CHEST X-RAY INTERPRETATION COURSE: RADIOLOGICAL IDENTIFICATION OF PNEUMONIA
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Follow us at https://www.escuelaonlinedesalud.com Pneumonia can be defined as an inflammatory condition, usually infectious, which produces from a radiological point of view a lobar or segmental pulmonary consolidation, although there may also be interstitial involvement. We can consider 5 radiological patterns of pneumonia: Lobar, segmental, interstitial, round and cavitated. Lobar pneumonia consists of a homogeneous consolidation of the affected lobe, with well-defined margins if they are limited by a fissure. These lobar pneumonias usually give rise to the silhouette sign in the areas where they come into contact with the heart, aorta or diaphragm. When they affect more central portions of the lung, they almost always contain an air bronchogram. The germ that most frequently produces this type of pneumonia is pneumococcus. Segmental pneumonia consists of patchy air consolidation that frequently affects several segments, with margins that tend to show a cottony and poorly defined appearance. They are also called bronchopneumonias, since they produce an exudate that fills the bronchi and, consequently, air bronchograms are not usually observed, but, yes, they are usually associated with an increased incidence of atelectasis due to the loss of volume generated by this bronchial exudate. This type of bronchopneumonia is typically caused by staphylococcus aureus, although there are many gram-negative bacteria, such as pseudomona aeruginosa that can produce the same condition. Interstitial pneumonia is characterized by affecting the walls of the airways and the alveolar septa, producing a fine reticular pattern in the lungs, although most of these pneumonias eventually spread to adjacent alveoli, producing a patchy disease similar to bronchopneumonia, which makes the original interstitial pneumonia impossible to identify. This pneumonia is classically caused by viruses and mycoplasma Pneumoniae. In patients with AIDS, the usual germ is pneumocystis carinii. Pneumonias with a round pattern usually take on a spherical shape. They are generally observed in the posterior areas of the lower lobes and usually occur in children. Obviously they can be confused with tumors, but it is usually easy to make the differential diagnosis since tumors do not usually occur in childhood and the semiology is clearly typical of a pulmonary infectious process. The most common germs that produce this type of pneumonia are pneumococcus and haemophilus influenzae.
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