Follow-up of community acquired pneumonia with chest imaging - is it relevant?

Introduction: Chest imaging to revaluate community acquired pneumonia (CAP) used to be common practice. Recently, it has been suggested that most patients do not need it routinely. Aim: To evaluate the relevance of CAP follow-up with chest imaging. Methods: Retrospective observational study of all patients (pts) with CAP radiological follow-up in the Pulmonology Department of a tertiary hospital, between 6/ 2018 and 6/ 2019. Results: In the study period, 154 pts with CAP had follow-up chest imaging (57.1% male; mean age 57 (±18); 60.2% smokers or former smokers; 51% treated as inpatients). Chest X-Ray (CXR) was requested as initial follow-up imaging in 90.3% of pts and computed tomography (CT) in the remainder 9.7%, after a period of 33 ±18 days. CT was performed in an additional 31.8% of pts after follow-up CXR (in a total of 64 pts). The results of CXR and CT are presented in the table below: Lung cancer was diagnosed in 2 pts (1.3%) which had a mean age of 66 ±1 and were both smokers. Conclusion: Although, as described in literature, lung cancer was only diagnosed in 1.3% of patients, other important findings, such as bronchiectasis, ILD or lung (micro)nodules, were detected with imaging follow-up in nearly 30% of pts. Therefore, to better select these patients, aditional studies concerning chest imaging after CAP should be performed.