Bronchopneumonia

Bronchopneumonia
ICD-10	J18.0
ICD-9	485
MeSH	D001996

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List of terms related to Bronchopneumonia

Overview[edit | edit source]

• Bronchopneumonia (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

Historical Perspective[edit | edit source]

• Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
• In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

Classification[edit | edit source]

• Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
  • Lobar
  • Lobular (Bronchopneumonia)

Pathophysiology[edit | edit source]

• The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
• On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a bronchia, are poorly delimited and have the tendency to confluence, especially in children.
• On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
• Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.

Clinical Features[edit | edit source]

• Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
• Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
• Older patients may also present with altered mental status.

Differentiating [disease name] from other Diseases[edit | edit source]

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics[edit | edit source]

• The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age[edit | edit source]

• Patients of all age groups may develop Bronchopneumonia.

• Bronchopneumonia is more commonly observed among elderly patients.

Gender[edit | edit source]

• Bronchopneumonia affects men and women equally.

Race[edit | edit source]

• There is no racial predilection for Bronchopneumonia.

Risk Factors[edit | edit source]

• Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
• Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

Natural History, Complications and Prognosis[edit | edit source]

• Early clinical features include sudden fever, chills, cough and chest pain.
• If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
• Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.

Diagnosis[edit | edit source]

Diagnostic Criteria[edit | edit source]

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms[edit | edit source]

• Symptoms of Bronchopneumonia may include the following:
  • Fever
  • Chills
  • Cough
  • Chest Pain
  • Shortness of breath

Physical Examination[edit | edit source]

• Physical examination may be remarkable for:

• Fever
• Respiratory rate >24 breaths/min (Tachypnea)
• Tachycardia
• Chest Examination:
  • Audible crackles
  • Decreased or bronchial breath sounds
  • Dullness to percussion in areas of consolidation
  • Tactile fremitus
  • Egophony

Laboratory Findings[edit | edit source]

• There are no specific laboratory findings associated with Bronchopneumonia.

• A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
• An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

Imaging Findings[edit | edit source]

• Chest x-ray is the imaging modality of choice for Bronchopneumonia.
• On chest x-ray, Bronchopneumonia is characterized by [finding 1], [finding 2], and [finding 3].
• [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies[edit | edit source]

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment[edit | edit source]

Medical Therapy[edit | edit source]

• The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery[edit | edit source]

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention[edit | edit source]

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References[edit | edit source]

• Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

External links

• Atlas of Pathology

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