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Pneumonia With Cavitary Necrosis
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Necrotizing pneumonia
              • Pulmonary gangrene
            • Definitions

              • Complication of bacterial pneumonia where dominant focus of necrosis develops in consolidated lung, resulting in variable number(s) of thin-walled cysts

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        Selected References

                                        1. de Benedictis FM et al: Complicated pneumonia in children. Lancet. 396(10253):786-98, 2020
                                        2. Andronikou S et al: Computed tomography in children with community-acquired pneumonia. Pediatr Radiol. 47(11):1431-40, 2017
                                        3. Liszewski MC et al: Lung magnetic resonance imaging for pneumonia in children. Pediatr Radiol. 47(11):1420-30, 2017
                                        4. Masters IB et al: Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan). 9:11, 2017
                                        5. Ramgopal S et al: Pediatric necrotizing pneumonia: a case report and review of the literature. Pediatr Emerg Care. 33(2):112-5, 2017
                                        6. Pawley B et al: Core curriculum illustration: necrotizing pneumonia and empyema. Emerg Radiol. 23(2):201-2, 2016
                                        7. Sodhi KS et al: Rapid lung MRI in children with pulmonary infections: time to change our diagnostic algorithms. J Magn Reson Imaging. 43(5):1196-206, 2016
                                        8. Lai SH et al: Value of lung ultrasonography in the diagnosis and outcome prediction of pediatric community-acquired pneumonia with necrotizing change. PLoS One. 10(6):e0130082, 2015
                                        9. Gorkem SB et al: Evaluation of pediatric thoracic disorders: comparison of unenhanced fast-imaging-sequence 1.5-T MRI and contrast-enhanced MDCT. AJR Am J Roentgenol. 200(6):1352-7, 2013
                                        10. LemaƮtre C et al: Necrotizing pneumonia in children: report of 41 cases between 2006 and 2011 in a French tertiary care center. Pediatr Infect Dis J. 32(10):1146-9, 2013
                                        11. Yikilmaz A et al: Evaluation of pneumonia in children: comparison of MRI with fast imaging sequences at 1.5T with chest radiographs. Acta Radiol. 52(8):914-9, 2011
                                        12. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                        13. Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
                                        14. Kurian J et al: Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 193(6):1648-54, 2009
                                        15. Sawicki GS et al: Necrotising pneumonia is an increasingly detected complication of pneumonia in children. Eur Respir J. 31(6):1285-91, 2008
                                        16. Copley SJ: Application of computed tomography in childhood respiratory infections. Br Med Bull. 61:263-79, 2002
                                        17. Hodina M et al: Imaging of cavitary necrosis in complicated childhood pneumonia. Eur Radiol. 12(2):391-6, 2002
                                        18. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                                        19. Juven T et al: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 19(4):293-8, 2000
                                        20. Markowitz RI et al: The spectrum of pulmonary infection in the immunocompromised child. Semin Roentgenol. 35(2):171-80, 2000
                                        21. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                                        22. Katz DS et al: Radiology of pneumonia. Clin Chest Med. 20(3):549-62, 1999
                                        23. Brunelle F: [Radiologic approach to community-acquired pneumonia] Arch Pediatr. 5 Suppl 1:26s-7s, 1998
                                        24. Donnelly LF et al: Cavitary necrosis complicating pneumonia in children: sequential findings on chest radiography. AJR Am J Roentgenol. 171(1):253-6, 1998
                                        25. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                                        26. Donnelly LF et al: CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 169(1):179-82, 1997
                                        27. Donnelly LF et al: Pneumonia in children: decreased parenchymal contrast enhancement--CT sign of intense illness and impending cavitary necrosis. Radiology. 205(3):817-20, 1997
                                        28. Kerem E et al: Bacteremic necrotizing pneumococcal pneumonia in children. Am J Respir Crit Care Med. 149(1):242-4, 1994
                                        29. Kirkpatrick JA: Pneumonia in children as it differs from adult pneumonia. Semin Roentgenol. 15(1):96-103, 1980
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Necrotizing pneumonia
                                                    • Pulmonary gangrene
                                                  • Definitions

                                                    • Complication of bacterial pneumonia where dominant focus of necrosis develops in consolidated lung, resulting in variable number(s) of thin-walled cysts

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Nonvascular Interventions

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              Selected References

                                                                              1. de Benedictis FM et al: Complicated pneumonia in children. Lancet. 396(10253):786-98, 2020
                                                                              2. Andronikou S et al: Computed tomography in children with community-acquired pneumonia. Pediatr Radiol. 47(11):1431-40, 2017
                                                                              3. Liszewski MC et al: Lung magnetic resonance imaging for pneumonia in children. Pediatr Radiol. 47(11):1420-30, 2017
                                                                              4. Masters IB et al: Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan). 9:11, 2017
                                                                              5. Ramgopal S et al: Pediatric necrotizing pneumonia: a case report and review of the literature. Pediatr Emerg Care. 33(2):112-5, 2017
                                                                              6. Pawley B et al: Core curriculum illustration: necrotizing pneumonia and empyema. Emerg Radiol. 23(2):201-2, 2016
                                                                              7. Sodhi KS et al: Rapid lung MRI in children with pulmonary infections: time to change our diagnostic algorithms. J Magn Reson Imaging. 43(5):1196-206, 2016
                                                                              8. Lai SH et al: Value of lung ultrasonography in the diagnosis and outcome prediction of pediatric community-acquired pneumonia with necrotizing change. PLoS One. 10(6):e0130082, 2015
                                                                              9. Gorkem SB et al: Evaluation of pediatric thoracic disorders: comparison of unenhanced fast-imaging-sequence 1.5-T MRI and contrast-enhanced MDCT. AJR Am J Roentgenol. 200(6):1352-7, 2013
                                                                              10. LemaƮtre C et al: Necrotizing pneumonia in children: report of 41 cases between 2006 and 2011 in a French tertiary care center. Pediatr Infect Dis J. 32(10):1146-9, 2013
                                                                              11. Yikilmaz A et al: Evaluation of pneumonia in children: comparison of MRI with fast imaging sequences at 1.5T with chest radiographs. Acta Radiol. 52(8):914-9, 2011
                                                                              12. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                                              13. Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
                                                                              14. Kurian J et al: Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 193(6):1648-54, 2009
                                                                              15. Sawicki GS et al: Necrotising pneumonia is an increasingly detected complication of pneumonia in children. Eur Respir J. 31(6):1285-91, 2008
                                                                              16. Copley SJ: Application of computed tomography in childhood respiratory infections. Br Med Bull. 61:263-79, 2002
                                                                              17. Hodina M et al: Imaging of cavitary necrosis in complicated childhood pneumonia. Eur Radiol. 12(2):391-6, 2002
                                                                              18. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                                                                              19. Juven T et al: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 19(4):293-8, 2000
                                                                              20. Markowitz RI et al: The spectrum of pulmonary infection in the immunocompromised child. Semin Roentgenol. 35(2):171-80, 2000
                                                                              21. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                                                                              22. Katz DS et al: Radiology of pneumonia. Clin Chest Med. 20(3):549-62, 1999
                                                                              23. Brunelle F: [Radiologic approach to community-acquired pneumonia] Arch Pediatr. 5 Suppl 1:26s-7s, 1998
                                                                              24. Donnelly LF et al: Cavitary necrosis complicating pneumonia in children: sequential findings on chest radiography. AJR Am J Roentgenol. 171(1):253-6, 1998
                                                                              25. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                                                                              26. Donnelly LF et al: CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 169(1):179-82, 1997
                                                                              27. Donnelly LF et al: Pneumonia in children: decreased parenchymal contrast enhancement--CT sign of intense illness and impending cavitary necrosis. Radiology. 205(3):817-20, 1997
                                                                              28. Kerem E et al: Bacteremic necrotizing pneumococcal pneumonia in children. Am J Respir Crit Care Med. 149(1):242-4, 1994
                                                                              29. Kirkpatrick JA: Pneumonia in children as it differs from adult pneumonia. Semin Roentgenol. 15(1):96-103, 1980