Bacterial pneumonia CT

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

Overview

Although CT scans are not a primary modality of testing for bacterial pneumonia, they may be utilized in complex cases where the underlying cause is unknown[1] and or when empiric antibiotic use yields no symptomatic relief in the patient. CT scans may be very informative and assist in differentiating infectious and noninfectious pneumonia.[2] Similar to chest x-rays, CT findings can also be described according to the type of pneumonia including lobar or focal nonsegmental pneumonia, lobular or multifocal bronchopneumonia, and diffuse or interstitial (atypical) pneumonia.

CT Scan

Type of Pneumonia Common Organisms CT Scan Findings
Lobar/ Focal non-segmental[3] Klebsiella pneumoniae

Legionella pneumophila

Haemophilus influenzae

Lobar pneumonia - Case courtesy of Dr Chris O'Donnell
Pneumococcal Pneumonia (complication: parapneumonic effusion) - Case courtesy of Dr Henry Knipe
  • Focal dense opacification of the majority of an entire lobe
  • Relative sparing of the large airways
  • Ground glass opacity appearance in a lobar or segmental pattern
Lobular/ Multifocal Bronchopneumonia[4] Staphylococcus aureus

Klebsiella pneumoniae

Haemophilus influenzae

Pseudomonas aeruginosa

Escherichia coli

Bronchopneumonia CT - Case courtesy of Dr Ayush Goel
Bronchopneumonia CT (Tree in Bud) - Case courtesy of The Radswiki
Bronchopneumonia CT (Tree in Bud: Enhanced) - Case courtesy of The Radswiki
  • Multiple foci of opacity in a lobular pattern
  • "Tree in Bud" appearance
  • Larger areas of consolidation may appear as 'patchwork quilt'
Diffuse/ Interstitial (Atypical)[5] Mycoplasma

Chlamydophila pneumoniae

Chlamydophila psittaci

Legionella

Atypical pneumonia - Case courtesy of Dr Mostafa El-Feky
  • Focal ground glass opacity appearance (in a centrilobular pattern)
  • Diffuse and bilateral (in most cases)
  • Bronchial wall thickening
  • Segmental atelectasis from small airway obstruction may occur
  • Radiological findings are often more pronounced than the patients appearance
  • Mycoplasma pneumoniae: airspace consolidation
  • Legionella pneumophila: residual scarring may persist

References

  1. "StatPearls". 2021. PMID 30020693.
  2. Murata K, Takahashi M, Furukawa A, Itoh R, Yamasaki M, Sho K; et al. (1999). "[CT findings of pulmonary infections]". Nihon Igaku Hoshasen Gakkai Zasshi. 59 (8): 371–9. PMID 10459281.
  3. https://radiopaedia.org/articles/lobar-pneumonia. Missing or empty |title= (help)
  4. https://radiopaedia.org/articles/bronchopneumonia?lang=us. Missing or empty |title= (help)
  5. https://radiopaedia.org/articles/atypical-pneumonia?lang=us. Missing or empty |title= (help)

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