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Introduction The value of performing a follow up chest X-ray (CXR) after hospital admission with community-acquired pneumonia (CAP) is debated; currently randomised-controlled trial evidence is lacking. BTS guidelines advise those with persistent symptoms, or a higher malignancy risk warrant a CXR 6 weeks after discharge.This single-centre study from a large UK teaching hospital describes follow up CXR outcomes from a cohort of CAP patients managed by the local Respiratory Infections Team (RIT) over a one-year period.Methods A retrospective database review was conducted of consecutive patients admitted with confirmed CAP and followed up by the RIT between October 2023 and October 2024. Patient records and imaging reviewed to identify outcomes.Results 1034 patients were identified, with 995 surviving from hospital discharge to CXR and RIT follow up. Of these, 163 (16.4%) were identified as having residual radiographic changes.48 (4.8%) did not attend follow up because of choice, area or other health reasons.Through follow up, 26/995 (2.6%) patients were found to have a new underlying pathology requiring further investigation. 9 (0.9%) were referred on for cancer investigations with 7 confirmed lung cancers. Of these, 6 were smokers or had significant smoking history. Other new respiratory disease diagnosed included interstitial lung disease, bronchiectasis and persistent empyema (table 1).For those with persisting CXR abnormalities, symptoms resolved in 73/163 (44.8%), and the persistent changes were deemed clinically non-significant following MDT discussion. 61/163 (37.4%) had further interval radiographic surveillance and 29/163 (17.8%) had further respiratory specialty input.Of those that had further imaging, 15/61 (24.6%) resolved by second CXR and 21/61 (34.4%) showed clinical resolution with residual non-significant CXR change, so were discharged. Slow resolvers tended to be current smokers (42/163, 25.8%) or have significant smoking history (78/163, 47.9%), and 55/163 (33.7%) patients had COPD. Median age of slow resolvers was 73 compared to 70 of the whole cohort (p=0.004).Abstract P181 Table 1A summary of new respiratory diagnoses found through follow upConclusion Follow up CXR at 6 weeks for CAP identified a new significant respiratory diagnosis in 2.6% of patients, of which lung cancer was identified in 0.7%. Most patients with ongoing CXR abnormalities at 6 weeks resolve on subsequent imaging.