Pneumonia other imaging findings

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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

Bronchoscopy with bronchoalveolar lavage is useful to obtain samples for gram stain and culture in patients with certain conditions, such as immunocompromised patients, ICU admission or antibiotic failure.

Bronchoscopy

  • Bronchoscopy is used in the diagnosis of pneumonia only in certain cases, such as patients admitted in the ICU, immunocompromised patients, or patients with treatment failure.
  • When sputum is not produced or not sufficient for evaluation, bronchoscopic sampling and bronchoalveolar lavage (BAL) is used to collect samples for gram stain and culture.[1]
  • Bronchoscopy is particularly helpful in the diagnosis of PCP, as the sputum analysis have a high false-negative rate. [2]

Ultrasound

  • In one study, ultrasonography was used to diagnose community acquired pneumonia with a high sensitivity and specificity (Sensitivity of 93% and specificity of 98%).[3]
  • Findings in the ultrasound for pneumonia include air bronchogram within an echopoor area and pleural effusion seen in some cases. [4]
  • Ultrasound can also be used for the follow-up of pneumonia.[4]

References

  1. Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
  2. Pitchenik AE, Ganjei P, Torres A, Evans DA, Rubin E, Baier H (1986). "Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome". Am Rev Respir Dis. 133 (2): 226–9. PMID 3484921.
  3. Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P; et al. (2012). "Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study". Chest. 142 (4): 965–72. doi:10.1378/chest.12-0364. PMID 22700780.
  4. 4.0 4.1 Reissig A, Copetti R (2014). "Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases". Respiration. 87 (3): 179–89. doi:10.1159/000357449. PMID 24481027.