Cavitary necrosis complicating pneumonia in children: sequential findings on chest radiography

AJR Am J Roentgenol. 1998 Jul;171(1):253-6. doi: 10.2214/ajr.171.1.9648799.


Objective: The objective of this study was to describe the sequential clinical and radiographic findings of cavitary necrosis complicating pneumonia in childhood.

Materials and methods: A study group of 17 children (mean age, 6 years) was identified by reviewing CT examinations of all patients who underwent CT of the chest to evaluate possible complications of pneumonia over a 3-year period. Children included in the study group were those who met the criteria for cavitary necrosis: loss of lung architecture, decreased enhancement, and multiple cavities with thin, nonenhancing walls. In the 17 identified cases, sequential chest radiographs were reviewed for visibility of a lung cavity. Long-term follow-up radiographs were evaluated for persistent abnormalities.

Results: Ten of the 17 cases of cavitary necrosis seen on CT showed cavities at some time on radiography: one cavity was visible at the time of diagnosis on CT and nine were visible only later. All three cavities that were predominantly air-filled on CT were revealed by radiography, whereas 50% (7/14) of predominantly fluid-filled cavities were revealed by radiography. Eleven children underwent follow-up radiography more than 40 days after the diagnosis of cavitary necrosis. Radiographs of those 11 children showed clear lungs without pulmonary sequelae.

Conclusion: In children, cavitary necrosis is associated with severe illness; however, cases usually resolve without surgical intervention, and long-term follow-up radiography shows clear lungs without pulmonary sequelae. Evidence of cavitary necrosis complicating pneumonia is often seen on CT before or in the absence of findings on chest radiography.

MeSH terms

  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Lung / diagnostic imaging
  • Lung / pathology
  • Male
  • Necrosis
  • Pneumonia, Pneumococcal / complications
  • Pneumonia, Pneumococcal / diagnostic imaging*
  • Radiography, Thoracic*
  • Time Factors
  • Tomography, X-Ray Computed