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{{ | __NOTOC__ | ||
[[ | {{Pneumonia}} | ||
{{CMG}}; {{AE}} {{HQ}}, [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] ; {{AL}} | |||
An important test for pneumonia | ==Overview== | ||
An important test for making a diagnosis of [[pneumonia]] is a chest [[x-ray]]. [[Chest X-ray|Chest x-rays]] can reveal areas of opacity (seen as white) which represent [[Consolidation (medicine)|consolidation]]. Pneumonia is not always seen on [[x-rays]], either because the disease is only in its initial stages, or because it involves a part of the [[lung]] not easily seen by [[X-rays|x-ray]]. | |||
==Chest X-Ray== | |||
===Indications=== | |||
Patients with the following conditions should be evaluated with a [[chest X-ray]]:<ref name="pmid21661712">{{cite journal| author=Watkins RR, Lemonovich TL| title=Diagnosis and management of community-acquired pneumonia in adults. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 11 | pages= 1299-306 | pmid=21661712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21661712 }} </ref> | |||
* [[Fever]] (>37.8° C / 100° F) | |||
* [[Tachypnea]] (> 20 breaths/min) | |||
* [[Tachycardia]] (> 100 bpm) | |||
* Decreased [[breath sounds]] and [[crackles]] in the physical exam | |||
===Findings=== | |||
* [[X-ray]]s of the chest reveal areas of opacity. | |||
*A normal [[Chest X-ray|chest x-ray]] makes community-acquired pneumonia (CAP) less likely; however, CAP is sometimes not seen on [[x-rays]] because the disease is either in its initial stages or involves a part of the lung not easily seen by [[X-rays|x-ray]]. | |||
* [[X-rays]] can be misleading, because other problems, like [[lung]] scarring and [[congestive heart failure]], can mimic pneumonia on [[X-rays|x-ray]].<ref name="syrjala">Syrjala H, Broas M, Suramo I, et al. ''High resolution computed tomography for the diagnosis of community-acquired pneumonia.'' Clin Infect Dis 1998; 27:358-363 PMID 9709887</ref> [[Chest X-ray|Chest x-rays]] are also used to evaluate for complications of pneumonia. | |||
* [[Chest x-ray]] findings are usually nonspecific in [[viral pneumonia]]. | |||
* [[Computed tomography]] is used in situations when the diagnosis is not clear with a chest x-ray | |||
==Hospital Acquired== | |||
*The American Thoracic Society recommends that all patients with a suspicion of [[Nosocomial infection|nosocomial]] pneumonia should have a [[Chest X-ray|chest x-ray]] to confirm diagnosis and determine the severity of the disease.<ref>{{cite journal|title=Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=4|year=2005|pages=388–416|issn=1073-449X|doi=10.1164/rccm.200405-644ST}}</ref> | |||
* A chest X-ray also helps to determine [[pleural effusion]]s or [[cavitation]]s, as a possible complication. | |||
*Ideally, the [[chest X-ray]] should be posteroanterior and lateral, but this will depend on the patient's condition. | |||
*Findings include the following:<ref name="KoenigTruwit2006">{{cite journal|last1=Koenig|first1=S. M.|last2=Truwit|first2=J. D.|title=Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention|journal=Clinical Microbiology Reviews|volume=19|issue=4|year=2006|pages=637–657|issn=0893-8512|doi=10.1128/CMR.00051-05}}</ref> | |||
:*Unilateral or bilateral [[lung consolidation|consolidation]] | |||
:*Air bronchogram | |||
:*[[Pleural effusion]] | |||
:*[[Cavitation]] | |||
:*Ground glass opacities | |||
*[[Chest X-ray|Chest x-ray]] is also used to assess improvement or lack of clinical response in hospitalized patients. | |||
===Chest X-ray Gallery=== | |||
[[File:Pneumonia-right-middle-lobe-4.jpg|thumb|left|369x369px|Right middle lobe consolidation pneumonia [https://radiopaedia.org/cases/pneumonia-right-middle-lobe-4 Source:Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14979]]] | |||
<br clear="left" /> | |||
[[File:Hospital_acquired_pneumonia.png|200px|thumb|left|X-ray shows homogenous radio-opaque areas in bilateral lung fields. These represent areas of consolidation [https://radiopaedia.org/cases/hospital-acquired-pneumonia Source: Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 26828]]] | |||
<br clear="left" /> | |||
===Videos=== | |||
{{#ev:youtube|uhRIu8bDYA0}} | |||
{{#ev:youtube|zDOFzw0Cmp4}} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Pneumonia]] | |||
[[Category:Pulmonology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Pediatrics]] | |||
[[Category:Disease]] | |||
Latest revision as of 23:45, 29 July 2020
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Pneumonia chest x ray On the Web |
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American Roentgen Ray Society Images of Pneumonia chest x ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Priyamvada Singh, M.D. [3] ; Alejandro Lemor, M.D. [4]
Overview
An important test for making a diagnosis of pneumonia is a chest x-ray. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray.
Chest X-Ray
Indications
Patients with the following conditions should be evaluated with a chest X-ray:[1]
- Fever (>37.8° C / 100° F)
- Tachypnea (> 20 breaths/min)
- Tachycardia (> 100 bpm)
- Decreased breath sounds and crackles in the physical exam
Findings
- X-rays of the chest reveal areas of opacity.
- A normal chest x-ray makes community-acquired pneumonia (CAP) less likely; however, CAP is sometimes not seen on x-rays because the disease is either in its initial stages or involves a part of the lung not easily seen by x-ray.
- X-rays can be misleading, because other problems, like lung scarring and congestive heart failure, can mimic pneumonia on x-ray.[2] Chest x-rays are also used to evaluate for complications of pneumonia.
- Chest x-ray findings are usually nonspecific in viral pneumonia.
- Computed tomography is used in situations when the diagnosis is not clear with a chest x-ray
Hospital Acquired
- The American Thoracic Society recommends that all patients with a suspicion of nosocomial pneumonia should have a chest x-ray to confirm diagnosis and determine the severity of the disease.[3]
- A chest X-ray also helps to determine pleural effusions or cavitations, as a possible complication.
- Ideally, the chest X-ray should be posteroanterior and lateral, but this will depend on the patient's condition.
- Findings include the following:[4]
- Unilateral or bilateral consolidation
- Air bronchogram
- Pleural effusion
- Cavitation
- Ground glass opacities
- Chest x-ray is also used to assess improvement or lack of clinical response in hospitalized patients.
Chest X-ray Gallery
Videos
{{#ev:youtube|uhRIu8bDYA0}} {{#ev:youtube|zDOFzw0Cmp4}}
References
- ↑ Watkins RR, Lemonovich TL (2011). "Diagnosis and management of community-acquired pneumonia in adults". Am Fam Physician. 83 (11): 1299–306. PMID 21661712.
- ↑ Syrjala H, Broas M, Suramo I, et al. High resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis 1998; 27:358-363 PMID 9709887
- ↑ "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.
- ↑ Koenig, S. M.; Truwit, J. D. (2006). "Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention". Clinical Microbiology Reviews. 19 (4): 637–657. doi:10.1128/CMR.00051-05. ISSN 0893-8512.