the lower lobe

Design
Retrospective study.

Methodology
Children with round pneumonia were identified by electronically searching radiology reports which corresponded to a 6-year study interval. Children with underlying medical conditions were excluded. Epidemiologic characteristics, radiographic and CT findings, and follow-up imaging were reviewed. Imaging studies were evaluated by two reviewers. Radiographs and CT scans were evaluated for lesion parameters (number, size, margin, and location of round pneumonia). The margin was described as sharp or indistinct.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging

Results of the Study
Of 109 children in the study (mean age, 5 years), boys and girls were equally affected. The lesions were solitary in 98% and had sharp margins in 70%. The mean lesion diameter was 3.8 cm, and 83% of children had posteriorly located round pneumonias. On follow-up radiographs, 95% of lesions resolved, and the remaining lesions developed into lobar pneumonias. Of the patients originally suspected of having round pneumonia, three were later shown to have other diagnoses, including cavitary necrosis complicating pneumonia and a focal collection of pleural fluid.

Conclusions
Round pneumonias occur in young children, tend to be solitary with sharp margins, and are most commonly found posteriorly in the lower lobe. Misdiagnosis is uncommon. Children are presumed to be more susceptible, especially at an age younger than 8 years, due to incomplete formation of the pores of Kohn and canals of Lambert, which facilitate airspace communication between alveoli and contribute to the spread of airspace consolidation in mature lungs.

Reviewer’s Comments
In this great study with a large study population, the findings for round pneumonia on radiographs are remarkable for their reproducibility and simplicity. The subtler message in the study is the importance of follow-up examinations. Approximately 95% of the pneumonias clear up within 1 month, and alternate diagnoses should be considered for those exceptions to this trend.

Author: Basil Hubbi, MD

Reference:
Kim YW, Donnelly LF. Round Pneumonia: Imaging Findings in a Large Series of Children. Pediatr Radiol; 2007; 37 (December): 1235-1240

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging
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