Bacterial pneumonia other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

Bacterial pneumonia is primarily diagnosed with chest x-ray and, in complex cases, CT scans. Other diagnostic tests are available but are not frequently utilized compared to the aforementioned two modalities. These tests include ultrasonography, chest MRI, and biopsy of the affected lung. . Ultrasonography can help identify the characteristics of the pleural fluid including its amount, viscosity, loculations, as well as pulmonary septations. Lung biopsy is a reliable but invasive method of diagnosing pneumonia, so this test is often reserved for cases in which the underlying cause can not be identified. Bronchopsy may also be utilized in diagnosing pneumonia, especially in non-immunocompromised and mechanically ventilated patients.

Lung Ultrasound

Ultrasonography is very useful in assessing the pleural fluid including its amount, viscosity and loculations as well as pulmonary septations. It can be helpful in cases of complex pleural collections. Results of ultrasonography rely upon the homogeneity, shape, marginal characteristics as well as presence or absence of air bronchograms. Pneumonia progresses to hepatization in which it appears liver-like on imaging, with the exception of branching structures naturally present within the lungs.

Lung consolidation on ultrasound - Case courtesy of Dr Ian Bickle

MRI of the chest

MRI is not a commonly utilized method of imaging for pneumonia, but it may be helpful in evaluating the heart, vessels, and surrounding chest structures. Patients affected with pneumonia often present with shortness of breath and have difficulty holding their breath for long periods of time. Due to the fast imaging technique provided by MRI, this method can be helpful for such patients. MRI can also help in reducing radiation exposure. It is important to note that calcifications and air pockets within lesions are not easily visualized using MRI.

Biopsy of Lung

Lung biopsy is a reliable but invasive method of diagnosing pneumonia. Biopsies are often reserved for cases in which the underlying cause can not be identified. Obtaining a biopsy sample can be done by an open surgical approach, needle biopsy, bronchoscopic or via video-assisted thoracoscopic surgery (VATS).

Bronchoscopy

Bronchoscopy is performed when patients are unable to provide sufficient sputum to identify the cause of pneumonia. It is useful in determining the presence of bacterial pneumonia in non-immunocompromised and mechanically ventilated patients.