Radiologist Questions Chest X-Rays

Other than a chest X-ray what are the other tests recommended for diagnosing the cause of cough?

My son is 3 years old and has been suffering from severe cough. According to the recent X-ray report there was ill defined haziness seen in the right perhilar and para-cardiac regions - pneumonitis. What does this mean? What are the other tests likely to be done to figure out the actual cause of the cough?

6 Answers

This is a typical viral bronchitis, I would not recommend antibiotics as this is viral and they don't work on viruses. He should do fine on his own unless he is immune compromised. You would know that. Robitussin is good for this.
If an additional imaging exam is required, and it may very likely not be required, CT scanning would be the next step. A much more sensitive computerized X-ray to look at the lungs, etc., in more than one plane.

With regards to the term "pneumonitis," it refers to inflammation of lung tissue and generally is used to describe findings that are non-infectious, caused most often by an allergic response, as opposed to "pneumonia," which would be caused by an infection with some microorganism.

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There are typically a variety of conditions which can reproduce a cough in the pediatric population that may stem from viral, bacterial, or even environmental. The clinical picture typically dictates the diagnosis of the cough in children with the routine chest X-ray being one that many physicians utilize to diagnose the cause. The chest X-ray is the most basic radiological exam applied.
Majority of the times the X-ray is negative due to a viral cause, however there can be mild interstitial disease usually viral in etiology. If there are any relevant findings, they can be a bacterial cause which is treated more aggressively. Typically these resolve over time, however a follow up may be suggested prompting additional assessment. Typically, the chest X-ray suffices but the dominant approach is to assess the child clinically. There are some remote outliers that are more serious, either acquired or congenital. I would not put weight on the overall finding, but more on the final outcome.
Pneumonitis is a general term used to refer to inflammation in the lungs. Pneumonia, an infectious cause of inflammation in the lungs, can technically be considered a cause of pneumonitis, can have a similar clinical presentation, and can appear similarly on an X-ray. However, most often, the term pneumonitis is used to indicate a non-infectious cause of the changes in the lungs, in other words inflammation that is reactive. This would include things in the environment such as mold, animal dander, and dust, inhaling "spit up," and also allergic reactions and drug interactions. In many cases, the X-ray changes alone may not differentiate between pneumonia and pneumonitis. A thorough history and physical examination by the attending physician and blood tests play an important role in determining the presumptive diagnosis. If it is determined that the cause is reactive or allergic, then allergy tests may be useful in identifying the underlying cause. In a few circumstances, if the cause cannot be determined and the symptoms persistent, then a lung biopsy may be warranted.
The meaning is simply what it says. Many times, children will get a condition called bronchopneumonia. This occurs in younger people more frequently. This involves the main bronchi and some of the surrounding alveoli near the hilar areas around the heart. Many times, it is caused by viral infection, but it can also develop into a bacterial infection. Clinical Monitoring is the key to a successful recovery along with plenty of rest and fluid and antibiotic, if prescribed by a pediatrician. If the pneumonia is not successfully cured, sputum samples might be indicated to find out the type of organism by doing culture and sensitivity studies.
Depending if there is increased lung volumes, additional considerations may include a viral infection or asthma. Most of the diagnosis should come from the pediatrician who should do a good exam to exclude asthma or a virus and then treat accordingly.

Dr Cox