Pneumonia chest x ray
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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
 Image courtesy of Dr Aditya Shetty, Radiopedia. (original file here). Creative Commons BY-SA-NC |
- 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
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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 -
X-ray shows homogenous radio-opaque areas in bilateral lung fields. These represent areas of consolidation.
Image courtesy of Dr Aditya Shetty, Radiopedia. (original file here). Creative Commons BY-SA-NC
Videos
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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.