Pneumonia other imaging findings

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

Overview

Bronchoscopy with bronchoalveolar lavage is useful to obtain samples for gram stain and culture in patients with certain conditions, such as immunocompromised patients, ICU admission, or antibiotic failure.

Bronchoscopy is used in the diagnosis of pneumonia only in certain cases, such as patients admitted in the ICU, immunocompromised patients, or patients with treatment failure.
When sputum is not produced or not sufficient for evaluation, bronchoscopic sampling and bronchoalveolar lavage (BAL) is used to collect samples for gram stain and culture.^[1]
Bronchoscopy is particularly helpful in the diagnosis of PCP, as the sputum analysis have a high false-negative rate. ^[2]

In one study, ultrasonography was used to diagnose community acquired pneumonia with a high sensitivity and specificity (sensitivity of 93% and specificity of 98%).^[3]
Findings in the ultrasound for pneumonia include air bronchogram within an echopoor area and pleural effusion seen in some cases. ^[4]
Ultrasound can also be used for the follow-up of pneumonia.^[4]

↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). “Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults”. Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
↑ Pitchenik AE, Ganjei P, Torres A, Evans DA, Rubin E, Baier H (1986). “Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome”. Am Rev Respir Dis. 133 (2): 226–9. PMID 3484921.
↑ Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P; et al. (2012). “Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study”. Chest. 142 (4): 965–72. doi:10.1378/chest.12-0364. PMID 22700780.
↑ ^4.0 ^4.1 Reissig A, Copetti R (2014). “Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases”. Respiration. 87 (3): 179–89. doi:10.1159/000357449. PMID 24481027.