First-time wheezing in infants during respiratory syncytial virus season: Chest radiograph findings

Objectives: To evaluate the prevalence of pathologic chest radiographs in infants presenting with a first episode of wheezing during respiratory syncytial virus (RSV) seasons and to compare demographics and clinical variables between patients with benign and pathologic chest radiographs. Methods: We conducted a descriptive study of infants presenting to the emergency departments and urgent care centers of two tertiary care children's hospitals. All previously healthy infants aged 0 to 12 months presenting with a first episode of wheezing were eligible. Signs and symptoms were recorded, and then a chest radiograph was obtained. After the completion of the study, all chest radiographs were reviewed by two pediatric radiologists blinded to the child's clinical presentation and diagnosis. Associations between signs and symptoms and chest radiograph findings were evaluated. Results: A total of 140 patients were enrolled. One (0.7%) patient had a cardiac anomaly, and 23 patients (16%) had an infiltrate versus atelectasis. The cardiac anomaly was suspected based on the clinical signs and symptoms present prior to obtaining the chest radiograph. Of the 23 patients with infiltrate/atelectasis, only eight (35%) were febrile, 12 (52%) were tachypneic, and nine (39%) were hypoxemic. Conclusion: Seventeen percent of 140 previously healthy infants presenting with a first episode of wheezing during RSV seasons had a pathologic chest radiograph. However, only one patient (0.7%) had a cardiac anomaly, and all others had chest radiograph findings consistent with a respiratory tract infection.