Abstract:
Pediatric thoracic infections remain a major cause of morbidity worldwide and represent a frequent indication for imaging evaluation. Accurate and timely diagnosis is essential for appropriate treatment and prevention of complications. Although chest radiography is commonly used as the initial imaging modality, ultrasound and computed tomography (CT) have increasingly important complementary roles in pediatric thoracic imaging.
Lung ultrasound has gained widespread acceptance because it is radiation-free, bedside-accessible, repeatable, and highly sensitive for pleural effusions, empyema, and peripheral pulmonary consolidations. It is particularly valuable in critically ill children and for follow-up examinations. Ultrasound also enables real-time assessment and image-guided interventions such as thoracentesis and pleural drainage. However, its limitations include operator dependency and reduced ability to evaluate deep pulmonary parenchyma and mediastinal structures.
CT remains the most comprehensive imaging modality for complicated thoracic infections. It provides excellent visualization of lung parenchyma, airways, mediastinum, and pleural disease, allowing accurate detection of necrotizing pneumonia, lung abscesses, cavitation, bronchiectasis, and mediastinal involvement. CT is particularly indicated in cases of treatment failure, suspected complications, immunocompromised patients, or unclear findings on radiography and ultrasound. Due to radiation exposure, CT in children should always follow ALARA principles and optimized low-dose protocols.
A multimodality imaging approach combining ultrasound and CT improves diagnostic accuracy while minimizing unnecessary radiation exposure. Understanding the strengths and limitations of each modality is essential for selecting the most appropriate imaging strategy in pediatric thoracic infections.
