Pneumonia Radiology

This pneumonia ppt is basically focused on radiological point od view.... but you can find almost everything here except treatment...

1. PNEUMONIA DR. BIJAY KUMAR YADAV MBBS, MD (Radiology Resident)

2. INTRODUCTION: Pneumonia  is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty in breathing Many organisms, including viruses and fungi , can cause pneumonia, but the most common causes are  bacteria , in particular species of Streptococcus and Mycoplasma.

3. What ever are the cause, x-rays appearance look very much same, because x-rays appearances are so non-specific No useful classification of pneumonia can be based on x-rays alone Radiologist can draw most useful distinction between primary and secondary pneumonia Major purpose of chest imaging: to establish whether or not pneumonia. Basic radiological feature: one or more areas of consolidation varying from a small ill-defined shadow to a large shadow involving the whole of one or more lobes

4. CLASSIFICATION ON THE BASIS OF : SITE AETIOLOGY MODE OF ACQUIRING PNEUMONIA Lobar pneumonia Bronchopneumonia Interstitial pneumonia Primary Pneumonia Secondary Pneumonia (Aspiration) Suppurative Pneumonia (Necrotizing) CAP Hospital acquired Ventilator associated Health care associated Pneumonia in immunu-compromised host

5. CLASSIFICATION: Radiological classification: Lobar Pneumonia Bronchopneumonia I nterstitial pneumonia

6. 1. LOBAR PNEUMONIA Referring to homogeneous consolidation of one or more lung lobes, often with associated pleural inflammation. Causes : Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis . Mycobacterium   tuberculosis Clinical Features: P roductive   cough Dyspnea/SOB Malaise/Fatigue F evers –sweating/chills/rigors Pleuritic chest pain Nausea, vomiting or diarrhea

7. RUL Consolidation RML Consolidation RLL Consolidation X-ray of Right Side Pneumonia

8. P neumococcal pneumonia, chest radiograph reveals a left lower lobe opacity with pleural effusion.

9. Klebsiella pneumonia - large cavity in right lower zone following cavitation of pneumonic consolidation.

10. Radiological signs: Early stage: Lung markings get more and thicker in the suffered lobe or segment, or no X-ray findings. Progressive stage: The radiograph shows consolidations localized to the affected lobe. Occasionally, the sign of Air bronchogram or a complication such as pleural effusion, abscess formation or emphysema can be found on the X-ray film. Last stage: The radiograph shows patchy opaque shadows localized to the affected lobe.

11. PATHOLOGY 4 Pathological Phases Of Lobar Pneumonia Congestion: This stage occurs within the first 24 hours of contracting pneumonia . Pulmonary capillaries dilated and serous fluid leaks out of capillaries into the alveoli. The patient develop fever with SOB and cough. Red Hepatization : 2-3 days after the congestion. That means the lung look like “ RED LIVER ”. The affected lobe is solid as the alveoli are full of RBCs , Neutrophils, desquamated epithelial cells and Fibrin instead of air, so there is no gaseous exchange in this lobe. The patient becomes breathless and hypoxic. The cough is associated with blood stained or rusty sputum.

12. Grey H epatization: 2-3 days after Red hepatization and is an avascular stage. The affected part look like “ GREY LIVER ”. The alveoli are full of Neutrophils and Dense fibrous strands. The patient cough up purulent sputum and remain breathless. Resolution: Begins after 8-10 days (without antibiotics). Monocytes clear the inflammatory debris and normal air filled lung architecture is restored. Improvement of patient's conditions is noticed.

13. PATHOPHYSIOLOGY Infection to the lung ( e.g bacteria , virus ) ▼ Inflammatory response initiated ▼ Alveolar edema + exudate formation ▼ Alveoli & respiratory bronchioles fill with serous exudate, blood cells, fibrin, bacteria ▼ Consolidation of lung tissues

14. 2. BRONCHOPNEUMONIA R efers to more patchy alveolar consolidation associated with bronchial & bronchiolar inflammation often affecting both lower lobes. Causes: Most common causes are : Haemophilus influenzae Staphylococcus aureus Clinical features: Fever - Cough - Mucus Shortness of breath Chest pain Tachypnea Sweating Headache Muscle aches

15. X-ray F eatures: Increase in the size & number of Lung markings. Small patchy alveolar consolidation distribute along lung markings. Lesions are frequently found in both lower lung fields. The hilar shadows may become larger. Affected position: lobule of lung

16. In R ight M iddle & L ower lung fields, on Admission & after Recuperation On Admission After Recovery

17. Staphylococcal pneumonia - with abscess formation

18. 3. INTERSTITIAL PNEUMONIA Causes: Bacteria, viruses or fungi Mycoplasma pneumoniae is the most common cause It is a heterogeneous group of diffuse parenchymal lung diseases characterized by specific clinical, radiologic and pathologic features. Involves the areas in between the alveoli . Clinical Features: Fever S OB Cough

19. X-ray Features: A lung  volume loss and a craniocaudal gradient of peripheral septal thickening, Bronchiectasis & Honeycombing Peribronchovascular Infiltrate

20. S.N Pathology Types Radiological Features 1. Usual interstitial pneumonia (UIP) Dominated by reticular and honeycomb findings; peripheral and bibasilar in distribution 2. Nonspecific interstitial pneumonia (NSIP) Dominated by reticular and ground-glass findings; honeycombing rare, though has been reported; peripheral and central distribution, often bibasilar more than upper lobe; characteristic subpleural sparing may be seen 3. Cryptogenic organizing pneumonia (COP) Migratory, consolidative and ground-glass infiltrates, often bilateral and peripheral with lower lobe predominance; atoll (reverse halo) sign supportive but not frequent; minimal fibrosis or long-term sequelae Types of Interstitial Pneumonia:

21. 4. Desquamative interstitial pneumonia (DIP) More centrally located and diffuse ground-glass infiltrates; occasional reticular findings centrally located without peripheral predominance 5. Respiratory bronchiolitis-interstitial lung disease (RB-ILD) Patchy bilateral centrilobular ground-glass infiltrates or fine nodules, with airway enlargement or thickening; minimal reticular or fibrotic findings 6. Acute interstitial pneumonia (AIP) Patchy ground-glass infiltrates and consolidation, absent of underlying fibrotic or chronic appearing interstitial process 7. Lymphoid interstitial pneumonia (LIP) Thin-walled cystic findings in the majority, with underlying patchy ground-glass or consolidative features with lower lobe predominance 8. Pleuroparenchymal fibroelastosis (PPFE) Upper-lobe-predominant bilateral pleural thickening, often associated with underlying parenchymal interstitial process and varying degrees of fibrosis (possibly UIP vs. NSIP-like)

22. Complications Of Pneumonia: Pleural effusion, Empyema & Pleurisy Lung abscess Bacteremia & Septic shock Respiratory Failure

23. Pneumonia due to covid-19 Covid-19 is a disease caused by the novel corona virus Early symptoms of covid-19 are: A fever, Dry cough & Shortness of breath If your COVID-19 infection starts to cause pneumonia , you may notice things like : Rapid heartbeat Shortness of breath or breathlessness Rapid breathing Dizziness Heavy   sweating

24. Chest CT scan from a 65-year-old man with COVID-19. Pneumonia caused by the new coronavirus can show up as distinctive hazy patches on the outer edges of the lungs, indicated by arrows . ( ground glass opacities) Chest CT Scan findings in Covid-19 Pneumonia Patient

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