RADIOLOGICAL-DIAGNOSIS OF PNEUMONIA IN CHILDREN

During 12 months in 1981-82, 201 children were hospitalized due to rad iologically verified definite or probable pneumonia. In 1985, 194 ches t radiographs (anteroposterior views) were re-evaluated jointly by two radiologists, and classified into three categories: alveolar, interst itial and probable pneumonia, In 127 cases definite pneumonia was diag nosed on both occasions, alveolar in 48 cases and interstitial in 79 c ases, Variation between the two evaluations 3 years apart was observed in 46 (24%) of the 194 cases; the adjusted kappa (0.47) was in the mo dest region, Factors contributing to this variation were young age, le ss than 12 months, and the presence of interstitial infiltration, bron chial obstruction and low C-reactive protein, Factors associated with less marked variation were the presence of alveolar infiltration, ausc ultatory fine rales and elevated C-reactive protein, The microbial aet iology of infection, assessed by viral and bacterial antigen and antib ody assays, showed no association with diagnostic variation, A lateral view of the chest radiograph was obtained from 158 patients; it was p ositive in 99 (91%) of the 109 cases with definite pneumonia. In only three cases the diagnosis was based on the lateral view alone. Our res ults show that the radiological diagnosis of pneumonia is difficult in children, especially in young children with interstitial pneumonia.