Radiology of Pulmonary Infection, Lowry Example For Students

Radiology of Pulmonary Infection, Lowry Pneumonia CXR Lung Cancer CXR RML. Right heart border is being blurred/lost Atelectasis CXR This particular one is in the minor fissure Loculated Pleural Fluid CXR Pneumonia CT Atelectasis CT Lung Cancer CT Pleural Fluid CT The loss of a normal interface or border due to the pathological opacification of a region. Silhouette Sign Normal CXR Interfaces -Accentuation of patent airways within an opacity -Surrounding airspace if fluid filled -More suggestive of pneumonia than atelectasis Air Bronchograms -Peripheral opacity that rapidly evolves into a confluent homogenous consolidation -Nonsegmental -Effects entire lobe -Commonly caused by streptococcus pneumoniae and klebsiella -usually heals without sequela Lobar Pneumonia CXR -Form of lobar pneumonia -Klebsiella classically, S. Pneumo more common -Bulging fissure Round Pneumonia -Infection of the airway mucosa that extends into alveoli -Patchy nodular opacities -S. Aureus, or G- organisms -Scarring after healing Bronchopneumonia CXR -Anaerobic bacteria -Findings; bilateral medial lower low basal segment, right more common than left. -Can become necrotic, capitate, and form an abscess. -Any patient that cannot protect their airway is at risk. Aspiration Bronchopneumonia -Viruses, M. pneumoniae, PCP -Inflammation of interstitium -Bilateral symmetric linear reticular opacities -CT; Ground glass, whatever the (%$ that is. Interstitial Pneumonia -Organizing pneumonia -Cancer -Timeline differentiates them. Diseases that mimic pneumonia -Disease with histo description of peripheral airspaces filling with mononuclear cells, foamy macrophages, and organizing fibrosis. -Many known causes -Findings; variable appearances with migratory multifocal peripheral opacities. -Clinical; patient with protected nonproductive cough and low grade fever with restrictive pattern on PFT. Does not respond to antibiotics, does respond to steroids. -Good prognosis. Organizing pneumonia -Persistent opacity despite treatment Cancer -Get smaller post treatment -Halo border Acutely present or subside on serial imaging Infectious nodules -Thick walled cavity -Due to mixed anaerobic infection (S Aureus, pseudomonas) -Often related to aspiration, poor dental hygiene, LOC, esophageal dysmotlity, neurological disease Lung Abscess -Hematogenous spread of infection -Multiple peripheral basilar nodules, which may cavitate. -Some may show a feeding vessel, and an infarct -Related to IVDU, and bacterial tricuspid valve endocarditis -Staph Aureus and epidermis. Septic Emboli -Purulent material in the pleural space -Often related to evolution of a parapneumonic effusion, or an underlying lung infection that erupts into the pleural space (abscess or septic emboli). -Often located -Split Pleural sign Empyema -Granuloma; benign calcified nodules in the lung representing immune response to certain pathological insults. -Caused by infectious and non-infectious causes -Common infectious causes; Histo and TB. -Often seen with calcified hilar/mediastinal lymph nodes and hepatic/splenic granulomata. Granulomatous disease in the lung Progression of TB Infection -Clinical infection following first exposure. -Usually asymptomatic in children, only detected via PPD. -Symptomatic in adults. -FTT, night sweats, weight loss, hemoptysis. -Often no imaging signs. Primary TB -Airspace consolidation, right more often than left. -Mediastinal and ipsilateral hilar lymphadenopathy in children and immunocompromised. Atelectasis may occur from compression of central airways. -Plural effusion, usually small, isolated, and unilateral. -Findings clear slowly. Findings in primary TB -Ghon complex; Visualization of sight of initial infection and enlarged ipsilateral lymph node. -Ranke Complex; Calcified tuberculoma and ipsilateral hilar lymph node. Latent TB -Consolidation process -Extensive consolidation and cavitation can develop. -Posterior upper lobe and superior segment of lower lobes is most common. Primary Progressive TB -Reactivation TB -Classically in the apical posterior upper lobes and superior segments of lower lobes. -Rarely any pleural effusion or LAD. -May be associated with Tree in Bud opacities, which indicates the spread of the disease via the small airways. (Image) Post Primary TB -Miliary TB -indicates hematogenous spread Disseminated Disease -CD4>200; typical post-primary findings -CD4 Tuberculosis in the Immunocompromised -Consolidation -Endobronchial spread -Miliary Patterns -Centrilobular nodules (tree in bud) -Primary, progressive primary, post-primary. Signs of Active TB -Bronchiectasis -Linear scarring -Calcified nodules. -Stable for 6mos. Signs of inactive TB -M Avium Intracellulare Complex (MAC) -From natural water, soil, and animals. -Types; cavitary, bronchiectasis and nodules, centrilobular nodules. -Symptom; chronic cough. Non-Tubercular mycobacterium -Resembles post primary TB -Older men in 60s with COPD or mildly immunocompromised. Cavitary MAC -Bronchiectasis with waxing/waning nodules. -Middle lobe and lingual predominant -Women in their 60s. -Lady Wndemere syndrome Bronchiectasis and nodules MAC -Centrilobular ground glass nodules -Owners of hot tubs -Hot tub lung MAC with hypersensitivity pneumonitis -Bronchitis; cough and fever, +/- consolidation -Bronchiectasis Chronic Infection of the airways -AR genetic disorder with decreased airway mucus clearance. -Upper lobe in central cystic/varicoid bronchiectasis -Pseudomonas, aspergillus, mycobacterial infection Cystic Fibrosis -Invasive; neutropenic patients. -Semi-invasive; mild immunocompromised patients. (Chronic necrotizing aspergillosis) -Mycetoma; normal immunity, history of apical cavity. -Findings; angio invasive (halos early, air crescent late), airway invasive (tree in bud and centrilobar nodules) Aspergillosis -Mild immunocompromised patients -Chronic necrotizing aspergillosis -Findings like TB; upper lobe consolidation and cavity. Semi-invasive Aspergillosis -Mycetoma. -Normal immunity -History of apical cavity (prior TB, bull, abscess) Fungus ball fills a preexisting cavity. Saprophytic Aspergillosis