Management Of Bacterial Pneumonia
The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. First-line antimicrobials for S pneumoniae, the most prevalent cause of bacterial pneumonia, are, for the penicillin-susceptible form of the bacterium, penicillin G and amoxicillin. For the penicillin-resistant form of S pneumoniae, first-line agents are chosen on the basis of sensitivity.
Supportive measures include the following:
Analgesia and antipyretics
Intravenous fluids , if indicated
Pulse oximetry with or without cardiac monitoring, as indicated
Positioning of the patient to minimize aspiration risk
Respiratory therapy, including treatment with bronchodilators and N-acetylcysteine
Suctioning and bronchial hygiene
Ventilation with low tidal volumes in patients requiring mechanical ventilation secondary to bilateral pneumonia or acute respiratory distress syndrome
Systemic support: May include proper hydration, nutrition, and mobilization
Characteristics Of Cavities Used For Differential Diagnosis
While wall thickness alone has at best questionable utility in discriminating between malignant and nonmalignant etiologies of a pulmonary cavity, other radiographic characteristics may provide additional clues to the nature of the underlying disease. The presence of a cavity on computed tomography of the lung essentially ruled out a viral infection in a small study of immunocompromised patients with lung infection, but the etiologies of cavities among these patients were about equally divided among bacterial, mycobacterial, and fungal infections . Another study of 131 adults in South Korea with cavities on plain radiography examined radiographic factors associated with specific disease etiologies . In that study, in which 50% of subjects had active or prior mycobacterial lung disease , the presence of the largest cavity in the upper lobes suggested a mycobacterial etiology, while lesions confined to only one lobe and the presence of multiple enlarged mediastinal lymph nodes were associated with another etiology . Nonradiographic factors such as age of > 50 years and a history of malignancy were also associated with nonmycobacterial etiology. Of note, cavity wall thickness did not differ between subjects with mycobacterial cavities and those with nonmycobacterial cavities in that study.
Enhancing Healthcare Team Outcomes
Pneumonia is a common infectious lung disease. It requires interprofessional care and the involvement of more than one subspecialty. This patient-centered approach involving a physician with a team of other health professionals, physiotherapists, respiratory therapists, nurses, pharmacists, and support groups working together for the patient plays an important role in improving the quality of care in pneumonia patients. It not only decreases the hospital admission rates but also positively affect the disease outcome. For healthy patients, the outcomes after treatment are excellent but in the elderly and those with comorbidities, the outcomes are guarded.
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Which Abnormalities Cause Increased Lung Opacity On Ct
Lung mass: Single axial CT scan of the chest in lung windows shows a mass in the medial left upper lobe extending towards the left hilum. Cavitary lung mass: Two weeks later in the same patient, the same mass is seen, although now there is frank cavitation. The differential for cavitating lung mass is wide, including neoplasms such as non-small. t PA Subtle retrocardiac opacity may be present in the left lung base lateral aspect with partial obscuration of the left hemidiaphragmatic outline. Increased streaky densities are suggested in the upper to mid lung zones as well. The cardiac silhouette is mildly prominent. Impression: 1) Increased focal mass in right perihilar-infrahilar region Pneumonia involving the right middle lobe If the fissure is displaced upwards, this may be because of volume loss of the right upper lobe, for example due to collapse, or fibrosis. If the horizontal fissure is displaced downwards, there may be a process which has caused volume loss of the right lower lobe. Left lower lobe lung cavity. CT halo sign. Enhanced CT of the chest in a patient with angioinvasive aspergillosis depicts a left upper lobe lesion with a thin ground glass halo , presumably relating to hemorrhage. Source Signs in Thoracic Imaging Journal of Thoracic Imaging 21:76-90, March 2006
Opacities In The Lung
Solitary, Circumscribed Opacity of the Lung
Singular, Circumscribed Opacity of the Lung
Is the radiographic appearance of the lesion homogeneous or inhomogeneous?
Is the margin to the surrounding parenchyma sharp or unsharp?
Is its contour smooth or irregular, straight or lobulated?
Are any interfaces to adjacent structures obscured?
Does the lesion displace its neighboring tissues or cause loss of volume with resulting shift of adjacent structures toward the lesion?
All of a suddena spot in the lung
Sidel Zastro has come into the hospital to get his inguinal hernia repaired. Since he has not really felt well for the past months and since he has got some mileage on him, a preoperative chest radiograph is performed. With a patient of this age, Paul anticipates seeing some traces of a life gone bylong, exhaustive work, war, malnutrition, diseases, smoking, surgery, and vice of any kind may leave their traces in the thorax of an individual. He expects apical and possibly basal pleural adhesions, irregular vascular markings such as in old age emphysema, and possibly some scarring due to past pneumonias . Mr. Zastro did not, of course, bring previous filmswhy on earth should he have bothered? He last saw the inside of a hospital 30 years ago. Paul and Joey study the CXR together, following the analysis scheme outlined above .
I A Chest Radiograph Appropriate for Age
I The Case of Sidel Zastro
I The Case of Sidel Zastro
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Causes Of Upper Lobe Pneumonia
Note upper-lobe-predominant pleural thickening with significant volume loss of the left lung and compensating hyperinflation of the right lung . Underlying interstitial pneumonia pattern appeared consistent with possible UIP characterized by bibasilar reticular and mild honeycomb changes â¢ Streptococcus pneumoniae, â¢ Klebsiella pneumoniae, â¢ Haemophilus influenzae, can cause pneumonia. The viruses that cause colds and flu can cause pneumonia. Fungi : Pneumonia caused by fungi is the least common as pneumonia. Fungus in the soil in certain parts of the United. This sign is caused by the hyperexpanded superior segment of the left lower lobe interposed between the aortic arch and the atelectatic left upper lobe. The direct diagnosis of atelectasis is easier with CT than with radiography, especially when atelectasis involves the middle lobe or lingula or the atelectatic area is small
Which Lobe Is Affected In Pneumonia
Depending on which lung lobe is affected, the pneumonia is referred to as upper, middle or lower lobe pneumonia. If there are several multi-lobe focal inflammations in the lungs, the term focal pneumonia is used. Some people use the term bronchopneumonia if the focal inflammations started in inflamed airways .
Subsequently, one may also ask, which lobe is mostly affected by pneumonia?
Most cases of pneumonia are caused by bacteria, usually Streptococcus pneumonia but viral pneumonia is more common in children. The lungs are made up of separate lobes three in the right lung and two in the left lung. Pneumonia may affect only one lobe or be widespread in the lungs.
Beside above, what is lower lobe pneumonia? This figure also shows pneumonia affecting the lower lobe of the left lung. Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung.
Similarly one may ask, what causes upper lobe pneumonia?
The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. It may affect one part of the lung, a condition called lobar pneumonia. Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia.
Who is at risk for pneumonia?
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Firstthe Signs Of The Disease
Pneumonia is a very serious disease, which is why when the first symptoms should immediately consult a doctor. What are the first signs?
First, there is a dry and bad cough without sputum discharge, fever to 39 degrees, and the condition of fever does not go more than three days. Weakness throughout the body, not allowing you to perform common actions. There is also the constant feeling of lack of sleep, possible loss of appetite.
Doctors say if the fever continues more than three days, it is the first symptom of a bacterial infection. In this case, the doctor may prescribe drugs with antibacterial action, but only under the condition of high body temperature. If the temperature is less than 38 degrees, then run her down is not necessary. The body tries to fight infection on its own.
What Are The Complications Of Pneumonia
Most people with pneumonia respond well to treatment, but pneumonia can be very serious and even deadly.
You are more likely to have complications if you are an older adult, a very young child, have a weakened immune system, or have a serious medical problem like diabetes or cirrhosis. Complications may include:
Acute respiratory distress syndrome . This is a severe form of respiratory failure.
Lung abscesses. These are pockets of pus that form inside or around the lung. They may need to be drained with surgery
Respiratory failure. This requires the use of a breathing machine or ventilator.
This is when the infection gets into the blood. It may lead to organ failure.
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How Is It Different From A Pleural Effusion
A pleural effusion is a collection of fluid in the space between your chest wall and lungs. Like lung consolidation, it looks like white areas against the darker air-filled lungs on your chest X-ray. Since an effusion is a fluid in a relatively open space, it will usually move due to gravity when you change your position.
A lung consolidation may also be fluid, but its inside your lung, so it cant move when you change positions. This is one way your doctor can tell the difference between the two.
Some of the causes of pleural effusions, such as congestive heart failure, pneumonia, and lung cancer, also cause lung consolidation. So, its possible for you to have both at the same time.
How Are Lung Nodules Diagnosed
Most people find out they have a lung nodule after getting an imaging test in preparation for a procedure or another purpose. The findings are often a surprise.
If an imaging test shows a lung nodule, your healthcare provider may recommend active surveillance. In six to 12 months, you get another CT scan. Nodules that stay the same size during a two-year surveillance period are not likely to be cancer. You may be able to stop getting CT scans.
Your provider may order further tests if the nodule is large or it grows. These tests include:
- Bronchoscopy: While youre sedated, your provider threads a thin tube down your throat into the lung. A tiny surgical instrument on the end of the scope snips and retrieves a tissue sample from the nodule. A lab analyzes this biopsy sample for abnormal cells.
- CT scan-guided biopsy: For nodules on the outer part of the lung, your provider uses CT images to guide a thin needle through the skin and into the lung. This needle biopsy takes tissue samples from the nodule to examine for abnormal cells.
- Positron emission tomography scan: A PET scan uses a safe, injectable radioactive chemical and an imaging device to detect diseased cells in organs.
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What Are The Symptoms Of Pneumonia
The symptoms of bacterial pneumonia include:
Bluish color to lips and fingernails
Confused mental state or delirium, especially in older people
Cough that produces green, yellow, or bloody mucus
Mycoplasma pneumonia has somewhat different symptoms, which include a severe cough that may produce mucus.
Chest Imaging To Detect Cavities
Plain chest radiography and computed tomography are the radiographic modalities most often used to image the chest. Ultrasound is a suboptimal modality for imaging the lung parenchyma because of poor sound transmission through the mostly air-filled lungs . Magnetic resonance imaging of the lung has been limited by motion artifact and relatively low spatial resolution , so this modality is not generally used to examine the lungs. Computed tomography is clearly more sensitive than plain chest radiography for the detection of pulmonary pathology, particularly in immunocompromised hosts. For example, one study of 61 patients at a single institution who had undergone bone marrow transplants for malignancies demonstrated that plain chest radiography was 58% sensitive in detecting pulmonary infection, compared to a sensitivity of 89% for computed tomography , with similar specificities for both modalities . Another study of 188 high-resolution computed tomography scans performed on 112 patients with febrile neutropenia and normal chest radiographs reported that 60% of the scans had findings suggestive of pneumonia. However, these abnormal scan findings were not specific, as 46% of these 112 scans did not meet criteria for the diagnosis of pneumonia upon follow-up .
Miscellaneous Diseases Associated With Cavities
A less common disorder associated with lung cavities is bronchiolitis obliterans organizing pneumonia, also called cryptogenic organizing pneumonia when there is no underlying etiology. This disorder, which is a pathological diagnosis, may be triggered by drug or toxin exposure, autoimmune diseases, viral infections, or radiation injury but is most often idiopathic . Patients with bronchiolitis obliterans organizing pneumonia usually present with fever, cough, weight loss, and dyspnea over weeks to months, similar to many infectious diseases associated with lung cavities . The most common computed tomography appearance of this disorder is patchy consolidation, often accompanied by ground-glass opacities and nodules . Cavitation has been reported in 0 to 6% of cases, varying with the series and the imaging modality . Unfortunately, none of the clinical or radiographic manifestations of this disorder are specific, and diagnosis must be made by lung biopsy .
How Is Pneumonia Diagnosed And Evaluated
Your primary doctor will begin by asking you about your medical history and symptoms. You will also undergo a physical exam, so that your doctor can listen to your lungs. In checking for pneumonia, your doctor will listen for abnormal sounds like crackling, rumbling or wheezing. If your doctor thinks you may have pneumonia, an imaging test may be performed to confirm the diagnosis.
One or more of the following tests may be ordered to evaluate for pneumonia:
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Diagnosis Of Infectious Causes
In the initial evaluation of a cavitary lung lesion, it is important to first determine if the cause is an infectious process. The infectious etiologies to consider include lung abscess and necrotizing pneumonia, tuberculosis, and septic emboli. Important components in the clinical presentation include presence of cough, fever, night sweats, chills, and symptoms that have lasted less than one month, as well as comorbid conditions, drug or alcohol abuse, and history of immunocompromise .
Given the public health considerations and impact of treatment, tuberculosis will be discussed in its own category.
Tuberculosis. Given the fact that TB patients require airborne isolation, the disease must be considered early in the evaluation of a cavitary lung lesion. Patients with TB often present with more chronic symptoms, such as fevers, night sweats, weight loss, and hemoptysis. Immunocompromised state, travel to endemic regions, and incarceration increase the likelihood of TB. Nontuberculous mycobacterium should also be considered in endemic areas.
Can Pneumonia Be Prevented
Check with your healthcare provider about getting immunizations. The flu is a common cause of pneumonia. Because of that, getting a flu shot every year can help prevent both the flu and pneumonia.
There is also a pneumococcal vaccine. It will protect you from a common form of bacterial pneumonia. Children younger than age 5 and adults ages 65 and older should get this shot.
The pneumococcal shot is also recommended for all children and adults who are at increased risk of pneumococcal disease due to other health conditions.
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What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What is the best plan of action for me?
- Do I need a biopsy?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Lung nodules are fairly common and usually arent cause for concern. Still, it can be alarming to learn that you have a spot on your lung. Fortunately, the majority of lung nodules arent a sign of lung cancer. A noncancerous condition causes the abnormal growth. Most benign lung nodules dont need treatment. If a nodule is cancerous, your healthcare provider can discuss next steps.
Last reviewed by a Cleveland Clinic medical professional on 05/28/2021.
Shortness Of Breath In Search Of A Cause
Jonathan Bootleg has developed shortness of breath while on dialysis for his terminal renal insufficiency. The internist in charge has requested a CXR . Hannah is alone this late morning in the chest unit and takes a close look at the film. She considers the list of differential diagnoses.
I The Case of Jonathan Bootleg
- Fig. 6.28 Analyze the CXR of Mr. Bootleg. Does anything appear abnormal?
What Is Your Diagnosis?
Pleural effusion: A multitude of diseases, for example, pleural tumors can result in a unilateral effusion. A homogeneous opacity of both lung fields can naturally also be caused by bilateral pleural effusions. The bilateral effusions may be different in quantity , especially in cardiac decompensation and subsequent pulmonary venous congestion.
Do You Know Other Causes for a Diffuse Homogeneous Opacity of the Lung?
Posttraumatic loss of radiolucency: Trauma can result in a diffuse unilateral opacity of the thorax a chest wall hematoma, possibly due to a serial rib fracture, or a hemothorax after an injury of intrathoracic vessels may be the cause.
Atelectasis: An atelectasis of the left upper lobe or of a total lung can increase the density of a complete hemithor-ax .
I Pleural Effusion
- Fig. 6.31 These CXRs in inspiration and expiration show decrease in vasculature in the right hemithorax and hyperinflation of the right lung . The right hemidiaphragm does not move at all.
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