PDF for practice questions for B pharmai

Practice

1. BACTERIAL PNEUMONIA IMAGING
DR. DEV LAKHERA

2. Imaging modalities used
Radiographic patterns
Specific causes and their findings
Complications of pneumonia
Bacterial pneumonia

3. Imaging modalities used
CHEST RADIOGRAPH
1.PRESENCE
2.LOCATION AND EXTENT
3.MONITOR RESPONSE TO THERAPY
4.DETECT COMPLICATIONS
COMPUTED TOMOGRAPH
1.SUBTLE ABNORMALITIES
2.TO RULE OUT ALTERNATIVE DISEASE PROCESS IN PATIENTS WITH PERSISTANT OR
RECCURENT PNEUMONIAS

4. RADIOGRAPHIC
PATTERNS OF
PNUEMONIAS
1.LOBAR PNEUMONIA
2.BRONCHOPNEUMONIA
3.SPHERICAL OR ROUND
PNEUMONIA
4.INTERSTITAL PNEUMONIA

5. Lobar pneumonia
Begins in the distal air spaces/ acini as
an inflammatory exudate

6. Characteristic
appearance
Homogenous non segmental
consolidation.
Lung volume is retained.
Exudate may be affected by
gravity

8. loss of
silhouette
sign

9. CT APPEARANCE

10. Round pneumonia
Rounded lesion with ill defined
margins
More common in children
Looks like a mass lesion

12. Bronchopneumonia
Affects the mucosal surface
of bronchi and bronchioles.
Peribronchiolarfocus of
infection.

13. Inhomogeneous patchy,
poorly defined opacities

14. CT appearance
Bilateral peribronchial
dense infiltrations

15. Centrilobular nodules
in a patient with
bronchopneumonia

16. Tree-in-bud sign
Tree-in-bud sign is an imaging finding that
implies impaction within bronchioles

17. Specific causes and their findings
Lobar type
Pneumococcus
Klebsiella
Legionella
Chlamydia
Moraxella
Nocardia
Actinomycetes

18. Streptococcus pneumonia
Responsible for most of the cases of community acquired pneumonia.
Associated small pleural effusion may be seen.
Cavitation and empyema is rare.

20. Pneumococcal pneumonia
involving the entire left
lung
radiographic manifestations
may vary

21. Associated
complication
Pleural effusion
Empyema and cavitation
are rare features

22. Klebsiella pneumoniae
0.5-5 % of all the cases of pneumonia
Higher prevalence in older patients with alcoholism and debilitated
hospitalized patients

23. Bulging fissure sign
Voluminous exudates causing lobar expansion

24. 75-year-old man with alcoholism and Klebsiellapneumonia

26. Legionella Pneumophila
Legionella contaminates water systems, such as air conditioners and
condensers.
Affects smokers and debilitated

27. Radiologically
Spreading consolidation
Small effusions
Slow resolution

28. Actinomyces sp
Ability to spread across fascial planes to contiguous tissues without
regard to normal anatomic barriers
Seen in immunocompromised people

29. On CT, parenchymal
actinomycosis is
characterized by airspace
consolidation.
Central areas of low
attenuation
Adjacent pleural thickening

30. BRONCHOPNEUMONIC APPEARANCE
Staphylococcus aureus
Pseudomonas aeruginosa
Hemophilusinfluenza
Anaerobic organisms
E.coli

31. STAPH AUREUS
Seen in patients in chronically ill patients in hospital setting.
Follows aspiration from upper respiratory tract.
Rarely hematogenous.

32. Features
Rapid spread
Volume loss
Pneumatoceles
Empyema and abscess formation

34. PSEUDOMONAS AEROGINOSA
confluent bronchopneumonia
that is often extensive and
frequently cavitates

35. Haemophilus Pneumoniae
Found in sputum in association with chronic lung diseases like
bronchitis and bronchiectasis
They have no characteristic radiographic
appearance(widespread and bronchopneumonic).

36. ANAEROBIC PNEUMONIAS
Associated with aspiration
Common organisms: Bacteroids, clostridium and peptostreptococcus.
STANDING POSITION SUPINEPOSTION
POSTEROBASALSEGMENTOF
LOWER LOBE
POSTERIORSEGMENT OF UPPER
LOBE

38. Anaerobic lung abscess in an alcoholic
patient with poor oro-dental hygiene

39. Complications of pneumonia
Lung abscess
Pneumatocele
Bronchiectasis
Empyema
Bronchopleural fistula
Pulmonary gangreane
Septic emboli

40. LUNG ABSCESS
Lung abscessis defined as a localized necrotic cavity containing pus
PRIMARY SECONDARY
•Seenafter pneumonia.
•-They most commonly arise from
aspiration , necrotizing pneumonia
or chronic pneumonia
•-More with staphylococcus ,
Klebsiella
•Bronchogenic carcinoma ,inhaled
foreign body
•Hematogeneous spread:bacterial
endocarditis
•Direct extension from adjacent
infection : mediastinum ,
subphrenic

42. On CT the wall of the
abscess is typically thick
and the luminal surface
irregular , enhance with
contrast

43. Pneumatoceles
thin-walled, gas-filled space that usually develops in association with
infection.
It presumably results from drainage of a focus of necrotic lung
parenchyma

44. Feeding vessel sign
Direct vessel leading up
to the opacity
Septic emboli
cardiac valves (endocarditis),
peripheral veins (thrombophlebitis)
venous catheter
Mutiplenodules with cavitation

45. Empyema
Streptococcus pyogenes and S. aureus.
Radiographically, early signs include obliteration of the
costophrenicangle
2-5% of pulmonary infections

47. Fungal Infections
Endemic human mycoses Opportunistic mycoses
1-Histoplasmosis
2-Coccidioidomycosis
3-Blastomycosis
1-Aspergillosis
2-Candidiasis
3-Cryptococcosis
4-Mucormycosis

48. Allergic Bronchopulmonary
Aspergillosis (ABPA)
a) Etiology
b) Clinical Picture
c) Radiographic Features

49. a) Etiology :
-ABPA represents a complex hypersensitivity reaction
(type 1) to Aspergillus occurring almost exclusively in
patients with asthma and occasionally cystic fibrosis

50. Radiographic Features :
Plain Radiography :
-Transient patchy areas of consolidation may be evident
representing eosinophilic pneumonia
-Eventuallybronchiectasis may be evident

51. Finger like projections from
hilum from bronchial
mucoid impaction
Glove finger sign

52. CT :
--Fleeting pulmonary alveolar opacities (common
manifestation)
--Central upper lobe saccular bronchiectasis (hallmark)
--Bronchial wall thickening (common)
--Cavitation , 10%

53. Gloved finger
appearance

54. INVASIVE
ASPERGIOLSIS
Halo sign
Air crescent
sign

55. HISTOPLASMOSIS
Cause –Inhalation of soil contaminated by bird excreta
Radiographic picture resembles tuberculosis

56. THANK YOU