Lobar pneumonia & bronchopneumonia

Question 1

Describe the pathology of lobar pneumonia.

Answer 1

• acute inflammation where inflammatory exudate fills within the intra-alveolar space (alveoli)
• consolidation and inflammation that affects a specific area of the lobe of the lung.
• starts distally and spreads more proximally compared to bronchopneumonia which affects the bronchiole and spreads distally to the alveoli.

Question 2

Briefly the pathophysiology of lobar pneumonia.

Answer 2

1. Inflammatory fluid fills the alveolus –> reduces SA and ability for oxygen to diffuse through alveolar-capillary membrane –> gas exchange impairment
2. Infection causes cilial dysfunction –> this may affect MCC and lead to changes to mucus production
3. Pathogens (e.g. bacteria) can overcome/bypass pulmonary defence system (i.e. macrophages) - lung becomes inflamed and lead to pain upon breathing -> decreased chest wall compliance affecting breathing

Question 3

What symptoms might someone with lobar pneumonia have?

Answer 3

Cough +/- sputum:

• air sacs filling with fluid due to infection so coughing is natural reflex to rid the excess fluid in the airways and the infection
• cough can be dry or mucus/haemoptysis (blood)

Dyspnea: inflammation and mucus in the airways increases airway resistance

Muscle pain - as body tries to fight infection

Malaise

Question 4

What might be some signs of lobar p?

Answer 4

CXR: opacification, lack of vascular markings
Ausc: crackles, wheeze, bronchial breath sounds
Palpation: decreased chest expansion
Obs: increased RR

Question 5

Describe what you might hear if you auscultated this patient with lobar p.

Answer 5

Bronchial breath sounds - bronchial tubes filled with fluid

Wheeze - narrowed airways due to inflammation

Crackles - fluid in the air sacs

Pleural rub - movement of inflamed pleural surfaces rubbing against each other during chest wall movement

Question 6

What features might you see on a CXR for this patient with lobar p?

Answer 6

Consolidation - fluid in the airspaces of the lung

Opacification sharply defined at the fissures - fluid or solid material within the airways (not patchy

Air bronchogram - fluid in the alveoli while there is still air in the airways

Question 7

What might the PFT findings be for patient with lobar p?

Answer 7

RESTRICTIVE DISEASE

• decreased FVC - mucus and fluid in the air sacs reduces volume of exhalation so can’t exhale fully after inspiration.
• decreased FEV1 - increased resistance of airway, decreased chest compliance
• normal FEV1/FVC
• decreased DLCO

Question 8

What impairments might someone with pneumonia have?

Answer 8

Gas movement impairment:

• inflammatory exudate in the alveoli reduces SA for oxygen diffusion across membrane (gas exchange impairment)
• decreased lung compliance due to pain of inflamed visceral pleural impacting function (CO2 impairment)
• won’t be able to transfer enough oxygen to your blood or get rid of the carbon dioxide in your blood –> decreased gas movement
• SOB, abnormal breathing pattern, chest wall pain

SECRETION

• cilial dysfunction –> loss of cilia which affects MCC as it needs cilia to sweep the mucus along airways and expectorated out
• MCC impairment can lead to abnormal amounts of mucus production

Question 9

Briefly describe the pathology of bronchopneumonia.

Answer 9

Form of inflammation of the bronchi that is PATCHY and DIFFUSE in nature (unlike lobar pneumonia) and affect areas through both lungs.

Question 10

What features might you see on a CXR for this patient with bronchopneumonia.

Answer 10

Opacifications (not sharply defined by the fissures since the nature of the inflammation is diffuse - fluid within the airways

Patchy, diffuse consolidation - fluid-filled alveoli