Respiratory Illness (Acute)

Pathway

Images

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1a		Pneumococcal Pneumonia Images 1a and 1b (Plain Radiograph, PA and Lateral): There is widespread consolidation of the right lung with air bronchograms and bulging of the fissues (arrows) indicative of lobar pneumonia.
1b
2		Pneumocystis Pneumonia Image 2 (Plain Radiograph): Patchy bilateral infiltrates extending from the perihilar region is suggestive of Pneumocystis jirovecii (formely Pneumocystic carinii) infection in this immunocompromised patient.
3		Tuberculous Pneumonia Image 3 (Plain Radiograph): There is right middle and upper lobe consolidation with bilateral paratracheal lymphadenopathy (arrows). Multiple small nodules are scattered throughout the remaining lung parenchyma (arrowheads) indicative of tuberculous pneumonia with miliary spread.
4a		Lung Abscess Images 4a and 4b (Plain Radiograph, PA and Lateral): A large circumscibed lesion is present in the right lower lobe with a well defined wall and an air-fluid level consistent with a lung abscess.
4b
5a		Bronchopneumonia Images 5a and 5b : Post-mortem specimen showing patchy areas of consolidation consistent with bronchopneumonia.
5b
6a		Collapse Lung Images 6a, 6b and 6c (Plain Radiograph): There is collapse of the right upper lobe, the left upper lobe( the Golden S sign) and the left lower lobe respectively.
6b
6c

Teaching Points

Teaching Points

Role of Imaging in Acute Respiratory Illness

• Chest radiography is over utilized in the management of acute respiratory illness
• Certain clinical symptoms and signs can suggest a diagnosis of pneumonia but none can definitely rule in or out the diagnosis
• 5% of patients with acute respiratory illness have pneumonia from a primary care setting. This increases to 28% of patients in the accident and emergency environment
• CT is not routine in the setting of acute respiratory illness
• Lung ultrasonography (LUS) has shown to be promising in the evaluation of pneumothorax, pleural effusion and consolidations but with varying outcomes for the diagnosis of pneumonia. Therefore, an inconspicuous LUS does not exclude pneumonia and necessitates a chest radiography or chest CT scan for further evaluation

References

References

Date of literature search: June 2015

The search methodology is available on request. Email

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

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