Discussion

Strengths of CXR

• CXR is cost-effective, readily available, and exposes patients to minimal radiation, making it ideal for initial diagnosis and follow-up in uncomplicated cases.
• Its diagnostic performance is robust for typical bacterial pneumonia, characterized by consolidation and pleural effusion.

Limitations of CXR

• Limited sensitivity for detecting subtle or atypical findings, including viral pneumonia and early abscess formation.
• Overlap in radiographic features can make differentiation between viral and bacterial pneumonia challenging.

Strengths of CT

• CT offers unparalleled sensitivity for detecting subtle parenchymal changes, interstitial patterns, and complications such as abscesses or empyema.
• It is particularly valuable in cases with persistent symptoms, atypical clinical presentations, or where surgical intervention is considered.

Radiation Concerns

• While CT delivers a significantly higher radiation dose, advances in low-dose protocols mitigate risks, especially when CT is used judiciously.
• Pediatric imaging necessitates careful justification and optimization to balance diagnostic benefits against potential long-term risks of radiation exposure.

Recommendations

• CXR should remain the first-line imaging modality for suspected pediatric pneumonia due to its efficacy and safety profile.
• CT should be reserved for cases with diagnostic uncertainty, severe or complicated presentations, or poor clinical response to treatment.

Conclusion

This study highlights the complementary roles of CXR and CT in managing pediatric pneumonia. CXR is effective for initial diagnosis and follow-up in most cases, while CT provides critical insights in complex scenarios. Future efforts should focus on further optimizing CT protocols to minimize radiation exposure without compromising diagnostic quality.