Acute Air Space Pneumonia

Results from infection by bacteria that multiply extracellularly in the alveoli.

o Causes Aveolar Inflammation
o Causes Dilation of Alveolar Capillaries
o Causes Exudation of Fluid into Alveoli
o Causes emigration of Neutrophils into Alveoli
o Causes Consolidation(Airlessness) of the effected lung.
Classification
o Two Patterns of Air Space Pneumonia
Lobar Pneumonia (Characteristics)
Bronchi are not involved
Large area is Consolidated, sometimes entire lobes
Typically occurs with Primary Pneumonias caused by
virulent agents (most commonly Pneumococci)
Bronchopneumonia
Bronchi are Involved (Infected)
Involvement of adjacent alveoli is patchy and limited
Patchy Consolidation
Typically occurs in Secondary Pneumonia caused by
less virulent agents.
Etiology
o Most common cause of Airspace Pneumonia: S Pneumoniae
60-70% of primary community-acquired pneumonias of lobar
pattern
Pathologic Features
o Air Space Pneumonia progresses through four stages:
Acute Congestion:
Early Phase of Infection (Bacteria multiplying and
spreading to adjacent alveoli)
Injury to Alveoli/Normal defenses have been overcome
Resulting Acute Inflammation
Alveolar Capillary Dilation
Fluid Exudation
Neutrophil Emigration
Erythrocyte Diapedesis (Passage of blood cells through
capillary walls)
Onset of Disease: High Fever and Cough
Possible Bacteremia
Possible Involvement of Pleura
Red Hepatization
Increasing Consolidation of involved lung
Continued Exudation
Continued Neutrophil emigration
Alveolar congestion still present
Alveolar air replaced with Exudate
Loss of Lining Cells but Alveolar Architecture
maintained
Infection is controlled in this stage (naturally or with
ABX)
Gray Hepatization (Healing Phase)
Features of Consolidation still present
Infection has been controlled
No continued Hyperemia
No continued Exudation
No continued Neutrophil emigration
Clinical Symptoms have diminished
Resolution (Healing Phase)
Exudate is slowly removed
Alveolar injury is repaired
Clinical Features and Diagnosis
o Patients Present with:
Acute Onset of Fever
Dyspnea
Cough (commonly productive of purulent, rust colored
sputum)