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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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