Community-acquired pneumonia chest x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

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:

• 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. 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.

Chest X-ray Gallery

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  Extensive consolidation and air bronchograms with loss of the right hemidiaphragm in keeping with right lower lobe pneumonia.
  Image courtesy of Dr Frank Gaillard, Radiopedia. (original file here). Creative Commons BY-SA-NC

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  Pneumonic infiltration of the right middle lobe.
  Image courtesy of Dr Sajoscha Sorrentino, Radiopedia. (original file here). Creative Commons BY-SA-NC