DR.JIBAN PPT.pptx civil service hospital nepal

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1. PNEUMONIA “The captain of the men of death.”  “The old man's friend" — Sir William Osler DR. RAM JIBAN YADAV INTERNAL MEDICINE RESIDENT (FCPS ) CIVIL SERVICE HOSPITAL NEW BANESHWOR, NEPAL

2. PNEUMONITIS : broad term for inflammation of the lung . PNEUMONIA: used more specifically to indicate lung inflammation which is: Caused by an infectious agent . Leads to formation of an inflammatory exudate inside the alveoli. Leads to impaired gas exchange. This is referred to as hepatitation (pathology) or consolidation (clinical).

3. Health Care Associated Pneumonia (HCAP ) (NEW ) arises in patients who were hospitalized in the last 3 months or attended out-patient clinic/ED or HDU in the last month

4. ANATOMICAL CLASSIFICATION Bronchopneumonia affects the lungs in patches around bronchi (affects the bronchi in the lungs) Lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Interstitial pneumonia involves the areas in between the alveoli

5. INCREASE SUSCEPTIBILITY OF CAP RISK FACTORS FOR COMMUNITY ACQUIRED PNEUMINA

6. Chest X-ray RUL RML RLL LUL Lingula LLL RUL RML RLL LUL Lingula LLL

7. Chest X-ray – Pneumonia

8. Consolidation predominant pattern (alveolar/ lobar pneumonia) Believed to be formed by the spread of inflammation through pores of Kohn or canals of Lambert at the periphery of the lung. Thus, nonsegmental consolidation in the early stage of disease. Most bacterial pneumonias like Streptococcus and Klebsiella .

9. Streptococcus pneumoniae pneumonia showing alveolar pattern nonsegmental consolidation in the right middle lung field, which is demarcated by the fissure suggestive of upper lobe pneumonia

10. Klebsiella pneumonia Suspected when there is a  cavitatory pneumonia, a bulging fissure sign. Often there can be extensive lobar opacification with air bronchogram .

11. Mycoplasma pneumoniae pneumonia showing alveolar pattern Chest radiograph demonstrates ill-defined consolidation in the right lower lung field (arrow); B: Thin-section CT reveals a non-segmental consolidation with air bronchograms at the dorsal aspect of the right lower lobe.

12. Peribronchial nodules predominant pattern (bronchopneumonia) Predominance of peribronchial nodules including centrilobular nodules with or without peribronchial consolidations. Consolidations are probably formed by enlargement and coalescence of the peribronchial nodules . may follow a chronic clinical course. Bronchial wall thickening is often associated. Hemophilus influenzae , Mycoplasma pneumoniae,Staphylococccus aureus , Chlamydophila pneumoniae , and viruses, MTB, NTM

13. Staph aureus pneumonia Chest radiograph shows extensive consolidations and peribronchovascular consolidations of the right lung (arrows); B: Thin-section CT reveals extensive consolidation with air bronchograms and cavities in the left upper lobe (black arrows). Note that the bronchi in the consolidation are dilated. Dense centrilobular nodules are seen in the left lower lobe (white arrows).

14. Mycoplasma pneumoniae CXR shows reticulonodular opacities and focal consolidation in the left middle to lower lung field (arrow). The left pulmonary hilum appears enlarged; B: Thin-section CTdemonstrates fluffy centrilobular nodules with surrounding ground-glass opacity in the left lower lobe (arrows). Note that central bronchial wall is thickened (arrow heads).

15. Chlamydophila pneumoniae pneumonia showing infectious bronchiolitis Chest radiograph shows faint reticulonodular opacities in both lower lung fields (arrows); B: Thin-section computed tomography reveals centrilobular nodules (arrows) with bronchiectasis (arrow heads) in the middle lobe and lingula

16. Ground-glass opacity predominant pattern GGO may correspond to Incomplete alveolar filling by inflammatory cells or exudate , Pulmonary edema secondary to infection leaving air in the alveoli, Interstitial infiltrates of inflammatory cells (interstitial pneumonia). Viruses, Mycoplasma pneumoniae and Pneumocystis jirovecii are the representative pathogens

17. Mycoplasma pneumoniae pneumonia showing groundglass opacity predominant pneumonia Chest radiograph shows patchy ground-glass opacity (GGO) with peribronchial nodules in the right middle lung field (arrow); B: Thin-section computed tomography reveals areas of GGO in the right upper lobe. Note that the GGO are partly demarcated by interlobular septa (arrows).

18. Pneumocystis jirovecii pneumonia Chest radiograph shows bilateral reticulonodular opacities; B: Chest computed tomography with a 5 mm slice thickness demonstrates bilateral ground-glass opacity with reticulations.

19. Random nodules predominant Probably produced by hematogenous spread of the disease or granulomatous infection. Viral pneumonia ( varicella -zoster ) , Miliary tuberculosis, Granulomatous infection, such as tuberculosis , nontuberculous mycobacterial infection or fungal infection

20. Random nodules predominant pneumonia ( varicella -zoster pneumonia) Thin-section computed tomography demonstrates scattered small solid or ground-glass opacity nodules which are unrelated to centrilobular structures (arrows).

21. Miliary tuberculosis Chest radiograph Diffuse reticulonodular opacities in both lungs; B: Thin-section CT demonstrates diffuse military nodules with a random distribution.

22. Pathogen Specific imaging appearances Streptococcus pneumoniae Alveolar/lobar pneumonia Mycoplasma pneumoniae Bronchopneumonia with bronchial wall thickening affecting central bronchi Chlamydophila pneumoniae Infectious bronchiolitis with bronchial dilatation Legionella pneumophila Sharply marinated peribronchial consolidations within ground-glass opacities varicella -zoster Scattered nodules with a random distribution Staph aureus Patchy unilateral or bilateral consolidation,rapid progression,centrilobular nodules,pneumatocele in children. Cryptococcus neoformans Multiple nodules/masses with or without cavities in the same pulmonary lobe Pneumocystis jirovecii Bilateral patchy ground-glass opacities with a geographic distribution

23. REFERENCE- NEJM REVIEW ARTICLE FEBRUARY 2023

24. ***intensive respiratory or vasopressor support

25. Always take proper detailed history of a patient.