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__NOTOC__
__NOTOC__
{{Community-acquired pneumonia}}
{{Community-acquired pneumonia}}
{{CMG}}; {{AE}} {{chetan}}
{{CMG}}; {{AE}} {{chetan}}; {{JS}}


==Pathophysiology==
==Chest X-Rays==
==Overview==
[[Pneumonia]] can be transmitted by various methods. The etiology depends upon various factors like age, immune status, geographical area, and comorbid conditions. The transmission can be systemic , local , trauma or iatrogenic. It could also be due to decreased immunity or inability to filter out pathogen.


===Modes of transmission===
====Lobar Pneumonia====
=====1.Microaspiration of oropharyngeal contents=====
Inoculation of lung by pathogenetic organisms is one of the mechanism of acquiring pneumonia.  It most commonly occurs in normal persons during sleep , in unconscious persons due to impaired gag reflex, cough reflex or gastroesopahegeal reflux.<ref name="Wunderink-2004">{{Cite journal  | last1 = Wunderink | first1 = RG. | last2 = Waterer | first2 = GW. | title = Community-acquired pneumonia: pathophysiology and host factors with focus on possible new approaches to management of lower respiratory tract infections. | journal = Infect Dis Clin North Am | volume = 18 | issue = 4 | pages = 743-59, vii | month = Dec | year = 2004 | doi = 10.1016/j.idc.2004.07.004 | PMID = 15555822 }}</ref>


=====2.Inhalation of aerosolized droplets=====
{|
Inhalation of aerosolized droplets of 0.5 to 1 micrometer is the most common pathway of acquiring pneumonia. A few bacterial and viral infections are transmitted in this fashion.  The lung can normally filter out particles between 0.5 to 2  micrometer by recruiting the [[alveolar macrophages]].<ref name="Wunderink-2004">{{Cite journal  | last1 = Wunderink | first1 = RG. | last2 = Waterer | first2 = GW. | title = Community-acquired pneumonia: pathophysiology and host factors with focus on possible new approaches to management of lower respiratory tract infections. | journal = Infect Dis Clin North Am | volume = 18 | issue = 4 | pages = 743-59, vii | month = Dec | year = 2004 | doi = 10.1016/j.idc.2004.07.004 | PMID = 15555822 }}</ref>
| [[File:Strep Pneumon CXR 01.png|thumb|x370px|Extensive consolidation with branching radiolucencies corresponding to bronchi ('''[[Chest X-ray#Signs|air bronchogram sign]]''') of the right lung. Obscured right hemidiaphragm suggests right lower lobe involvement ('''[[Chest X-ray#Signs|silhouette sign]]''').{{imgrp}}]]
| [[File:Right lung middle lobe pneumonia.jpg|x400px|thumb|Consolidation of the right middle lobe. '''[[Chest X-ray#Signs|Air bronchogram sign]]''' is modestly evident.{{imgwc}}]]
|}


=====3.Blood borne or sytemic infection=====
{|
Another way of acquiring pneumonia systematically is through blood. Blood-borne pneumonia is more common in intravenous drug users . [[Staphylococcal aureus]] causes pneumonia in this way. Gram negative bacteria are found to cause pneumonia in immunocompromised individuals.
| [[File:Right upper lobe pneumonia pediatric.jpg|400px|thumb|Right upper lobe consolidation with '''[[Chest X-ray#Signs|air bronchogram sign]]''', indicating underlying alveolar processes.{{imgwc}}]]
| [[File:Left lower lobe.jpg|x400px|thumb|Enhanced opacity at the left lung field. Sharply demarcatd left heart contour suggests lower lobe pneumonia without lingula involvement ('''[[Chest X-ray#Signs|silhouette sign]]''').{{imgrp}}]]
|}


=====4.Trauma or Local spread=====
====Interstitial Pneumonia====
Pneumonia can be caused iatrogenically by a surgeon during an operative procedure or by a penetrating trauma to the lung.  A local spread of a hepatic abscess and amoebic abscess can also lead to pneumonia.


===Pathogenetic mechanism===
{|
The lung can normally filter out large droplets of aerosols. Smaller droplets of the size of 0.5 to 2 micrometer are deposited on the alveoli and then engulfed by alevolar macrophages. These macrophages release cytokines and chemokines , which also includes  [[Tumor necrosis factor-alpha]], [[interleukin]]-8 and [[leukotriene]]B4 . The neutrophils are recruited by these cells and they kill these micro-organisms.<ref name="Strieter-2003">{{Cite journal  | last1 = Strieter | first1 = RM. | last2 = Belperio | first2 = JA. | last3 = Keane | first3 = MP. | title = Host innate defenses in the lung: the role of cytokines. | journal = Curr Opin Infect Dis | volume = 16 | issue = 3 | pages = 193-8 | month = Jun | year = 2003 | doi = 10.1097/01.qco.0000073766.11390.0e | PMID = 12821807 }}</ref><ref name="Mason-2005">{{Cite journal  | last1 = Mason | first1 = CM. | last2 = Nelson | first2 = S. | title = Pulmonary host defenses and factors predisposing to lung infection. | journal = Clin Chest Med | volume = 26 | issue = 1 | pages = 11-7 | month = Mar | year = 2005 | doi = 10.1016/j.ccm.2004.10.018 | PMID = 15802161 }}</ref>
| [[File:Pneumocystis carinii pneumonia01.jpg|x400px|thumb|Infiltration of the right middle lobe.]]
| [[File:PCP ground glass.jpg|x400px|thumb|Ground-glass pattern is seen on the X-ray.]]
|}
 
 
 
Atypical pneumonia has the radiographic features of patchy reticular opacities.
 
{|
| [[File:Atypical Pneumonia.jpg|x400px|thumb|Atypical pneumonia has the radiographic features of patchy reticular opacities.]]
| [[File:Pseudomonas.jpg|x400px|thumb| Curved red line shows a bulging fissure which is typical for Pseudomonas, Staphylococcus aureus,Klebsiella pneumoniae]]
|}
 
{|
| [[File:Candida pneumonia.jpg|x400px|thumb|Multifocal patchy air space opacification without a zonal predilection.]]
| [[File:Legionella Pneumonia 1.jpg|x400px|thumb| Right hemithorax air space shadowing predominantly right sided signs were correlated with this radiograph with almost complete right sided air space opacification and early left basal changes.]]
|}
 
{|
| [[File:Chlamydia previous.png|x400px|thumb|Chlamydia pneumonia before treatment.]]
| [[File:Chlamydia one month later.png|x400px|thumb| Chlamydia pneumonia one month later]]
|}
 
{|
| [[File:Golden S sign Staph.png|x400px|thumb|Right hilar mass (orange) obstructing the right upper lobe bronchus results in collapse of the right upper lobe (green arrow). This results in a reverse S shape to the pleural edge. .]]
| [[Q fever pneumonia.jpg|x400px|thumb|The right hemidiaphragm is elevated with some minor right basal atelectasis.
Hazy airspace opacity is seen in the left mid and upper zone which may be inflammatory in nature.  No areas of confluent consolidation are identified.]]
|}
 
==CT Images==
 
{|
| [[File:Chest pneumonia abscesses caverns effusions.jpg|400px|thumb|Pneumonia with abscesses on both lungs, caverns on the left lung and effusions on both lungs.]]
| [[File:CT right sided pneumonia.jpg|x400px|thumb|Right sided pneumonia.]]
|}
 
{|
| [[File:Axial CT aspiration.jpg|300px|thumb|]]
| [[File:Axial CT aspiration 2.jpg|300px|thumb|]]
| [[File:Axial CT aspiration 3.jpg|300px|thumb|]]
|}
 
 
{|
| [[File:Bronchopneumonia tree in bud appearance|400px|thumb|The tree-in-bud sign describes the CT appearance of multiple areas of centrilobular nodules with a linear branching pattern.]]
| [[File:Bronchopneumonia 2.jpeg|x400px|thumb|]]
|}
{|
| [[File:PCP CT.jpg|400px|thumb|]]
| [[File:PCP CT 1.jpg|x400px|thumb|]]
|}
{|
| [[File:PCP CT 2.jpg|400px|thumb|]]
| [[File:PCP CT 3.jpg|x400px|thumb|]]
|}


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:primary care]]

Latest revision as of 00:04, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]; João André Alves Silva, M.D. [3]

Chest X-Rays

Lobar Pneumonia

Extensive consolidation with branching radiolucencies corresponding to bronchi (air bronchogram sign) of the right lung. Obscured right hemidiaphragm suggests right lower lobe involvement (silhouette sign).

Image Courtesy of Radiopaedia and Copylefted.
Consolidation of the right middle lobe. Air bronchogram sign is modestly evident.

Image Courtesy of Wikimedia Commons and Copylefted.

Right upper lobe consolidation with air bronchogram sign, indicating underlying alveolar processes.

Image Courtesy of Wikimedia Commons and Copylefted.
Enhanced opacity at the left lung field. Sharply demarcatd left heart contour suggests lower lobe pneumonia without lingula involvement (silhouette sign).

Image Courtesy of Radiopaedia and Copylefted.

Interstitial Pneumonia

Infiltration of the right middle lobe.
Ground-glass pattern is seen on the X-ray.


Atypical pneumonia has the radiographic features of patchy reticular opacities.

Atypical pneumonia has the radiographic features of patchy reticular opacities.
Curved red line shows a bulging fissure which is typical for Pseudomonas, Staphylococcus aureus,Klebsiella pneumoniae
Multifocal patchy air space opacification without a zonal predilection.
Right hemithorax air space shadowing predominantly right sided signs were correlated with this radiograph with almost complete right sided air space opacification and early left basal changes.
Chlamydia pneumonia before treatment.
Chlamydia pneumonia one month later
Right hilar mass (orange) obstructing the right upper lobe bronchus results in collapse of the right upper lobe (green arrow). This results in a reverse S shape to the pleural edge. .
 x400px|thumb|The right hemidiaphragm is elevated with some minor right basal atelectasis. Hazy airspace opacity is seen in the left mid and upper zone which may be inflammatory in nature. No areas of confluent consolidation are identified.

CT Images

Pneumonia with abscesses on both lungs, caverns on the left lung and effusions on both lungs.
Right sided pneumonia.


File:Bronchopneumonia tree in bud appearance
The tree-in-bud sign describes the CT appearance of multiple areas of centrilobular nodules with a linear branching pattern.

References

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