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    Radiology ofBacterial Pneumonia

    Journal Reading

    Vilar J., Domingo M., et al. European Journal of Radiology. 2004. 51:10213

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    Bacterial PneumoniaClassic morphologic classification Lobar pneumonia

    Bronchopneumonia

    Acute interstitial pneumonia

    The mechanism of origin Community Acquired Pneumonia (CAP)

    Aspiration Pneumonia Nosocomial Pneumonia (NP) / Hospital Aquired

    Pneumonia (HAP)

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    Imaging Pneumonia

    Detection Characterization

    Follow-up

    Modality

    CXR basic & diffused imaging tool

    CT Recommended where CXR is uncertain in

    complication / underlying lesion

    MRI alternative

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    CXR CT-scan

    a) Paratracheal opacity in right

    upper lobeb) Same patient opacity

    due an air-space

    consolidation Clearly

    a

    b

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    Lobar Pneumonia

    Airspace Consolidation in one segment/lobeStreptococcal Pneumonia

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    Bronchopneumonia

    Patchy Confluent areasmultilobar/bilateralPneumococcal Pneumonia

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    Acute Interstitial Pneumonia

    Diffuse bilateral reticulo-nodular patternMycoplasma pneumonia, Chlamydia pneumonia

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    48 h later

    Unusual Pattern of CAP

    Multilobar Pneumonia Segmentalperipheral

    consolidations

    Spread rapidly

    one / more

    lobes

    Underlying

    disease

    Confused with

    other aetiology

    Legionella

    pneumonia

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    Bilateral / Multilobar Pneumonia

    a b

    c

    (a)Bulous Emphysema

    (b)Same patient pneumonia in

    left upper lobe + air-fluid level

    (c)Fluid filled the Bulla

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    Unusual Pattern of CAP

    Round Pneumonia

    Consolidation, round shape

    Pulmonary nodul infection history susp. Round Pneumonia

    Sterptococcus pneumoniae

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    ommunity Acquired Pneumonia (CAP)

    Aspiration Pneumonia

    Inhalation of orofaringeal / gastric contents into thelarynx & lower respiratory tract

    Aspiration pneumonitis Drug Abuse, seizures, massive cerebrovascular accident, use of

    anesthesia

    Aspiration pneumonia

    Neurologic dysphagia, anatomic abnormalities of upper

    aerodigestive tract, GERD, poor oral care

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    Bilateral Lower lobe consolidations

    Particulary in the right lung with perihiler and basal distribution

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    spiration Pneumonia

    Nosocomial Pneumonia (NP)

    Hospital acquired pneumonia (HAP) 48 h hospital admission

    48 h after discharge from hospital

    Risk Factor Condition of the patient, age, severity of underlying

    disease, how long, instrumentation invasive techniques

    Aerobic gram-negative bacilli / gram-positive cocci

    Enterobacter, E. coli, pseudomonas, S. aureus, S.pneumoniae

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    Most commonly bilateral with diffuse / multiple foci of consolidation

    Pleural Efussion

    Pseudomonas Aeruginosa

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    Intesive Care Unit (ICU)

    Frequent

    High Mortality

    Ventilator

    Ventilator Associated Pneumonia (VAP)

    First 5 Days S. pneumonia, H. Influenzae, Moxarella

    catarrhalis, anaerob (uncommonly)

    After 5 Days P. aeruginosa, acinetobacter, Enterobacter spp.

    Non-Ventilated Associated Pneumonia (NVAP)

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    Right perihiler consolidation

    Acinetobacter after 5 days of mechanical ventilation

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    omplicationMore common

    immunodepressant patient & NP

    Common Agent S. aureus, anaerobic & gram-negative

    Common occurs

    Pulmonary Gangrene

    Pneumatocele

    Pleural Effusion & empyema

    Lobar Enlargement

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    Sloughed lung tissue

    due to extensive

    necrosis in a large cavity

    with an air-fluid level

    Klebsiella pneumonia

    Pulmonary Gangrene

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    Pleural Effusion & Empyema

    Less frequent

    Ussualy reactive

    Resolve with antibiotic therapy

    5-10% case progress to empyema

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    Opacity in the left upper lobe

    Posterior Displacement of major fissure

    Swelling of lobe extensive exudative process

    Klebsiella pneumonia

    Lobar Enlargement

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