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Pneumonia: Difference between revisions
→Diagnosis
(Created page with "'''Pneumonia''' is an acute inflammation of the lung parenchyme, with involvement of the bronchioli and alveoli, most often caused by microbes. It can have significant mortality. It’s a very common condition. In young people, it usually have a mild natural course, but for elderly, it has a high mortality. '''Community-acquired pneumonia''' affects 0,1 – 1% of the adult population each year. It’s more common in young children and older adults, especially those with...") |
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* Bronchial breathing | * Bronchial breathing | ||
=== Laboratory examination === | |||
In nosocomial pneumonia, [[sputum culture]], [[blood culture]], and [[Arterial blood gas|ABG]] are important to guide treatment. <abbr>[[C-reactive protein|CRP]]</abbr> and [[leukocytes]] are usually measured to monitor severity. [[Procalcitonin]] can be used to differentiate bacterial from non-bacterial causes. | |||
=== Imaging of pneumonia === | |||
The gold standard for diagnosis is the presence of a new lung shadow on chest x-ray in the setting of typical clinical features. In elderly typical lung symptoms are not necessary for diagnosis. The shadow classically conforms to one lobe and is associated with air bronchograms. The chest x-ray findings usually persist for weeks even after symptoms have cleared, so they’re usually not used for follow-up. Chest x-ray is negative in the first 24 – 48 hours. The sensitivity of chest x-ray for pneumonia is low, and so a negative x-ray does not rule it out, especially in the early phases. | The gold standard for diagnosis is the presence of a new lung shadow on chest x-ray in the setting of typical clinical features. In elderly typical lung symptoms are not necessary for diagnosis. The shadow classically conforms to one lobe and is associated with air bronchograms. The chest x-ray findings usually persist for weeks even after symptoms have cleared, so they’re usually not used for follow-up. Chest x-ray is negative in the first 24 – 48 hours. The sensitivity of chest x-ray for pneumonia is low, and so a negative x-ray does not rule it out, especially in the early phases. | ||
In atypical pneumonia, chest x-ray can be negative. In these cases, CT can show characteristic changes. These bacteria can’t be cultured but the specific pathogen can be determined by serology or PCR. | In atypical pneumonia, chest x-ray can be negative. In these cases, CT can show characteristic changes. These bacteria can’t be cultured but the specific pathogen can be determined by serology or PCR. | ||
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There are rapid antigen tests of urine for detection of S. pneumoniae and legionella, which can be used for more complicated cases. This is usually not necessary in a typical case of CAP. | There are rapid antigen tests of urine for detection of S. pneumoniae and legionella, which can be used for more complicated cases. This is usually not necessary in a typical case of CAP. | ||
Differential diagnosis | === Differential diagnosis === | ||
* [[Acute bronchitis]] | * [[Acute bronchitis]] | ||
* Exacerbation of COPD | * [[COPD exacerbations|Exacerbation of COPD]] | ||
* [[Pulmonary embolism]] | * [[Pulmonary embolism]] | ||