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Debasis Das
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David C Howlett
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Abstract
Pneumonia is a leading cause of morbidity and mortality in the UK, and
chest X-rays are the initial modality of investigation in most cases.
Broad categories of infective change can be recognized on chest X-ray,
and are associated with different aetiological organisms. These chest
X-ray patterns, including lobar pneumonia, bronchopneumonia, nodular
consolidation, interstitial consolidation, atypical pneumonia, and lung
abscesses, are reviewed and the commonest micro-organisms that are
likely to be responsible discussed. The sequelae of pneumonia, and the
differential diagnoses that pneumonia is frequently mistaken for are
also discussed. Knowledge of the chest X-ray manifestations of
pneumonia will help readers to guide appropriate therapy in the future,
and anticipate any complications that may arise.
What is consolidation?
Consolidation is essentially inflammatory exudate within the
lung tissue. This results in the normally lucent (black), air-filled
pulmonary tissue appearing opaque (white) on CXR. Different
infective organisms tend to produce consolidation with differing
distribution around the lung and, when taken together with
clinical information, recognition of these different patterns of
infection on CXR can narrow down the list of likely causative
organisms and help guide appropriate therapy.
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Nodular consolidation
Nodules are small, rounded foci of air-space opacity, and are
usually associated with non-bacterial or uncommon bacterial
infections.1,2,4 Examples include:
Varicella zoster (chicken pox virus), which produces widespread, bilateral nodular pneumonia (see Figure 2)
Mycoplasma pneumoniae (atypical bacterium), which usually
causes nodular pneumonia within one lung. These nodules
can coalesce as the infection progresses and produce a patchy
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REFERENCES
1 Wilson AG, Armstrong P. Pulmonary infection in adults. In: Grainger RG,
Allison DJ, eds. Diagnostic radiology. 2nd edn. London: Churchill
Livingstone; 1992. p. 213e47.
2 Herold CJ, Sailer JG. Community-acquired and nosocomial pneumonia.
Eur Radiol 2004; 14: E2e20.
3 Wilson AG. Interpreting the chest radiograph. In: Grainger RG,
Allison DJ, eds. Diagnostic radiology. 2nd edn. London: Churchill
Livingstone; 1992. p. 149e61.
4 Ketai L, Washington S. Radiology of acute diffuse lung disease in
the immunocompetent host. Semin Roentgenol 2002 Jan; 37:
25e36.
5 Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J
Med 2001; 344(9): 665e71.
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