Round Pneumonia
Jhon Camacho-Cruz, Daniela Guerrero-Sanchez
N Engl J Med 2025;392: e39
A previously healthy 4-year-old girl who was up to date on routine vaccinations presented to the emergency department with a 3-day history of dry cough and fever. On physical examination, intercostal retractions and decreased breath sounds over the left lung were observed. Laboratory studies were notable for neutrophilic leukocytosis. A chest radiograph showed a large, rounded opacity in the left lower lobe with subtle air bronchograms (frontal view, arrows). A diagnosis of round pneumonia was made. Round pneumonia refers to the presence of a spherical or rounded lesion on chest imaging in young children with pneumonia. In early childhood, pathways of collateral ventilation — particularly the small openings between adjacent alveoli and between bronchioles and alveoli — are poorly developed, so pulmonary consolidation may be more delineated and compact than in adults. Air bronchograms may not be visible in all cases of round pneumonia. After hospitalization, the patient continued to have fevers despite empirical antimicrobial therapy, and a pleural effusion developed. A polymerase-chain-reaction assay for respiratory pathogens identified adenovirus and Mycoplasma pneumoniae. After a course of antimicrobial therapy, she was discharged home. At the 6-week follow-up, the patient felt well, and a repeat chest radiograph was normal.
