Lung scintigraphy in the assessment of recurrent bronchitis and pneumonia in children.

Recurrent bronchitis and pneumonia in childhood are a significant factor in predisposing adults to chronic respiratory disease. Lung scintigraphy in children with recurrent respiratory problems very frequently shows regional abnormalities, even in the absence of radiological signs: the main problem being the correct clinical use of such a high sensitivity. Structural changes, also at the histological level, are accompanied by functional disturbances that cause lung scan abnormalities to become stable with time and are very likely responsible for persisting disease in adulthood: the above condition needs to be identified by means of follow-up scintigraphies. Moreover, any chronic respiratory condition that has already been diagnosed, like cystic-fibrosis, bronchiectasis, bronchopulmonary malformations, lung fibrosis, should be assessed and followed-up by means of lung scintigraphy. Suspected radiotransparent foreign-body inhalation, radiographical hyperlucencies (compensatory or pathological emphysema?), functional assessment before lung surgery, suspected mucociliary function impairment, suspected interstitial pneumonia, pre-bronchographic or angiographic assessment, all of the above conditions represent important indications to lung scintigraphy in children. Finally, it is wise pointing out that, in order to avoid false positive results towards the diagnosis of structural disease, any easily reversible functional impairment should be removed before the scan, by proper patient preparation: in children this is done by at least aerosol therapy with beta-agonists, local steroids and mucolytics for 1 week-10 days.