PNEUMONIA. respiratory disease presentation

Radiology

1. PNEUMONIA
DR.DESHVIKASH SWAIN
RADIOLOGY
SEU [40141]

2. •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. •Whatever 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

5. CLASSIFICATION:



Radiological classification:

1. Lobar Pneumonia

2. Bronchopneumonia

3. Interstitial pneumonia

8. Pneumococcal 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:
1.Early stage: Lung markings get more and thicker in the suffered lobe
or segment, or no X-ray findings.

2.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.

3.Last stage: The radiograph shows patchy opaque shadows localized
to the affected lobe.

11. PATHOLOGY
4 Pathological Phases Of Lobar Pneumonia
1) 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.

2) 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.

3) Grey Hepatization: 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.

4) 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
Refers to more patchy alveolar consolidation associated with bronchial &
bronchiolar inflammation often affecting both lower lobes.

Causes:
Most common causes are:
i. Haemophilus influenzae
ii. Staphylococcus aureus

Clinical features:
i. Fever -
ii. Cough - Mucus
iii. Shortness of breath iv. Chest pain
v. Tachypnea
vi. Sweating
vii. Headache viii.Muscle aches

15. X-ray Features:
1. Increase in the size & number of Lung
markings.

2. Small patchy alveolar consolidation
distribute along lung markings.

3. Lesions are frequently found in both
lower lung fields.

4. The hilar shadows may become larger.

5. Affected position: lobule of lung

16. In Right Middle & Lower lung fields, on Admission & after
Recuperation

17. 3. INTERSTITIAL PNEUMONIA

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.

Causes
i. Bacteria, viruses or fungi
ii. Mycoplasma pneumoniae is the most
common cause

Clinical Features:
i. Fever
ii. SOB
iii. Cough

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

•Peribronchovascular Infiltrate

19. Types of Interstitial Pneumonia:

21. Complications Of Pneumonia:
i. Pleural effusion, Empyema & Pleurisy
ii. Lung abscess
iii. Bacteremia & Septic shock
iv. Respiratory Failure

22. 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

23. Chest CT Scan findings in Covid-19 Pneumonia Patient

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)