CHEST

1 Localized Alveolar Pattern

Eisenberg an Aid to Differential Diagnosis

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig C 1-1 Staphylococcal pneumonia. (A) Ill-defined bronchopneumonia at the right base. (B) In another patient, there is consolidation in the left upper lobe and entire right lung with a moderate right pneumothorax. The extensive consolidation presents further collapse of the right lung. The pneumothorax was due to the rupture of a pneumatocele, although no pneumatocele can be identified.

• Fig C 1-2 Pneumococcal pneumonia. Homogeneous consolidation of the right upper lobe and the medial and posterior segments of the right lower lobe. Note the associated air bronchograms (arrows).

• Fig C 1-3 “Spherical” pneumonia. Frontal view of the chest shows a rounded soft-tissue density in the posterolateral aspects of both lower lobes (arrows) with mild bilateral hilar prominence.1

• Fig C 1-4 Klebsiella pneumonia. (A) Air-space consolidation involving much of the right upper lobe. (B) Progression of the necrotizing infection produces a large abscess cavity with an air-fluid level (arrows).

• Fig C 1-5 Enteric gram-negative bacteria. (A) Proteus. (B) Pseudomonas.2

• Fig C 1-6 Haemophilus influenzae pneumonia. In addition to the ill-defined right lower lung consolidation, note the extensive pleural thickening or fibrinous exudate (arrows) that appears out of proportion to the associated parenchymal infiltrate.3

• Fig C 1-7 Haemophilus pertussis. Bilateral central parenchymal infiltrates and linear areas of atelectasis obscure the normally sharp cardiac border to produce the shaggy heart contour.

• Fig C 1-8 Legionnaires' disease. There is extensive consolidation of much of the right lung, with a smaller area of infiltrate (arrows) at the left base.

• Fig C 1-9 Bacteroides pneumonia. Patchy areas of consolidation primarily involve the middle and lower portions of the right lung.

• Fig C 1-10 Histoplasmosis. (A) Initial film demonstrates an ill-defined area of parenchymal consolidation in the right upper lobe. (B) One week later, there is a marked extension of the infiltrate, which now involves most of the upper half of the right lung.

• Fig C 1-11 Blastomycosis. (A) Patchy areas of air-space consolidation in the right upper lung associated with several nodules in the left upper lung. (B) In another patient, there is development of a right upper lobe cavity with thick walls and a faintly visible air-fluid level (arrow). There is an associated soft-tissue mass along the lateral wall of the cavity.4

• Fig C 1-12 Coccidioidomycosis pneumonia. Ill-defined area of patchy infiltrate in the left lower lung.

• Fig C 1-13 Cryptococcosis. (A) Initial film demonstrates an air-space consolidation in the right upper lung. (B) With progression of the infection, the right upper lung pneumonia has cavitated, and a left lower lobe air-space consolidation has developed.

• Fig C 1-14 Actinomycosis. Bilateral, non segmental air-space consolidation.

• Fig C 1-15 Nocardiosis. (A) Initial chest radiograph demonstrates an area of nonspecific alveolar infiltrate in the right lower lobe. (B) Without appropriate therapy, infection spreads to involve both lungs diffusely with a patchy infiltrate and multiple small cavities.

• Fig C 1-16 Mycoplasma pneumonia. Initial acute interstitial inflammation produces a diffuse fine reticular pattern.

• Fig C 1-17 Viral pneumonia. Diffuse peribronchial infiltrate with associated air-space consolidation obscures the heart border (shaggy heart sign). A patchy alveolar infiltrate is present in the right upper lung.

• Fig C 1-18 Q fever. Right upper lobe air-space consolidation simulating pneumococcal pneumonia.

• Fig C 1-19 Pneumocystis carinii pneumonia. Severe, bilateral air-space consolidation with air bronchograms. The patient was undergoing immunosuppressive therapy for lymphoma and died shortly after this radiograph was made.

• Fig C 1-20 Primary tuberculosis. Consolidation of the right upper lobe.

• Fig C 1-21 Post obstructive pneumonitis. Homogeneous increased density involving the right upper lobe secondary to carcinoma of the lung. Patchy increased opacification at the right base is due to a combination of atelectasis and infiltrate secondary to extension of the tumor into neighboring bronchi.

• Fig C 1-22 Pulmonary infarction. (A) Chest film made 3 days after open-heart surgery demonstrates a very irregular opacity at the right base (pneumonia versus pulmonary embolization with infarction). (B) On a film made 5 days later, the consolidation is seen to have reduced in size yet to have retained the same general configuration as on the initial view. The diagnosis of pulmonary embolism was confirmed by a radionuclide lung scan.5

• Fig C 1-23 Pulmonary hemorrhage. Consolidation of the middle lobe in a patient with AIDS-related Kaposi's sarcoma.6

• Fig C 1-24 Lipoid pneumonia. (A) Frontal and (B) lateral views demonstrate an air-space consolidation in the posterior segment of the right upper lobe (arrows). Note the prominence of interstitial reticular markings leading from the right hilum to the infiltrate.

• Fig C 1-25 Pulmonary edema in pulmonary emphysema. (A) Initial chest radiograph demonstrates a paucity of vascular markings in the right middle and upper zones along with increased interstitial markings elsewhere. (B) With the onset of congestive heart failure, there is patchy interstitial and alveolar edema that does not affect the segments in which the vascularity had been severely diminished.

• Fig C 1-26 Alveolar cell carcinoma. Patchy, ill-defined right-sided mass simulates an area of focal pneumonia.

• Fig C 1-27 Radiation pneumonitis. After post mastectomy radiation, a mass of fibrous tissue (arrows) extends from the right hilum to parallel the right border of the mediastinum.