Pneumonia knowledge for medical students and physicians. The radiographic manifestation of legionnaires disease in. Legionnaires disease is a severe type of pneumonia, or lung infection. Chest radiographic characteristics of communityacquired. Pneumonia and pulmonary infiltrates anesthesia key. Epidemiology legionella pneumonia tends to be more p. The causative organism is not identified on gram stain or culture of sputum. Upperlobe involvement and pleural effusion are rare. Apr 17, 2019 chest computed tomography scan in a 45yearold patient with chlamydia pneumonia shows a right upperlobe infiltrate. The radiologic manifestations of legionella pneumonia.
If you develop pneumonia symptoms, see a doctor right away. Legionella is an important communityacquired pneumonia pathogen. Chest radiographic characteristics of communityacquired legionella. Pneumonia is the most commonly described manifestation of legionella infection and is termed legionnaires disease. Chest computed tomographic findings and clinical features. The most common type of bacteria is streptococcus pneumoniae and h. The radiologic manifestations of legionnaires disease chest. On the chest x ray there is an illdefined area of increased density in the right upper lobe without volume loss. So yes if they saw an infiltrate you have pneumonia and should be treated with antibiotics. The chest x ray in legionella pneumoniae legionnaires disease. Atypical pneumonia refers to the radiological pattern associated with patchy inflammatory changes, often confined to the pulmonary interstitium, most commonly associated with atypical bacterial etiologies such as mycoplasma pneumoniae, chlamydophila pneumoniae and legionella pneumophilia.
The term atypical pneumonia is applied to nonlobar patchy or interstitial infiltrates on chest x ray the causative organism is not identified on gram stain or culture of sputum often they are not toxic. Viral and fungal pathogens may also create the radiological and clinical picture of atypical pneumonia. Imaging features can be variable although changes are often described as. Legionella communityacquired pneumonia cap presenting with. Legionnaires disease is a severe form of pneumonia caused by the bacterium legionella pneumophila that sickens about 5,000 people in the u. Reversible neurological syndromes with atypical pneumonia. The biggest antibiotic being used these days seems to been avelox. The chest radiographic manifestations of legionnaires disease in. It is what we look for on a chest x ray when looking for pneumonia. The classic etiologic agents of atypical pneumonia are legionella.
Language of the chest xray neighborhood radiologist. The demonstration of pyopneumothorax and of cavities with airfluid levels by x ray is highly suggestive of staphylococcal pneumonia. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Do not have shivers and do not seek medical attention. There may be early signs of pleural effusion, empyema, or tension pneumothorax. Lobular often staphlococcus, multifocal, patchy, sometimes without air bronchograms. When should patients with bacterial pneumonia have followup chest radiography, and which findings indicate the need for further treatment. Communityacquired pneumonia occurs in 4 million people and results in 1 million hospitalizations per year in the united states. Patients may develop acute pneumonia with rapid progression to acute respiratory distress syndrome. Ct scan showed extensive consolidation of the right upper lobe and the superior segment of the right lower lobe. Legionnaires disease signs and symptoms legionella cdc.
Cxr patchy unilobar infiltrate tx respiratory quinolones e. A newly developed pulmonary infiltrate on chest x ray in combination with the clinical features confirms the diagnosis. Apr 18, 2016 legionella pneumonia sx fever, productive cough, and diarrhea. The chest radiograph usually shows a patchy subsegmental infiltrate, overlapping with the appearance of legionella pneumonia. What is the oneyear mortality rate of someone with pneumonia 65 years old. Legionella pneumonia, also known as legionnaires disease, refers to pulmonary infection primarily with the organism legionella pneumophila.
On the chest xray there is an illdefined area of increased density in the right upper lobe without volume loss. The chest radiograph frequently shows a patchy infiltrate, with the occasional appearance of hilar adenopathy and pleural effusions figure 653. A darker chest x ray is a good one infiltrate patterns and pathogens lobar from pharm 406 at rutgers university. We describe three patients with leukemic involvement of the lung who. Our only patient with hilar infiltrate died of progressive pneumonia. What chest x ray finding would indicate that the pneumonia will be difficult to treat and is life threatening. In its more common manifestation, pneumonia is caused by a bug that forms pus in the airways and alveoli, resulting in consolidation in part of the lung. From our series, 17 patients had an abnormal chest xray on admission. A number of radiologic features on chest xray may aid in diagnosis and management of the patient with legionella infection. Diagnostically it is defined as a presence of infiltrate on chest x ray.
Thirty patients 68% were classified as having patchy airspace opacities, four 16% had confluent opacities, and 11 25% had interstitial infiltrates. The radiographic manifestation of legionnaires disease in taiwan is variable, ranging. Chlamydial infection is linked to adultonset asthma. In adults with normal vital signs and a normal lung examination the diagnosis is unlikely. Pontiac fever symptoms are primarily fever and muscle aches. A newly developed pulmonary infiltrate on chest xray in combination with the clinical. Infection with chlamydophila usually causes a mild illness with sore throat, lowgrade fever, and nonproductive cough, although occasionally patients have a more severe course. Pneumonia may have an associated parapneumonic effusion. Start studying bacterial infections of the lower respiratory tract. Pneumonia is typically diagnosed based on a combination of physical signs and a chest x ray. Small pleural effusions are common, whereas cavitation and hilar adenopathy are unusual. In the proper clinical setting this is most likely a lobar or segmental pneumonia.
But do these two definitions overlap 100% of the time. Legionella can also cause a selflimiting acute febrile illness, termed pontiac fever. Legionella pneumonia sx fever, productive cough, and. Many other diseases, caused by various pathogens, should be considered in the differential diagnosis. Pleuralbased infiltrates associated with pleuritic pain may mimic pulmonary embolism. X ray examination reveals lung consolidation, pneumatoceles, abscesses, empyema, and pneumothorax. Pneumonia is a respiratory infection characterized by inflammation of the alveolar. The bacteria were discovered after an outbreak at a philadelphia. A darker chest x ray is a good one infiltrate patterns and. Legionella pneumonia definition of legionella pneumonia by. Image in a 66yearold patient with legionella pneumonia. Etiologically it is defined as a infection of the lung parenchyma. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
Patchy infiltrate definition of patchy infiltrate by. The discovery of legionnaires disease as a communityacquired pneumonia in immunocompetent healthy children occurred fortuitously. Patchy frequently basilar infiltrate, occasional pleural effusion. Dec 03, 2016 i believed god has sent dr onokun to help people out from this horrible virus. Differential diagnosis for a respiratory disease outbreak. Other systemic manifestations associated with legionella include diarrhea, highgrade fever and hyponatremia. Pleural effusion is common and occasionally seen even in the absence of lung field infiltrates. When should patients with bacterial pneumonia have follow. Legionella pneumonia radiology reference article radiopaedia. Chest computed tomographic findings and clinical features of legionella pneumonia article in journal of computer assisted tomography 316. It seems reasonable that one could have a moderately severe bacterial infection of the lung parenchyma without evidence on chest x ray. Chest radiographs are often nonspecific with unilateral or bilateral, patchy infiltrate, bronchial or peribronchial in distribution in one or more segment, usually in lower lobe.
With viral pneumonias, chest radiographic findings usually are nonspecificthey cause an interstitial infiltrate, but some features are characteristic of individual viruses. When should patients with bacterial pneumonia have followup. Usually, there are 3 patterns of pneumonia that can be seen on a chest x ray. Legionella pneumonia, also known as legionnaires disease, refers to pulmonary. The term atypical pneumonia is applied to nonlobar patchy or interstitial infiltrates on chest xray. Mycoplasma pneumonia also occurs yearround, although it tends to cluster in epidemics every 4 to 8 years. Previously reported cases of patients who had symptomatic or roentgenographic acute leukemic lung diseases invariably presented with diffuse pulmonary infiltrates. Be sure to mention if you may have been exposed to legionella, have used a hot tub, spent any nights away from home, or stayed in a hospital in the last two weeks. Differential diagnosis for a repiratory disesae outbreak. The classic etiologic agents of atypical pneumonia are legionella species, mycoplasma pneumoniae, and chlamydia pneumoniae. Other organisms, such as staphylococcus aureus pneumonia can be seen on chest x ray as extensive infiltration and effusion or empyema. Dec 03, 2006 an infiltrate is a spot of the lung that means you have pneumonia. Legionnaires disease was first described after a pneumonia outbreak among american legion members attending a convention in philadelphia in july of 1976.
Chlamydophila pneumonia frequently have rales or rhonchi. Legionella has not been a prominent pathogen in children with pneumonia. Although commonly found at autopsy, leukemic infiltration of the lung is rarely recognized as a cause of respiratory symptoms or roentgenographic densities. A chest x ray taken during the illness is more likely to show diffuse lung involvement than a lobar pneumonia. Chest x ray in cases of typical pneumonia shows extensive opacity restricted to one lobe, while atypical pneumonia presents with diffuse, often subtle infiltrates. Can see nodular infiltrates, similar to those associated with fungal infection, in solid organ and hematopoietic stem cell transplant recipients, especially with infection caused by nonpneumophila legionella spp. Bacterial infections of the lower respiratory tract. The infiltrates in mycoplasma pneumonia can be unilateral, multilobar, or bilateral. Rarely, legionella causes extrapulmonary infections such as cellulitis, abscesses, endocarditis, or meningitis. Clinical manifestations and diagnosis of legionella infection.
Lobar classically pneumococcal pneumonia, entire lobe consolidated and air bronchograms common. Legionella pneumophila pneumonia presenting with severe. Atypical pneumonia refers to the radiological pattern associated with patchy. Hsv can produce focal lesions on chest x ray that begin as small nodules in the periphery. Chest ct findings and clinical features in mild legionella. Common pathogens include mycoplasma, legionella, chlamydiae, and. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The aim of this study was to explore the chest radiographic characteristics of communityacquired legionella pneumonia in the elderly.
Pneumonia and pulmonary infiltrates tintinallis emergency. Legionella pneumonia sx fever, productive cough, and diarrhea. The bug that causes the pneumonia bacteria, virus, or funguscan affect how it appears on a chest xray. Chest computed tomography scan shows dense alveolar consolidations in both lower lobes. Legionella urine antigen was positive and levofloxacin and rifampin were started. Pneumonia is an infection of the alveoli the gasexchanging portion of the lung emanating from different pathogens, notably bacteria and viruses, but also fungi. Chest radiographs for typical pathogens1,3 typical pneumococcal cap demonstrates a segmental infiltrate at the lobar regions chest x ray for atypicalviral pathogens1,3 not very well defined, with patchy like appearance and interstitial infiltrates that are generalized legionella pneumophilapresents on radiograph with. The type of pneumonia is sometimes characteristic on chest x ray.
In addition, legionella can affect other organ systems, causing sinusitis, pancreatitis, myocarditis, and pyelonephritis. Pioped study were atelectasis and patchy pulmonary opacity. The chest xray features of legionella pneumonia are nonspecific but include a midtolower zone predominance of patchy consolidation and. What are the atelectasis findings on a chest x ray. Chest radiograph shows multifocal, patchy consolidation in the right. Chest radiographs demonstrate normal findings or unilateral or patchy bilateral areas of consolidation, nodular opacities, bronchial wall thickening, and small pleural effusions. It is usually caused by a mixture of normally aerated and infected lung lobules. Legionnaires disease in chest x ray it is acute gramnegative bacterial pneumonia that occurs in local outbreaks or as sporadic cases and may cause a fulminant, often fatal, pneumonia. Classic diffuse, patchy infiltrates seen with legionella pneumonia. Patchy interstitial infiltrates respiratory disorders medhelp. Legionella pneumonia is usually classified as atypical. To evaluate mild legionella pneumonia lp by chest ct, and clinical features.
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