Introduction

Pneumonia

Pneumonia is airspace disease and consolidation. The air spaces are filled with bacteria or other microorganisms and pus. Other causes of airspace filling not distinguishable radiographically would be fluid (inflammatory), cells (cancer), protein (alveolar proteinosis) and blood (pulmonary hemorrhage), Pneumonia is NOT associated with volume loss. Pneumonia is caused by bacteria, viruses, mycoplasmae and fungi.

The x-ray findings of pneumonia are airspace opacity, lobar consolidation, or interstitial opacities. There is usually considerable overlap. Again, pneumonias is a space occupying lesion without volume loss. What differentiates it from a mass? Masses are generally more well-defined. Pneumonia may have an associated parapneumonic effusion.

The type of pneumonia is sometimes characteristic on chest x-ray:

Lobar - classically Pneumococcal pneumonia, entire lobe consolidated and air bronchograms common

Lobular - often Staphlococcus, multifocal, patchy, sometimes without air bronchograms

Interstitial - Viral or Mycoplasma; latter starts perihilar and can become confluent and/or patchy as disease progresses, no air bronchograms

Aspiration pneumonia - follows gravitational flow of aspirated contents; impaired consciousness, post anesthesia, common in alcoholics, debilitated, demented pts; anaerobic (Bacteroides and Fusobacterium)

Diffuse pulmonary infections - community acquired (Mycoplasma, resolves spontaneoulsy) nosocomial (Pseudomonas, debilitated, mechanical vent pts, high mortality rate, patchy opacities, cavitation, ill-defined nodular) immunocompromised host(bacterial, fungal, PCP)

Major differentiating factors between atelectasis and pneumonia

Atelectasis

Pneumonia

Volume Loss

Associated Ipsilateral Shift

Linear, Wedge-Shaped

Apex at Hilum

Normal or Increased Volume

No Shift, or if Present Then Contralateral

Consolidation, Air Space Process

Not Centered at Hilum

Air bronchograms can occur in both.

These are PA and lateral films of RML pneumonia (arrows).
Note the indistinct borders, air bronchograms, and silhouetting of the right heart border.

PA and Lateral films of RUL pneumonia