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Imaging of pneumonia: trends and algorithms

Dept of Radiology, Section of Thoracic Imaging, Hospital de Sant Pau, Universidad Autónoma de Barcelona, San Antonio, Barcelona, Spain

CORRESPONDENCE: T. Franquet, Dept of Radiology, Section of Thoracic Imaging, Hospital de Sant Pau, Universidad Autónoma de Barcelona, San Antonio Ma Claret 167, 08025, Barcelona, Spain. Fax: 93 2919282

Keywords: chest radiograph, diagnosis, G-thorax, pneumonia, respiratory infections

Received: October 24, 2000
Accepted February 9, 2001

Abstract

Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Imaging plays a crucial role in the detection and management of patients with pneumonia.

This review article discusses the different imaging methods used in the diagnosis and management of suspected pulmonary infections. The imaging examination should always begin with conventional radiography. When the results of routine radiography are inconclusive, computed tomography is mandatory. A combination of pattern recognition with knowledge of the clinical setting is the best approach to the pulmonary infectious processes.

A specific pattern of involvement can suggest a likely diagnosis in many instances. In acquired immune deficiency syndrome patients, diffuse ground-glass and interstitial infiltrates are most commonly present in Pneumocystis carinii pneumonia whereas in the nonimmunosuppressed patients, a segmental lobar infiltrate is suggestive of a bacterial pneumonia. Round pneumonia is most often encountered in children than adults and is most often caused by Streptococcus pneumoniae. Different combinations of parenchymal and pleural abnormalities may be suggestive for additional diagnoses.

When an infectious pulmonary process is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures, and serving as an ideal tool for follow-up examinations.

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