Pneumonia (Paediatric, Recurrent or Persistent)

Population Covered By The Guidance

This pathway provides guidance on the imaging of paediatric patients with recurrent pneumonia

Lead Researcher: Arjun Shivananda

Experts & Contributors: Ravinder Dhillon, Michael Ditchfield, Peter Shipman

Date reviewed: July 2017

Date Published: September 2017

Image 1a and 1b (Computed Tomography): Mild bilateral bronchiectasis predominantly involving the lower lobes. There are multiples areas of

Cystic Fibrosis with Bronchiectasis

Image 1a and 1b (Computed Tomography): Mild bilateral bronchiectasis predominantly involving the lower lobes. There are multiples areas of

Cystic Fibrosis with Bronchiectasis

Image 2a: Pneumonectomy showing grossly dilated bronchi with mucous plugging (blue arrows) and distal consolidation.

Cystic Fibrosis with Bronchiectasis

Image 2b (H&E, x2.5): Section of a dilated bronchi with florid acute on chronic inflammation of the bronchial wall and surrounding interstitial

Cystic Fibrosis with Bronchiectasis

  • Recurrent pneumonia - two episodes within the same year, or 3 or more episodes over any time period. For a child to be diagnosed with recurrent pneumonia, there must be complete resolution of clinical and radiological findings between acute episodes
  • Persistent or non-resolving pneumonia - when there is clinical and radiological evidence of pneumonia despite adequate treatment for a month
  • Plain chest x-ray is indicated initially, with comparison to previous films essential
  • Further investigations are dictated by the most likely diagnosis, based on the age of the child, the onset of symptoms and findings on clinical history and examination. CT of the chest or bronchoscopy may be indicated

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Vaughan D, Katkin JP. Chronic and recurrent pneumonias in children. Semin Respir Infect. 2002;17(1):72-84. (Review article). View the reference
  2. Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. Int J Mol Sci. 2017;18(2):296. (Review article). View the reference
  3. Wald ER. Recurrent and nonresolving pneumonia in children. Semin Respir Infect. 1993;8(1):46-58. (Review article). View the reference
  4. Yousif TI, Elnazir B. Approach to a child with recurrent pneumonia. Sudanese Journal of Paediatrics. 2015;15(2):71-7. (Review article). View the reference
  5. Gaston B. Pneumonia. Pediatr Rev. 2002;23(4):132-40. (Review article). View the reference
  6. Donnelly LF, Klosterman LA. The yield of CT of children who have complicated pneumonia and noncontributory chest radiography AJR Am J Roentgenol. 1998;170(6):1627-31. (Level III evidence). View the reference
  7. Liu YL, Wu PS, Tsai LP, Tsai WH. Pediatric round pneumonia. Pediatr Neonatol. 2014;55(6):491-4. (Level IV evidence). View the reference
  8. Copley SJ. Application of computed tomography in childhood respiratory infections. Br Med Bull. 2002;61:263-79. (Review article). View the reference
  9. Bayramoglu S, Cimilli T, Aksoy S, Yildiz S, Salihoglu B, Hatipoglu S, et al. The role of HRCT versus CXR in children with recurrent pulmonary infections. Clin Imaging. 2005;29(5):317-24. (Level III evidence). View the reference
  10. Rosbe KW, Kenna MA, Auerbach AD. Extraesophageal reflux in pediatric patients with upper respiratory symptoms. Arch Otolaryngol Head Neck Surg. 2003;129(11):1213-20. (Level III evidence). View the reference
  11. Yellon RF, Goldberg H. Update on gastroesophageal reflux disease in pediatric airway disorders. Am J Med. 2001;111 Suppl 8A:78-84. (Review article). View the reference

Pathway User Guide

Yellow Boxes Denotes extra information. Some contain single or multiple white sub-boxes, click a white box to reveal detailed information in a pop-up.

White Boxes: Denotes standard pathway steps. (If inside a yellow box, they open a specific pop-up).

Zoom & Pan Controls: Use + / − or the slider to zoom. Reset returns to default. Tick Panning to drag the diagram when zoomed.

Blue “View Full Screen” Button: Opens the whole diagram in a large, full-screen pop-up window. Use Close to exit.

The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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