Pediatric Chest: A Review of the Must-know Diagnoses

Shreya Sood, MD; Julia Rissmiller, MD; Anastasia Hryhorczuk, MD


Appl Radiol. 2018;47(4):4-14. 

In This Article

Round Pneumonia

Round pneumonia is a phenomenon that typically occurs in children due to undeveloped communicating passages in the air spaces called pores of Kohn and channels of Lambert.[21] Underdevelopment of these channels allows for centrifugal spread of fluid and/or bacteria leading to rounded appearance of infection. Round pneumonias are usually pneumococcal infections in children under the age of 8, presenting as solitary, well-defined, lesions in the posterior and lower lobes (Figure 10).[22] Air bronchograms may be present. At imaging, round pneumonias may appear similar to a parenchymal bronchogenic cysts, pleuropulmonary blastoma or metastatic disease. However, a clinical history of acute/subacute onset of symptoms, with fever, leukocytosis, and cough should provide the diagnosis. Round pneumonias are treated with antibiotics and rarely progress to lobar consolidation.

Figure 10.

7-year-old male with cough and fever. (A) PA radiograph shows abnormal rounded opacity in left mid-lung near the left hilum (arrow).(B) On lateral view, this projects into left upper lobe, above the major fissure and projects over the heart (arrow). Patient received outpatient antibiotic treatment for pneumonia. Follow-up chest radiograph 6 weeks later was clear. Findings are compatible with round pneumonia.