CASE REPORT   

Journal of Radiological Review 2021 December;8(4):336-9

DOI: 10.23736/S2723-9284.21.00141-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

A combined X-ray and ultrasonographic detection of atypical pleural effusion unmasks a community-acquired necrotizing pneumonia

Laura M. CACIOPPA ¹ ✉, Donatella VIVACQUA ², Laura GRECO ², Michelangelo BALDAZZI ², Filomena CARFAGNINI ², Francesco MONTEDURO ¹, Rita GOLFIERI ¹

¹ Unit of Radiology, Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy; ² Unit of Pediatric Radiology, Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy

Necrotizing pneumonia (NP) occurs as a complication of nearly 4% of all community-acquired bacterial pneumonias in children and is associated with significant morbidity if not adequately treated. Streptococcus pneumonia, followed by Staphylococcus aureus, is the most common agent of NP and may lead to severe complications. We report a case of community-acquired Pneumococcal NP in a healthy 5-year-old child with fever and persistent cough, previously treated as an uncomplicated pneumonia. At the admission, a chest radiography showed an atypical distribution of left pleural effusion, suggestive of complicated pneumonia. Immediately after, the X-ray was completed by lung ultrasound, performed by the same radiologist. The radiographic and ultrasonographic signs were together sufficient to reveal a NP. A computed tomography (CT) performed as preoperative evaluation and the intraoperative microbiological analysis confirmed the diagnosis. The patient was successfully treated by pleural toilet and decortication by means of video-assisted thoracoscopic surgery and intravenous antibiotic therapy.

KEY WORDS: Pneumonia, bacterial; Radiography; Tomography, X-Ray computed; Ultrasonography; Community acquired infections; Intensive care units; Pediatrics