Bacterial pneumonia chest x ray

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

Overview

Imaging with chest x-rays remains the gold standard of diagnosis when supported with other lab findings but it is recommended that, apart from x-ray findings, the entire clinical picture be taken into consideration before treatment is started. Patterns commonly found on imaging include lobar or focal nonsegmental pneumonia, lobular or multifocal bronchopneumonia, and diffuse or interstitial (atypical) pneumonia.^[1]

Chest X-Ray


Type of Pneumonia	Common Organisms	Chest X-Ray	Typical Findings
Lobar/ Focal non-segmental^[2]	Klebsiella pneumoniae Legionella pneumophila Haemophilus influenzae	Middle lobe pneumonia (Frontal) - Case courtesy of Dr Roberto Schubert, Radiopaedia.org, rID: 16074 Middle lobe pneumonia (Lateral) - Case courtesy of Dr Roberto Schubert, Radiopaedia.org, rID: 16074 Pneumococcal-pneumonia Right upper lobe - Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 13553	Homogeneous (size may vary) opacification in a lobar pattern May be sharply defined at the fissures Appearance of air bronchograms
Lobular/ Multifocal Bronchopneumonia^[3]	Staphylococcus aureus Klebsiella pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Escherichia coli	Bronchopneumonia (Frontal) - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 49869 Bronchopneumonia (Lateral) - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 49869	Multiple small nodular opacities Patchy and confluent Patches of inflammation separated by normal lung parenchyma
Diffuse/ Interstitial (Atypical)^[4]	Mycoplasma Chlamydophila pneumoniae Chlamydophila psittaci Legionella	Legionella Pneumophilia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 49869 Chlamydia Pneumoniae - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 14567 Mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID: 45781	Inflammation is limited to the pulmonary interstitium Patchy reticular or reticulonodular opacities Patches are more pronounced in the hilar regions Segmental atelectasis from small airway obstruction may occur Radiological findings are often more pronounced than the patients appearance