Background Bronchiolitis, a lower respiratory tract infection that primarily affects the small airways (bronchioles), is a common cause of illness and hospitalisation in infants and young children. Although several Studies suggest that radiographs in children with typical bronchiolitis have limited value, chest x ray still performed on routine basis. There is limited data regarding which viral-associated bronchiolitis has the highest rate of consolidation on a Chest Radiograph.
Aim The purpose of our study is to determine which virus inducing bronchiolitis has the highest rate of consolidation of a chest radiograph.
Methods A retrospective and descriptive study was conducted at Hamad Medical Corporation (HMC).
Infants and children ages 0 to 18 months hospitalised in our paediatric unit with acute bronchiolitis from October 2010 to March 2013 were included in the study. The following data were collected: age at diagnosis, sex, direct fluorescent antibody (DFA) and results of chest radiograph.
Results The study comprised of 838 infants, median age 3.6 months, and boys constituted60% of total infants. 606 infants and children had a routine chest radiograph done in the paediatric emergency centre prior to admission. n = 226, 37.3%, showed normal findings on chest radiographs, while n = 380, 62.7% showed consolidations. 70 chest radiographs (18.4%) with consolidation were attributed to infants and children with bronchiolitis and negative DFA.
The results of positive DFA associated with consolidation on chest radiograph were as follow:
Respiratory Syncythial Virus (RSV) 161, 42.4%; rhinovirus 68, 17.9%; Human metapneumovirus (hMPV) 25, 6.6%; parainfulenza virus (type1) 3, 0.8%; parainfluenza virus (type 2) 2, 0.5%; parainfluenza virus (type 3)15, 3.9%; parainfluenza virus (type 4) 4, 1.1%; coronavirus 11, 2.9%;adenovirus 10,2.6%; enterovirus 3, 0.8%; bocavirus 5, 1.3%;H1N1 2, 0.5%;Influenzavirus B 1, 0.3%. There was no statistically significant difference relating chest consolidation with DFA status, p = 0.773
Conclusions Bronchiolitis can be triggered by a diversity of respiratory viruses that appear similar on a chest radiograph; therefore, chest imaging is not routinely required in the initial management of bronchiolitis unless the diagnosis is uncertain.