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[[Image:Pneumonia_x-ray.jpg|left|200px|'''Pneumonia as seen on chest x-ray.'''
{{Pneumonia}}
''A'': Normal chest x-ray. ''B'': Abnormal chest x-ray with shadowing from pneumonia in the right lung (white area, left side of image).]]
{{CMG}}; {{AE}} {{HQ}}, [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] ; {{AL}}
An important test for pneumonia in unclear situations is a chest [[x-ray]]. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray.  
==Overview==
An important test for making a diagnosis of [[pneumonia]] is a chest [[x-ray]]. [[Chest X-ray|Chest x-rays]] can reveal areas of opacity (seen as white) which represent [[Consolidation (medicine)|consolidation]]. Pneumonia is not always seen on [[x-rays]], either because the disease is only in its initial stages, or because it involves a part of the [[lung]] not easily seen by [[X-rays|x-ray]].


In some cases, chest CT ([[computed tomography]]) can reveal pneumonia that is not seen on chest x-ray.  
==Chest X-Ray==
===Indications===
Patients with the following conditions should be evaluated with a [[chest X-ray]]:<ref name="pmid21661712">{{cite journal| author=Watkins RR, Lemonovich TL| title=Diagnosis and management of community-acquired pneumonia in adults. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 11 | pages= 1299-306 | pmid=21661712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21661712  }} </ref>


X-rays can be misleading, because other problems, like lung scarring and [[congestive heart failure]], can mimic pneumonia on x-ray.<ref name=syrjala>Syrjala H, Broas M, Suramo I, et al. ''High resolution computed tomography for the diagnosis of community-acquired pneumonia.'' Clin Infect Dis 1998; 27:358-363 PMID 9709887</ref> Chest x-rays are also used to evaluate for complications of pneumonia. (''[[Pneumonia#Complications|See below]].'')
* [[Fever]] (>37.8° C / 100° F)
* [[Tachypnea]] (> 20 breaths/min)
* [[Tachycardia]] (> 100 bpm)
* Decreased [[breath sounds]] and [[crackles]] in the physical exam


If a person is not getting better with antibiotics, or if the health care provider has concerns about the diagnosis, a [[microbiological culture|culture]]of the person's [[sputum]] may be requested.  
===Findings===
* [[X-ray]]s of the chest reveal areas of opacity.
*A normal [[Chest X-ray|chest x-ray]] makes community-acquired pneumonia (CAP) less likely; however, CAP is sometimes not seen on [[x-rays]] because the disease is either in its initial stages or involves a part of the lung not easily seen by [[X-rays|x-ray]].
* [[X-rays]] can be misleading, because other problems, like [[lung]] scarring and [[congestive heart failure]], can mimic pneumonia on [[X-rays|x-ray]].<ref name="syrjala">Syrjala H, Broas M, Suramo I, et al. ''High resolution computed tomography for the diagnosis of community-acquired pneumonia.'' Clin Infect Dis 1998; 27:358-363 PMID 9709887</ref> [[Chest X-ray|Chest x-rays]] are also used to evaluate for complications of pneumonia.
* [[Chest x-ray]] findings are usually nonspecific in [[viral pneumonia]].
* [[Computed tomography]] is used in situations when the diagnosis is not clear with a chest x-ray
 
==Hospital Acquired==
*The American Thoracic Society recommends that all patients with a suspicion of [[Nosocomial infection|nosocomial]] pneumonia should have a [[Chest X-ray|chest x-ray]] to confirm diagnosis and determine the severity of the disease.<ref>{{cite journal|title=Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=4|year=2005|pages=388–416|issn=1073-449X|doi=10.1164/rccm.200405-644ST}}</ref>
* A chest X-ray also helps to determine [[pleural effusion]]s or [[cavitation]]s, as a possible complication.
*Ideally, the [[chest X-ray]] should be posteroanterior and lateral, but this will depend on the patient's condition.
*Findings include the following:<ref name="KoenigTruwit2006">{{cite journal|last1=Koenig|first1=S. M.|last2=Truwit|first2=J. D.|title=Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention|journal=Clinical Microbiology Reviews|volume=19|issue=4|year=2006|pages=637–657|issn=0893-8512|doi=10.1128/CMR.00051-05}}</ref>
 
:*Unilateral or bilateral [[lung consolidation|consolidation]]
:*Air bronchogram
:*[[Pleural effusion]]
:*[[Cavitation]]
:*Ground glass opacities
 
*[[Chest X-ray|Chest x-ray]] is also used to assess improvement or lack of clinical response in hospitalized patients.
 
===Chest X-ray Gallery===
 
[[File:Pneumonia-right-middle-lobe-4.jpg|thumb|left|369x369px|Right middle lobe consolidation pneumonia [https://radiopaedia.org/cases/pneumonia-right-middle-lobe-4 Source:Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14979]]]
<br clear="left" />
[[File:Hospital_acquired_pneumonia.png|200px|thumb|left|X-ray shows homogenous radio-opaque areas in bilateral lung fields. These represent areas of consolidation [https://radiopaedia.org/cases/hospital-acquired-pneumonia Source: Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 26828]]]
<br clear="left" />
 
===Videos===
{{#ev:youtube|uhRIu8bDYA0}}
{{#ev:youtube|zDOFzw0Cmp4}}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Pneumonia]]
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Pediatrics]]
[[Category:Disease]]

Latest revision as of 23:45, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Priyamvada Singh, M.D. [3] ; Alejandro Lemor, M.D. [4]

Overview

An important test for making a diagnosis of pneumonia is a chest x-ray. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray.

Chest X-Ray

Indications

Patients with the following conditions should be evaluated with a chest X-ray:[1]

Findings

Hospital Acquired

  • The American Thoracic Society recommends that all patients with a suspicion of nosocomial pneumonia should have a chest x-ray to confirm diagnosis and determine the severity of the disease.[3]
  • A chest X-ray also helps to determine pleural effusions or cavitations, as a possible complication.
  • Ideally, the chest X-ray should be posteroanterior and lateral, but this will depend on the patient's condition.
  • Findings include the following:[4]
  • Chest x-ray is also used to assess improvement or lack of clinical response in hospitalized patients.

Chest X-ray Gallery

Right middle lobe consolidation pneumonia Source:Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14979


X-ray shows homogenous radio-opaque areas in bilateral lung fields. These represent areas of consolidation Source: Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 26828


Videos

{{#ev:youtube|uhRIu8bDYA0}} {{#ev:youtube|zDOFzw0Cmp4}}

References

  1. Watkins RR, Lemonovich TL (2011). "Diagnosis and management of community-acquired pneumonia in adults". Am Fam Physician. 83 (11): 1299–306. PMID 21661712.
  2. Syrjala H, Broas M, Suramo I, et al. High resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis 1998; 27:358-363 PMID 9709887
  3. "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.
  4. Koenig, S. M.; Truwit, J. D. (2006). "Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention". Clinical Microbiology Reviews. 19 (4): 637–657. doi:10.1128/CMR.00051-05. ISSN 0893-8512.

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