This pneumonia ppt is basically focused on radiological point od view.... but you can find almost everything here except treatment...

1. PNEUMONIA
DR. BIJAY KUMAR YADAV
MBBS, MD (Radiology Resident)

2. INTRODUCTION:
 Pneumonia is an infection that inflames the air sacs in one
or both lungs. The air sacs may fill with fluid or pus
(purulent material), causing cough with phlegm or pus,
fever, chills, and difficulty in breathing
 Many organisms, including viruses and fungi, can cause
pneumonia, but the most common causes are bacteria, in
particular species of Streptococcus and Mycoplasma.

3.  What ever are the cause, x-rays appearance look very
much same, because x-rays appearances are so non-
specific
 No useful classification of pneumonia can be based on x-
rays alone
 Radiologist can draw most useful distinction between
primary and secondary pneumonia
 Major purpose of chest imaging: to establish whether or
not pneumonia.
 Basic radiological feature: one or more areas of
consolidation varying from a small ill-defined shadow to
a large shadow involving the whole of one or more lobes

4. CLASSIFICATION ON THE BASIS OF :
SITE AETIOLOGY
MODE OF ACQUIRING
PNEUMONIA
1. Lobar pneumonia
2. Bronchopneumonia
3. Interstitial pneumonia
1. Primary
Pneumonia
2. Secondary
Pneumonia
(Aspiration)
3. Suppurative
Pneumonia
(Necrotizing)
1. CAP
2. Hospital acquired
3. Ventilator associated
4. Health care associated
5. Pneumonia in immunu-
compromised host

5. CLASSIFICATION:
Radiological classification:
1. Lobar Pneumonia
2. Bronchopneumonia
3. Interstitial pneumonia

6. 1. LOBAR PNEUMONIA
Referring to homogeneous consolidation of one or more lung lobes,
often with associated pleural inflammation.
Causes:
i. Streptococcus pneumoniae
ii. Haemophilus influenzae
iii. Moraxella catarrhalis.
iv. Mycobacterium tuberculosis
Clinical Features:
i. Productive cough
ii. Dyspnea/SOB
iii. Malaise/Fatigue
iv. Fevers –sweating/chills/rigors
v. Pleuritic chest pain
vi. Nausea, vomiting or diarrhea

7. RUL Consolidation RML Consolidation RLL Consolidation
X-ray of Right Side Pneumonia

8. Pneumococcal pneumonia, chest radiograph
reveals a left lower lobe opacity with pleural
effusion.

9. Klebsiella pneumonia - large cavity in right lower zone
following cavitation of pneumonic consolidation.

10. Radiological signs:
1. Early stage: Lung markings get more and thicker in
the suffered lobe or segment, or no X-ray findings.
2. Progressive stage: The radiograph shows
consolidations localized to the affected lobe.
Occasionally, the sign of Air bronchogram or a
complication such as pleural effusion, abscess
formation or emphysema can be found on the X-ray
film.
3. Last stage: The radiograph shows patchy opaque
shadows localized to the affected lobe.

11. PATHOLOGY
4 Pathological Phases Of Lobar Pneumonia
1) Congestion: This stage occurs within the first 24 hours of
contracting pneumonia. Pulmonary capillaries dilated and
serous fluid leaks out of capillaries into the alveoli. The
patient develop fever with SOB and cough.
2) Red Hepatization: 2-3 days after the congestion. That means
the lung look like “RED LIVER”. The affected lobe is solid as
the alveoli are full of RBCs, Neutrophils, desquamated
epithelial cells and Fibrin instead of air, so there is no
gaseous exchange in this lobe. The patient becomes
breathless and hypoxic. The cough is associated with blood
stained or rusty sputum.

12. 3) Grey Hepatization: 2-3 days after Red hepatization and is an
avascular stage. The affected part look like “GREY LIVER”.
The alveoli are full of Neutrophils and Dense fibrous strands.
The patient cough up purulent sputum and remain
breathless.
4) Resolution: Begins after 8-10 days (without antibiotics).
Monocytes clear the inflammatory debris and normal air
filled lung architecture is restored. Improvement of patient's
conditions is noticed.

13. PATHOPHYSIOLOGY
Infection to the lung (e.g bacteria, virus)
▼
Inflammatory response initiated
▼
Alveolar edema + exudate formation
▼
Alveoli & respiratory bronchioles fill with
serous exudate, blood cells, fibrin, bacteria
▼
Consolidation of lung tissues

14. 2. BRONCHOPNEUMONIA
Refers to more patchy alveolar consolidation associated with bronchial
& bronchiolar inflammation often affecting both lower lobes.
Causes:
Most common causes are:
i. Haemophilus influenzae
ii. Staphylococcus aureus
Clinical features:
i. Fever -
ii. Cough - Mucus
iii. Shortness of breath
iv. Chest pain
v. Tachypnea
vi. Sweating
vii. Headache
viii.Muscle aches

15. X-ray Features:
1. Increase in the size & number
of Lung markings.
2. Small patchy alveolar
consolidation distribute along
lung markings.
3. Lesions are frequently found
in both lower lung fields.
4. The hilar shadows may
become larger.
5. Affected position: lobule of
lung

16. In Right Middle & Lower lung fields,
on Admission & after Recuperation
On Admission After Recovery

17. Staphylococcal pneumonia - with abscess
formation

18. 3. INTERSTITIAL PNEUMONIA
Causes:
i. Bacteria, viruses or
fungi
ii. Mycoplasma
pneumoniae is the
most common cause
 It is a heterogeneous group of diffuse parenchymal
lung diseases characterized by specific clinical,
radiologic and pathologic features.
 Involves the areas in between the alveoli.
Clinical Features:
i. Fever
ii. SOB
iii. Cough

19. X-ray Features:
 A lung volume loss and a
craniocaudal gradient of
peripheral septal thickening,
Bronchiectasis & Honeycombing
 Peribronchovascular Infiltrate

20. S.N Pathology Types Radiological Features
1.
Usual interstitial
pneumonia (UIP)
Dominated by reticular and honeycomb
findings; peripheral and bibasilar in
distribution
2.
Nonspecific interstitial
pneumonia (NSIP)
Dominated by reticular and ground-glass
findings; honeycombing rare, though has been
reported; peripheral and central distribution,
often bibasilar more than upper lobe;
characteristic subpleural sparing may be seen
3.
Cryptogenic organizing
pneumonia (COP)
Migratory, consolidative and ground-glass
infiltrates, often bilateral and peripheral with
lower lobe predominance; atoll (reverse halo)
sign supportive but not frequent; minimal
fibrosis or long-term sequelae
Types of Interstitial Pneumonia:

21. 4.
Desquamative interstitial
pneumonia (DIP)
More centrally located and diffuse ground-
glass infiltrates; occasional reticular findings
centrally located without peripheral
predominance
5.
Respiratory bronchiolitis-
interstitial lung disease
(RB-ILD)
Patchy bilateral centrilobular ground-glass
infiltrates or fine nodules, with airway
enlargement or thickening; minimal reticular
or fibrotic findings
6.
Acute interstitial
pneumonia (AIP)
Patchy ground-glass infiltrates and
consolidation, absent of underlying fibrotic or
chronic appearing interstitial process
7.
Lymphoid interstitial
pneumonia (LIP)
Thin-walled cystic findings in the majority,
with underlying patchy ground-glass or
consolidative features with lower lobe
predominance
8.
Pleuroparenchymal
fibroelastosis (PPFE)
Upper-lobe-predominant bilateral pleural
thickening, often associated with underlying
parenchymal interstitial process and varying
degrees of fibrosis (possibly UIP vs. NSIP-like)

22. Complications Of Pneumonia:
i. Pleural effusion, Empyema & Pleurisy
ii. Lung abscess
iii. Bacteremia & Septic shock
iv. Respiratory Failure

23. Pneumonia due to covid-19
 Covid-19 is a disease caused by the novel corona virus
 Early symptoms of covid-19 are: A fever, Dry cough &
Shortness of breath
 If your COVID-19 infection starts to cause pneumonia,
you may notice things like:
– Rapid heartbeat
– Shortness of breath or breathlessness
– Rapid breathing
– Dizziness
– Heavy sweating

24. Chest CT scan from a 65-year-old man with COVID-19. Pneumonia caused by the
new coronavirus can show up as distinctive hazy patches on the outer edges of the
lungs, indicated by arrows. (ground glass opacities)
Chest CT Scan findings in Covid-19 Pneumonia Patient