Chest X-ray in bronchial pneumonia: Is it useless in most cases?

The review of the literature and of the international guidelines about the usefulness of performing chest radiography for the diagnosis of bronchial pneumonia shows that this examination should be limited to selected cases. If symptoms are suggestive of bronchial pneumonia in clinically not severe children older than 2 years, the radiography should not be performed because it does not modify the therapeutic behaviours, it does not give accurate information about etiology, and it can give false negative or false positive results. In this context chest radiography does not offer advantages, does not modify clinical outcomes, could be misleading and could induce therapeutic mistakes. On the other hand, chest radiography is strictly indicated in selected cases such as the presence of severe respiratory symptoms, symptoms that do not improve with antibiotic therapy within 24-48 hours, suspected tuberculosis, respiratory distress from suspected non-infectious etiology, and highly feverish children without identified cause. Chest radiological controls during or after therapy should be limited to selected cases and never performed in patients responsive to therapy and clinically healed.