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Pneumonia Manifestation Seen And Diagnosed Via X-Rays: Different Radiographs To Show Lung Tissue Consolidation

Updated on February 6, 2014

Guided Diagnosis With X-Rays

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Introduction

Pneumonia is defined as an inflammation of the substance of the lungs and is usually caused by bacteria. Pneumonia can be classified both anatomically, eg. lobar (affecting the whole of one lobe) and bronchopneumonia (affecting the lobules and bronchi), or on the basis of aetiology. Mycobacterium tuberculosis is a cause of pneumonia and is considered separately as both mode of presentation and treatment are different from the other pneumonias. In about 25% of patients, no organism is isolated, Pneumonia may also result from chemical causes (e.g. aspiration of vomit and radiotherapy.

Pneumonia In Chest X-Ray

Pneumonia is an inflammatory condition of the lung—affecting primarily the microscopic air sacs known as alveoli
Pneumonia is an inflammatory condition of the lung—affecting primarily the microscopic air sacs known as alveoli | Source
 It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases.
It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases. | Source
Typical symptoms include a cough, chest pain, fever, and difficulty breathing. Diagnostic tools include x-rays and culture of the sputum. Vaccines to prevent certain types of pneumonia are available.
Typical symptoms include a cough, chest pain, fever, and difficulty breathing. Diagnostic tools include x-rays and culture of the sputum. Vaccines to prevent certain types of pneumonia are available. | Source
Treatment depends on the underlying cause. Pneumonia presumed to be bacterial is treated with antibiotics. If the pneumonia is severe, the affected person is, in general, admitted to hospital.
Treatment depends on the underlying cause. Pneumonia presumed to be bacterial is treated with antibiotics. If the pneumonia is severe, the affected person is, in general, admitted to hospital. | Source
Pneumonia affects approximately 450 million people globally per year, seven percent of population, and results in about 4 million deaths, mostly in third-world countries.
Pneumonia affects approximately 450 million people globally per year, seven percent of population, and results in about 4 million deaths, mostly in third-world countries. | Source
Although pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death", the advent of antibiotic therapy and vaccines in the 20th century has seen improvements in survival.
Although pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death", the advent of antibiotic therapy and vaccines in the 20th century has seen improvements in survival. | Source
Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death
Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death | Source
People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased respiratory rate
People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased respiratory rate | Source
In the elderly, confusion may be the most prominent sign. The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing
In the elderly, confusion may be the most prominent sign. The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing | Source
Fever is not very specific, as it occurs in many other common illnesses, and may be absent in those with severe disease or malnutrition.
Fever is not very specific, as it occurs in many other common illnesses, and may be absent in those with severe disease or malnutrition. | Source
In addition, a cough is frequently absent in children less than 2 months old. More severe signs and symptoms may include: blue-tinged skin, decreased thirst, convulsions, persistent vomiting, extremes of temperature, or a decreased level of conscious
In addition, a cough is frequently absent in children less than 2 months old. More severe signs and symptoms may include: blue-tinged skin, decreased thirst, convulsions, persistent vomiting, extremes of temperature, or a decreased level of conscious | Source
Bacterial and viral cases of pneumonia usually present with similar symptoms. Some causes are associated with classic, but non-specific, clinical characteristics.
Bacterial and viral cases of pneumonia usually present with similar symptoms. Some causes are associated with classic, but non-specific, clinical characteristics. | Source
Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or confusion, while pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum,
Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or confusion, while pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum, | Source
and pneumonia caused by Klebsiella may have bloody sputum often described as "currant jelly". Bloody sputum (known as hemoptysis) may also occur with tuberculosis,
and pneumonia caused by Klebsiella may have bloody sputum often described as "currant jelly". Bloody sputum (known as hemoptysis) may also occur with tuberculosis, | Source
Gram-negative pneumonia, and lung abscesses as well as more commonly with acute bronchitis. Mycoplasma pneumonia may occur in association with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection
Gram-negative pneumonia, and lung abscesses as well as more commonly with acute bronchitis. Mycoplasma pneumonia may occur in association with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection | Source
Viral pneumonia presents more commonly with wheezing than does bacterial pneumonia
Viral pneumonia presents more commonly with wheezing than does bacterial pneumonia | Source
A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain
A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain | Source
If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended
If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended | Source
Findings do not always match the severity of disease and do not reliably separate between bacterial infection and viral infection
Findings do not always match the severity of disease and do not reliably separate between bacterial infection and viral infection | Source
X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia (also known as lobular pneumonia), and interstitial pneumonia
X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia (also known as lobular pneumonia), and interstitial pneumonia | Source
Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia.
Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia. | Source
However, findings may vary, and other patterns are common in other types of pneumonia.[20] Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side.
However, findings may vary, and other patterns are common in other types of pneumonia.[20] Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side. | Source
Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation.
Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. | Source
Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to be interpreted in the obese or those with a history of lung disease.
Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to be interpreted in the obese or those with a history of lung disease. | Source
Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin
Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin | Source
 The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness
The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness | Source
A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old
A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old | Source
In children, increased respiratory rate and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope
In children, increased respiratory rate and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope | Source
In general, in adults, investigations are not needed in mild cases: There is a very low risk of pneumonia if all vital signs and auscultation are normal.
In general, in adults, investigations are not needed in mild cases: There is a very low risk of pneumonia if all vital signs and auscultation are normal. | Source
In persons requiring hospitalization, pulse oximetry, chest radiography and blood tests—including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests—are recommended
In persons requiring hospitalization, pulse oximetry, chest radiography and blood tests—including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests—are recommended | Source

References

1. All X-ray photos here are from DFM E-Group, in the photo and X-ray section.

2. Notes and explanations: Wikipedia, Essentials of Clinical Medicine by Kumar and Clark's, Medicinenet and Mayor's Clinic.

© 2014 Funom Theophilus Makama

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