Clinical relevance of computed tomography in children with persistent focal chest abnormalities

Objective. To assess what additional information chest computed tomography provides, alone or combined with clinical findings and further diagnostic tests, and how frequently it suggests changes in the management of persistent focal chest abnormalities. Methods. Fifty children with chronic cough and persistent focal chest abnormalities on conventional radiograph underwent chest computed tomography. Definitive diagnosis, made on the basis of the clinical course and additional diagnostic tests over a 12-month period, was the reference standard. At the end of the follow-up period we compared the radiologists' evaluation with the definitive diagnosis, and provided the percentage of clinical management changes. Results. Ultimate diagnoses were consolidation, bronchiectasis, congenital malformations of the lower respiratory tract and foreign body inhalation. The clinical management was modified in 64% of cases, and left unchanged in 36%; in the former group, computed tomography alone led to eighteen new diagnoses (56%) including twelve bronchiectasis and 6 congenital lung malformations, whereas in the remaining fourteen (44%) the diagnosis was made on the basis of non-imaging tests and clinical data. Conclusion. Computed tomography can increase the accuracy of diagnoses provided by chest radiography and may influence the management of children with chronic cough and persistent focal chest abnormalities.