Diagnosis and Assessment
Chest Radiography Initial Chest Radiographs: Outpatient
ÎRoutine chest radiographs are not necessary for the confirmation of suspected CAP in patients well enough to be treated in the outpatient setting (following evaluation in the office, clinic or emergency department setting). (SR-H)
ÎChest radiographs, posteroanterior (PA) and lateral, should be performed in patients with suspected or documented hypoxia or significant respiratory distress (Table 2) and in patients failing initial antibiotic therapy to verify the presence or absence of complications of pneumonia, including parapneumonic effusions, necrotizing pneumonia, and pneumothorax. (SR-M)
Initial Chest Radiographs: Inpatient
ÎChest radiographs (PA and lateral) should be performed in all patients hospitalized for management of CAP to document the presence, size, and character of parenchymal infiltrates and identify complications of pneumonia that may lead to interventions beyond antimicrobial agents and supportive medical therapy. (SR-M)
Follow-up Chest Radiograph
ÎRepeat chest radiographs are not routinely required in children who recover uneventfully from an episode of CAP. (SR-M)
ÎA repeat chest radiograph should be obtained in children who fail to demonstrate clinical improvement and in those who have progressive symptoms or clinical deterioration within 48-72 hours following initiation of antibiotic therapy. (SR-M)
ÎRoutine daily chest radiography is NOT recommended in children with pneumonia complicated by parapneumonic effusion following chest tube placement or following video-assisted thoracoscopic surgery (VATS), if they remain clinically stable. (SR-L)
ÎFollow-up chest radiographs should be obtained in patients with complicated pneumonia with worsening respiratory distress or clinical instability, or in those with persistent fever that is not responding to therapy over 48-72 hours. (SR-L)
ÎRepeat chest radiographs 4-6 weeks after the diagnosis of CAP should be obtained in patients with recurrent pneumonia involving the same lobe and in patients with lobar collapse on initial chest radiography with suspicion of an anatomic anomaly, chest mass or foreign body aspiration. (SR-M)
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