PNEUMONIA

Nur Yahya, T
05/1087561/KU/11522
Department of Radiology
Faculty of Medicine Gadjah Mada University/
Sardjito Hodpital
Definition and classification
Definition
is an inflammatory condition of the lung. It is often
characterized as including inflammation of the parenchyma
of the lung (that is, the alveoli) and abnormal alveolar filling
with fluid (consolidation and exudation).
Classification
Based on site of patient’s exposure
Community acquired pneumonia (CAP)
Health care-associated pneumonia (HCAP)
 Hospital-acquired pneumonia (HAP)
 Ventilator-associated pneumonia (VAP)
Classification
Based on site of infectious agent:
Bacterial pneumonia bakterial : Staphylococcus S,
Streptococcus Sp, Hemofilus influenza, Klebsiella Sp,
Pseudomonas Sp,
Viral pneumonia
Fungal Pneumonia
Classification
Based on anatomical site of infection
Lobar pneumonia
Bronkopneumonia
Pleuropneumonia
Pneumonia interstitiel
Pathogenesis
Mycroorganisms gain access to the lower resp tract via:
Microaspiation from the oropharynx (most commont)
Inhalation of contaminated droplets
Hematogenous spread
Contiguous exension from an infected pleural or
mediastinal space
Clinical findings - symtomps
 Typical symptoms
 Fever  Other common
 Chill symptoms
 Nausea
 Sweats
 Vomitting
 Cough
 Diarrhea

 Nonproductive

 Productive
Productive  Fatigue

 Mucoid
Mucoid sputum
sputum  Headache

 Purulent
Purulent sputum
sputum  Myalgias

 Blood-tinged
Blood-tinged sputum
sputum
 athralgias
 Pleuritic chest pain
 dyspnea
Clinical findings - signs
 Inspection:
 Tachypnea
 Palpation:
 Increased tactile
fremitus
 Percussion
 Dull
 Auscultation
 Crackles
 Bronchial breath
sound
 Pleural friction rip
Pneumonia fills the lung's
alveoli with fluid, keeping
oxygen from reaching the
bloodstream. The alveolus
on the left is normal,
while the alveolus on the
right is full of fluid from
pneumonia.
Upper panel shows a
normal lung under a
microscope. The white
spaces are alveoli that
contain air. Lower panel
shows a lung with
pneumonia under a
microscope. The alveoli
are filled with
inflammation and debris.
Inquired radiology examination
Thorax x-ray
Radiologic findings
Left lower lobe consolidation

A left lower lobe infiltrate usually silhouettes out the left hemidiaphragm on
frontal and/or lateral views.
A positive lateral spine sign (density to lower thoracic spine) is also usually evident.
Lingular consolidation

Infiltrates in the lingula silhouette out the upper left

heart border.
Right middle lobe consolidation

An infiltrate in the RML silhouettes out the right heart border.
On frontal view, RML consolidation has a straight upper border due to the minor fissure.
On lateral view, RML consolidation appears as a wedge shaped density overlying the heart, bordered superiorly by the minor fissure and
inferiorly by the major fissure.
Round pneumonia

 A pulmonary infiltrate due to pneumonia may infrequently present as a round mass- like density.
 The differential includes bronchioloalveolar cancer, therefore follow-up to complete resolution is
indicated.
Right upper lobe consolidation
The right upper lobe is densely
consolidated demonstrating air
bronchograms pathognomonic
of alveolar infiltration.
The straight inferior border is
the minor fissure.
Alveolar consolidation in lobar
distribution is usually due to
bacterial pneumonia.
Bibasalar pneumonia with lateral spine sign

Aspiration may cause pneumonia in the dependent basilar segments.

On lateral CXR, the normal spine should appear more lucent (darker) in the lower thorax.
On lateral CXR, a positive lateral spine sign is said to be present if the lower thoracic vertebrae appear whiter.
A positive lateral spine sign is frequently caused by basilar infiltrates.
Reference
Fauci, Braunwauld, Kasper, Hauser, Longo, Jameson,
Loscalso, 2008. Harrison’s Principles Of Internal
Medicine, 17th Edition. The McGraw-Hill Companies,
New York
Planner, Uthappa, Misra, 2007. A–Z of Chest
Radiology. Cambridge University Press, Cambridge
Gunderman, 2006. Essential Radiology. Thieme, New
York