CASE REPORT

Round Pneumonia

Round Pneumonia
Yousif Mokhtar (1), Elmuntasir Taha (1) Correspondence:
(1) Department of Paediatrics Faculty of Medicine The National Ribat University Yousif Mokhtar Gadalla, Assistant Professor of Pediatrics, Faculty of Medicine, The National Ribat University, Khartoum - Sudan E. mail: yousif091@live.com

ABStract Round Pneumonia is a type of pneumonia, characterized by spherical consolidation on chest radiograph and usually confused with pulmonary mass, and initially present with tachypnea, cough and generalized malaise, followed by acute febrile illness. The diagnosis of round pneumonia is based on chest radiograph and clinical finding. We present a 5 months old boy who was admitted with cough, fever, vomiting and rounded mass appearance on chest x-ray, diagnosed as round pneumonia and treated with cefuroxime and chloramphenicol with good response. Keywords: Pneumonia: round: spherical.

INTRODUCTION Round pneumonia is a type of pneumonia, characterized by spherical consolidation on chest radiograph and simulating pulmonary neoplasm1. Spherical pneumonia caused by Haemophilus influenzae, streptococcus pneumonia, and mycobacterium tuberculosis. The process begins in segmental bronchus and spread through the lymphatic channels and the pores of Kohn (inter -alveolar communications) producing spherical appearance, the disease involves mainly the small bronchi and alveoli and multiple segments may be involved2. Round pneumonia initially presents with tachypnea, cough and generalized malaise followed by acute febrile illness, less common symptoms are vomiting, abdominal pain and chest pain3. Round pneumonia is considered as a mild disease, but sometimes the outcome may be fatal, depending on the virulence of the infective organism and host immunity4.

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CASE REPORT
CASE REPORT A 5 months old boy was admitted to Ribat University Hospital with symptoms of cough, fever and vomiting. The fever was of high grade, continuous, not associated with sweating, rigors and convulsions. The cough developed in 5 days prior to admission when he also experienced productive cough with mild wheezy breathing. He was exclusively breastfed. Not fully vaccinated. There is no history of contact with a patient of tuberculosis. There is no family history of bronchial asthma. On admission, the patient was ill, pale, not jaundiced nor cyanosed, his body temperature was 40oC, the pulse was 120/min, respiratory rate was 40/min, the weight was 6kg (at 25th centile) and the length was 65cm (between 25th and 50th centile). Physical examination of the chest revealed decreased air entry over the right upper lung zone and inspiratory crackles were heard over the same area with mild rhonchi. There is no BCG scar, laboratory analysis showed white blood count 11000/mm3, on peripheral blood smear, PMNL 51% and lymphocyte,40% . Sedimentation rate was 46 mm/hr. Blood film for malaria was negative, PPD was negative, and sputum for AAFB was negative. Chest radiograph revealed rounded mass in the right upper lobe posterior segment. The patient was treated with cefuroxime and chloramphenicol for 7 days. On the fourth day, fever resolved and clinical condition gradually improved. On day 7, spherical consolidation started resolution and he was continued with intravenous antibiotics for another 7 days with good response.

Round Pneumonia

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DiScuSSion Round Pneumonia is characterized with spherical consolidation on chest radiograph and usually confused with pulmonary mass, and it is usually seen in children5. Although round pneumonia is a well-known clinical entity, there have been no large case reviews, with most knowledge based on case reports and small series from 1960s-1970s. Round pneumonia occurs in young children (mean age=5 years) and tend to be a solitary lesion, and is most commonly posteriorly located6. Round pneumonia usually requires no more than chest x-rays for diagnosis and follow-up. The region appears as rounded lung opacityy with well-formed borders. It is most seen in thee superior segment of lower lobes7. Streptococcus pneumoniae has been frequently reported in thee etiopathogenesis of round pneumonia besides haemophilusinfluenzae, mycobacterium tuberculosis and klebsiella8. Unnecessary antibiotic usage in pneumonia is s an important problem for cost effectiveness. It has been reported that up to 80% of non-bacterial pneumonia may be treated with antibiotics9. The clinical and radiological finding in our patient lead to diagnosis of round pneumonia, we treated our patient with cefuroxime and chloramphenicol because they are effective against S. pneumonia and H. influenzae which are the most frequent pathogens in the round pneumonia. We did not obtain blood culture, but clinical symptoms and mass appearance of the chest radiograph gradually recovered after few days of treatment which supports our diagnosis, in comparison to other cases which were reported as round pneumonia in Turkey, where they used cefuroxime and clindamycin as a treatment of round pneumonia and the symptoms improved rapidly10,11. In conclusion, if a patient with pulmonary mass appearance on chest radiograph and has symptoms of respiratory tract and also has no finding to suggest - -

CASE REPORT
malignancy, round pneumonia can be considered in the differential diagnosis. Follow up repeated chest x-ray within several days might be a guide. References: 1. Rose RW, Ward BH, Spherical pneumonia in children simulating pulmonary and mediastinal masses. Radiology, 1973; 106: 179 - 182 2. Greenfield H, Gyepes MT oval shaped consolidation simulating new growth of the lung. American journal of Roentgenology, 1964; 91 (1): 125 -129 3. Ricardo R, Rajaneeshankar P, uma M et al. Imaging in round pneumonia and mimics in children, pediatrRadiol, 2010; 40: 1931-1940 4. Wan Yl, Kuo HP, Tasi et al. Eight cases of severe acute respiratory syndrome presenting as round pneumonia. AJR, 2004; 182: 1567 1570 5. Talner LB. Pleuropulmonarypseudotumors in childhood. AMJ Rontgenol, 1967; 100: 208 213 6. Yong-Won Kim, Lane F. Round pneumonia: Imaging finding in large series of children. Paedriatric Radiology, 2007; 37 (12): 1235 1240 7. Bramson RT, Ciricom NT, Cleveland RH. Interpretation of chest radiographs in infants with cough and fever. Radiology 2005; 236 (1): 22 - 29 8. Soubani AO, Epstein SK. Life treating round pneumonia. AMJ Emerg Med, 1996; 14: 189 191 9. Bradley JS, Management of community acquired pediatric pneumonia in an ERA of increasing antibiotic resistance and conjugate vaccines. Pediatr infect Dis j, 2002; 21: 592 598 10. Coskun Y, AbdulKadir K, Melike E. A child who presenting with round pneumonia. The medical journal of kocatepe, 2006; 6: 71 - 73 11. Solmaze, Mustafa H. Round pneumonia in children. Indian j pediatr, 2008; 75 (5): 523 525

Round Pneumonia

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