Pneumonia/consolidation

Acute respiratory illness  with recently developed radiological shadowing is pneumonia

Inflammation of lung parenchyma  by accumulation of secretion and inflammatory cells in alveoli is consolidation/pneumonia

Radiological shadowing-Lobar ,segmental ,multilobar

Consolidation developes within 2 days

Radiological sign developes within 12 hours ,dissapears after 4 weeks

Types-

Clinically-CAP/community acquired pneumonia ,HAP/Hospital acquired pneumonia ,immunocompromised ,suppurative

Anatomically-Lobar ,lobular/bronchopneumonia

Spread-Droplet ,hematogenous/infective endocarditis

Agents/CAP-S.pneumoniae

                     Atypical-M.pneumoniae ,H.influenzae ,L.pneumophilla/cooling tower outbreak

Predisposing factors

• Infection
• Smoking
• Alcohol
• Drug abuser
• Brocnhiectasis
• Cystic fibrosis
• Immunocompromised

Lobar pneumonia

Homogenous consolidation of 1/more lobe with pleural inflammation

Bronchopneumonia

Patchy alveolar consolidation with bronchial or alveolar inflammation

Stages

Stage of congestion(1-2 d)-Alveoli filled with exudate

Stage of red hepatization(2-4d)-RBC in exudates ,cut surface looks like liver

Stage of grey hepatization(4-8d)-RBC hemolysed>Grey

Stage of resolution(8-9d)-Clearance and repair(Crepitation)

Clinical features(Typical pneumonia)

Constitutional-Fever ,rigor ,shivering ,loss of apetite

Pulmonary-

• Short painful dry cough
• Rusty sputum
• Pleuritic chest pain radiating ant.abdominal wall/shoulder
• Tender abdomen if with hepatitis

Differential diagnosis

TB

Pulmonary infarction

Pleural effusion

Malignancy

BOOP(Bronchiolitis obliterans organising pneumonia)

Recurrent pneumonia

When 3/more separate attack

Causes-Bronchial obs(Carcinoma ,FB) ,bronchiectasis ,lung abcess ,CF

Investigation

FBC with TC DC WBC ,Hb and ESR

Bacteria-Neutrophilic leucocytosis

Viral-Leukopenia

Atypical-Normal/slight leucocytosis

CXR-Homogenous opacity with air bronchogram within

Sputum for AFB ,Gm staining ,C/S

Pneumococcal Ag test

Cold agglutination test(Mycoplasma)

Treatment

Amoxicillin 500mg TDS /Clarithromycin 7 days

Pateint response but fever/CXR persists several wks

Complication

Para pneumonic effusion

Empyema

Lung abcess(4-6weeks treatment)

Lobar collapse

Pulmonary embolism

DVT/Deep vein thrombosis