Late pulmonary scintigraphic defects after uneventful recovery from simple focal pneumonia of childhood.

ABSTRACT

We present a pilot study designed to determine whether pneumonia in children accompanied by focal consolidation on the chest radiograph (CXR) is associated with late abnormality as detected by radionuclide lung scintigraphy. 14 children with focal pneumonia were assessed 1 year after initial presentation. In 12 both krypton-81m ventilation and technetium-99m MAA perfusion studies were performed, while in two only perfusion studies were obtained. All cases had a further CXR. Abnormal or equivocal cases were reviewed clinically. Scans and CXRs were independently assessed by two observers and subsequently consensus reached by discussion. There were five abnormal and nine normal lung scans. Two defects matched the site of the initial pneumonia while three did not. A CXR at the time of lung scanning was normal except for one case with a small focus of consolidation on the opposite side to the initial pneumonia but with a normal lung scan. Similarly, clinical assessment at the time of scanning was unremarkable, with no history of further respiratory episodes except in one child excluded from the study because of an interval diagnosis of asthma. This pilot study indicates that lung scan defects are common in the medium term after supposedly uncomplicated pneumonia in childhood. The cause of these defects remains uncertain. The correlation with the site of the initial radiological abnormality is variable, pointing to the need for further research in this area. The importance of independent blind interpretation is also highlighted.