Pneumonia

Definition
Pneumonia is an infection of the pulmonary

parenchyma by both viruses and bacteria Especially affecting the microscopic air sacs (alveoli) Assoc. with fever, chest symptoms, and a lack of air spaces on a chest x-ray.

Pathophysiology
Results from the proliferation of microbial

pathogens at alveolar level and the hosts response to those pathogens. Most common way is by aspiration from the oropharynx, inhaled as contaminated droplets Rarely via hematogenous spread or by contiguous extension.

 Reach alveolar, resident alveolar macrophages

clearing and killing pathogens. The alveolar macrophages initiate the inflammatory response to bolster lower respiratory tract defenses. Triggers the clinical syndrome of pneumonia: - IL 1, TNF fever - IL 8 release of neutrophils and increased purulent secretions. Create an alveolar capillary leak (ARDS) radiographic infiltrate and rales. Hypoxemia results from alveolar filling

Pathology
Initial phase: edema presence of proteinaceous

exudate and often bacteria in the alveoli Red hepatization phase: presence of erythrocyte and neutrophils. Gray hepatization phase: erythrocytes have been lysed and degraded, fibrin deposition Resolution : macrophage dominant, debris and fibrin has been cleared.

Normal Chest Radiograph

Right lobar pnaumonia affecting right middle lobe

AP and Lateral chest xray showing air fluid level into the cavity after 14 days of admission. small amount of free pleural effusion in the right pleural cavity.

Lung Abscess
Defined as pulmonary parenchymal necrosis and

cavitation resulting from infection High microorganism burden as well as inadequate microbial clearance from the airways. The abscess contents are primarily PMNs, with collections of bacterial organisms.

 Most frequently caused by mouth anaerobs.

Reaches the lower airways, and infection is initiated

because the bacteria are not cleared. Results in aspiration pneumonitis and progression to tissue necrosis 7-14 days later, resulting in lung abscess.

Chest radiograph
Irregularly shaped cavity with an air-fluid level

inside. Most frequently occur in the posterior segments of the upper lobes or the superior segments of the lower lobes. The wall thickness progresses from thick to thin and from ill-defined to well circumscribed as the surrounding lung infection resolves.

Lung abscess in the left lower lobe, superior segment

Lateral chest radiograph shows air-fluid level

CT scan
Help visualize better than chest radiography An abscess often is a rounded radioluscent lesion

with a thick wall and ill-defined irregular margins.

Lung abscess in the posterior segment of the right upper lobe. A thin-walled cavity with surrounding consolidation