Journal Reading

Radiology of Bacterial Pneumonia

Vilar J., Domingo M., et al. European Journal of Radiology. 2004. 51:10213

Bacterial Pneumonia
Classic morphologic classification
Lobar pneumonia Bronchopneumonia Acute interstitial pneumonia

The mechanism of origin

Community Acquired Pneumonia (CAP) Aspiration Pneumonia Nosocomial Pneumonia (NP) / Hospital Aquired Pneumonia (HAP)

Imaging Pneumonia
Detection Characterization Follow-up Modality
CXR basic & diffused imaging tool CT Recommended where CXR is uncertain in complication / underlying lesion MRI alternative

CXR

CT-scan

a) Paratracheal opacity in right upper lobe b) Same patient opacity due an air-space consolidation Clearly

The mechanism of origin

Community Acquired Pneumonia (CAP) Aspiration Pneumonia Related To causative agent Geographic area, Populated Study, Diagnostic Methods used Nosocomial Pneumonia (NP)
Causative agent
Streptococcal pneumonia Pneumococcal pneumonia Mycoplasma pneumonia Chlamydia pneumonia Legionella pneumonia

Lobar Pneumonia

Airspace Consolidation in one segment/lobe

Streptococcal Pneumonia

Bronchopneumonia

Patchy Confluent areas multilobar/bilateral

Pneumococcal Pneumonia

Acute Interstitial Pneumonia

Mycoplasma pneumonia, Chlamydia pneumonia

Diffuse bilateral reticulo-nodular pattern

Multilobar Pneumonia

Unusual Pattern of CAP

Segmental peripheral consolidations Spread rapidly one / more lobes

48 h later

Underlying disease Confused with other aetiology Legionella pneumonia

Bilateral / Multilobar Pneumonia

(a)Bulous Emphysema (b)Same patient pneumonia in left upper lobe + air-fluid level
c

(c) Fluid filled the Bulla

Round Pneumonia

Unusual Pattern of CAP

Consolidation, round shape Pulmonary nodul infection history susp. Round Pneumonia Sterptococcus pneumoniae

The mechanism of origin

ommunity Acquired Pneumonia (CAP) Aspiration Pneumonia

Inhalation of orofaringeal / gastric contents into the larynx & lower respiratory tract
Aspiration pneumonitis
Drug Abuse, seizures, massive cerebrovascular accident, use of anesthesia

Aspiration pneumonia
Neurologic dysphagia, anatomic abnormalities of upper aerodigestive tract, GERD, poor oral care

Bilateral Lower lobe consolidations Particulary in the right lung with perihiler and basal distribution

ommunity Acquired Pneumonia (CAP) spiration Pneumonia Nosocomial Pneumonia (NP)

Hospital acquired pneumonia (HAP)
48 h hospital admission 48 h after discharge from hospital

Risk Factor

Condition of the patient, age, severity of underlying disease, how long, instrumentation invasive techniques Enterobacter, E. coli, pseudomonas, S. aureus, S. pneumoniae

Aerobic gram-negative bacilli / gram-positive cocci

Most commonly bilateral with diffuse / multiple foci of consolidation Pleural Efussion Pseudomonas Aeruginosa

Intesive Care Unit (ICU)

Frequent High Mortality

Ventilator
Ventilator Associated Pneumonia (VAP)
First 5 Days S. pneumonia, H. Influenzae, Moxarella catarrhalis, anaerob (uncommonly) After 5 Days P. aeruginosa, acinetobacter, Enterobacter spp.

Non-Ventilated Associated Pneumonia (NVAP)

Right perihiler consolidation Acinetobacter after 5 days of mechanical ventilation

Complication
More common immunodepressant patient & NP Common Agent S. aureus, anaerobic & gram-negative Common occurs
Pulmonary Gangrene Pneumatocele Pleural Effusion & empyema Lobar Enlargement

Pulmonary Gangrene
Sloughed lung tissue due to extensive necrosis in a large cavity with an air-fluid level Klebsiella pneumonia

Pneumatocele
(a) Consolidation in left lower lobe (b) A cystic space (4 weeks later) S. aureus Most common in Children

Pleural Effusion & Empyema

Less frequent Ussualy reactive Resolve with antibiotic therapy 5-10% case progress to empyema

Lobar Enlargement

Opacity in the left upper lobe Posterior Displacement of major fissure Swelling of lobe extensive exudative process Klebsiella pneumonia

Conclusions
Three Main Groups CAP, AP, NP Role of Radiology Decisive diagnosis & Follow-up CXR Basic tool Intensive Care Unit Limited CT Close follow-up & adequate clinical correlation Mandatory