Pneumonia - Witwer Final Flashcards
T/F: With evaluation of pneumonia, radiographic appearance is predictive of the causative organism
False - not predictive (non-specific)
Radiographic appearance can help determine what about pneumonia?
- The presence of pneumonia
- Extent
- Possible complications
*Acts as a baseline study for future evaluations
Does the absence of radiographic findings of pnemonia exclude pneumonia as a Dx?
No! (dehydration)
Clinical Classification of pneumonia is based on ___ and ___ pneumonia is acquired.
Clinical Classification of pneumonia is based on how and where pneumonia is acquired.
What are the Clinical Classifications of pneumonia?
- Community Acquired (CAP)
- Nosocomial (Hospital Acquired, Healthcare Associated)
- Ventilator Associated
- Aspiration
What is the most common causative organism of CAP?
Streptococcus (Pneumococcus) pneumoniae (48%)
Viral is 2nd (19%)
What is the diagnostic strategy to confirm diagnosis in a CAP situation where a patient has a fever, cough, sputum, and coarse crackles?
Order CXR
If you see a segmental or lobar consolidation on CXR, there is a 90% chance of a CAP being caused by what 3 organisms?
- Pneumococcal
- Mycoplasma
- Viral
Nosocomial Pneumonia occurs after how many hours in the hospital?
48-72 hrs (or within 48 hrs of discharge)
What is the clinical presentation of typical bacterial pneumonia?
- High fever
- Rigors
- Productive cough
- Lobar consolidation
What is the clinical presentation of atypical bacterial pneumonia
- Dry cough
- Diffuse patchy infiltrates
What are the most common causative agents of Hospital Acquired Pneumonia?
- Aerobic Gram-Negative Bacilli (Enterobacter, E. coli, Pseudomonas, Aeruginosa)
- Gram positive cocci (Staph aureus - usually MRSA)
Does CAP or HAP have a higher mortality rate?
HAP
What is Health Care Associated Pneumonia (HCAP)?
- Now under HAP
- Patients who have extensive contact with health care -increasing the risk for virulent or drug resistant organisms
Intubation is a very high risk factor for what type of pneumonia?
Nosocomial (HAP)
What are the most common causative organisms of Ventilator Acquired Pneumonia (VAP)
- Pseudomonas aeruginosa is MC
- Klebsiella pneumoniae
- Serratia marcescans
- Enterobacter
What are examples of other radiographic findings in pneumonia that often complicate the evaluation of the radiographic studies?
- Atelectasis
- Pulmonary infarction
- Pulmonary edema
- Pleural effusions
- ARDS
*All of these are “water” density
Pneumococcal classically presents with what symptoms?
- Sudden onset of chills, fever, rigors
- Productive cough
- Pleuritic CP
- Focal pulmonary infiltrates
Staphylococcus aureus pneumonia can be rapidly ____ with destructive changes
Staphylococcus aureus pneumonia can be rapidly progressive with destructive changes
Haemophilus pneumonia in adults is found in smokers with ____
COPD
Mycoplasma and Chlamydia pneumonias often have insidious presentation with what symptoms?
- Dry cough
- Scattered infiltrates
Legionella pneumonia is often preceded by what?
GI complaints - presenting with hyponatremia, elevated LAD, delirium, or a very sick patient
An HIV patient presenting with strandy appearance (hazy) on CXR should make you think of what specific Dx?
Pneumocystis jiroveci (PJP)
*Note these pts could also present with subtle or absent findings
Tuberculosis causes what symptoms and is seen in what parts of the lungs?
- Chronic cough
- Weight loss
- Fevers
- Night sweats
Seen in upper lobes of lungs
What type of pneumonia is usually found bilaterally in the posterior lower lobes of the lungs?
Aspiration pneumonia
What would you expect to see during the PE of a pneumonia patient if there is consolidation?
- Fluid in the lungs may transmit sounds better than air
- Sounds created in vocal cords and trachea will be heard better and may be altered
- Tactile fremitus is augmented by fluid consolidation
- Normal spoken words heard clearer and louder
- Whispered words heard clearer and louder
- Spoken “E” will be altered to “A”
A CXR with diffuse alveolar infiltrate, enlarged hilar lymph nodes, and upper lung lobe changes should make you think of what specific Dx?
Primary Tuberculosis
*Note TB has a non-specific pattern
Ghon or Ranke complexes on CXR should make you think of what specific Dx?
TB - after the primary infection, there is healing with scar formation, usually in the upper lobes or upper portion of the lower lobes. The scar can contain viable bacteria
Primary Tuberculosis is associated with?
- Hilar adenopathy
- Pleural Effusions
What is Postprimary TB and what would you expect to see on CXR?
Reactivation TB or Secondary
- Cavitation is common (destroyed lung tissue in cave like manner)
- Thin walled
- Strandy fibrotic densities
- In upper lobes
What would you see on CXR for Miliary TB?
Multiple small tuberculomas scattered throughout the lungs
Viral pneumonias are radiographically ___-___
Viral pneumonias are radiographically non-specific - however tends toward interstitial, nodular, or patchy air-space consolidation, but can be segmental or lobar
What are the viral organisms that cause Viral Pneumonia?
- Influenza, Adenovirus
- Measles, Varicella-Zoster, Cytomegalovirus
- Beware more virulent forms such as Hanta virus
What is Non-Resolving Pneumonia?
Persistence of radiographic findings for more than a month in a clinically improved patient
*Beware of chronic underlying TB, fungal pneumonia, inflammatory pneumonitis, sarcoid or malignancy
What are these CXRs showing? Dx?
Peribronchial/Bronchial Cuffing –thickened bronchi secondary to inflammation and or mucus
Dx: Bronchopneumonia
What is this CXR showing?
Air bronchograms
*Note air in bronchi, airways are open and surrounded by alveolar consolidation of the lung
What is Bronchiolitis?
Diffuse inflammatory process involving the bronchioles
How does Bronchiolitis usually present in children?
- Usually seen in children < 18 months
- 2/2 to Respiratory Syncytial Virus (RSV), Adenovirus or others
- Diffuse hyperinflation of lungs - usually without pneumonia
- Child taking deep breaths in (children normally do not take deep breaths)
*Do not be fooled by a clear CXR - hyperinflation of lungs = difficulty moving air
In adults, Bronchiolitis can present as what?
- Can be a chronic inflammatory process
- Bronchiolitis Obliterans
- Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) with diffuse interstitial/alveolar infiltrates
