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Pneumonia

  • Ronald L. Eisenberg
Chapter

Abstract

This chapter describes the imaging patterns of pneumonia (lobar, lobular, interstitial, round) and its complications (abscess, empyema, pneumatocele); bacterial, fungal, and viral infections; and the many manifestations of pulmonary tuberculosis.

Keywords

Lobar pneumonia Lobular pneumonia Interstitial pneumonia Lung abscess Empyema Pneumatocele Fungal pneumonia Viral pneumonia Bacterial pneumonia Bulging fissure sign Pulmonary tuberculosis 

Supplementary material

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Fig. e6.1 Subtle retrocardiac pneumonia. (a) Frontal view shows normal discrete tubular vessels behind the heart (TIF 3129 kb)
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Fig. e6.1 Subtle retrocardiac pneumonia. (b) Obscuration of the vessels behind the heart (arrows) indicates pneumonia (TIF 511 kb)
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Fig. e6.2 Lobar pneumonia (right upper lobe). Homogeneous consolidation of the right upper lobe and the medial and posterior segments of the right lower lobe. Note the associated air bronchograms (arrows) [1] (TIF 795 kb)
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Fig. e6.3 Lobular pneumonia (right middle lobe). (a) Increased opacification at the right base medially silhouettes the right heart border (TIF 1725 kb)
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Fig. e6.3 Lobular pneumonia (right middle lobe). (b) Lateral view shows that the opacification projects over the cardiac shadow (arrows), consistent with a right middle lobe pneumonia (TIF 2078 kb)
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Fig. e6.4 Lobular pneumonia (lingula). (A) An area of consolidation silhouettes the left heart border (TIF 1400 kb)
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Fig. e6.4 Lobular pneumonia (lingula). (B) Lateral view shows that the opacification projects over the cardiac shadow (arrow), confirming its location in the lingula (TIF 1792 kb)
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Fig. e6.5 Lobular pneumonia (multifocal). (A) Heterogeneous areas of opacification in the lower lungs on the right (back arrow) and left (white arrow) (TIF 2110 kb)
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Fig. e6.5 Lobular pneumonia (multifocal). (B) On the lateral view, the anterior opacification (black arrow) is in the right middle lobe, with a sharp posterior margin at the major fissure. The posterior opacification (white arrow) is in the left lower lobe, silhouetting the left hemidiaphragm and producing a positive spine sign (TIF 2010 kb)
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Fig. e6.6 Lobular pneumonia (lingula). Focal consolidation with air bronchograms (arrow) [2] (TIF 581 kb)
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Fig. e6.7 Lobular pneumonia (multifocal). Ill-defined areas of mixed interstitial-alveolar infiltrates in the right upper lobe, along with a segmental ground-glass opacity in the superior segment of the left lower lobe [2] (TIF 441 kb)
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Fig. e6.8 Interstitial pneumonia (Pneumocystis jirovecii). Diffuse, bilateral ground-glass opacities with minimal peripheral sparing in a patient with AIDS [1] (TIF 532 kb)
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Fig. e6.9 Round pneumonia. Soft-tissue opacifications in the posterolateral aspects of both lower lobes (arrows) with mild bilateral hilar prominence [1] (TIF 646 kb)
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Fig. e6.10 Round pneumonia. (a) Radiographs demonstrate a mass-like lesion in the right lower lobe (arrows) (TIF 1776 kb)
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Fig. e6.10 Round pneumonia. (b) Radiographs demonstrate a mass-like lesion in the right lower lobe (arrows) (TIF 2085 kb)
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Fig. e6.10 Round pneumonia. (c) CT image shows an irregular cavitary mass with air bronchograms (TIF 1123 kb)
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Fig. e6.10 Round pneumonia. (d) After appropriate antibiotic therapy, a repeat scan demonstrates clearing of the pneumonia and a residual pneumatocele (arrow) (TIF 1271 kb)
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Fig. e6.11 Aspiration pneumonia. Bilateral air-space opacities (open arrows), predominantly in the posterior and lower lung, in a patient with gastroesophageal reflux disease. Note right-sided position of a dilated esophagus (solid arrow) [3] (TIF 1463 kb)
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Fig. e6.12 Lipoid pneumonia after laxative aspiration. Ovoid opacity with virtually pathognomonic central fat attenuation (arrow) in the medial segment of the middle lobe [3] (TIF 1122 kb)
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Fig. e6.13 Post-obstructive pneumonia (failure of pneumonia to clear). (a) Initial image shows an area of opacification in the left mid-lung (arrow) (TIF 1582 kb)
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Fig. e6.13 Post-obstructive pneumonia (failure of pneumonia to clear). (b) After a course of antibiotics, a repeat study 6 weeks later shows no improvement and prompted the ordering of a CT scan (TIF 1434 kb)
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Fig. e6.13 Post-obstructive pneumonia (failure of pneumonia to clear). (c) This demonstrates an irregular mass (arrow) that proved to be a bronchogenic carcinoma (TIF 737 kb)
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Fig. e6.14 Pneumatocele. (a) Following hydrocarbon poisoning, there has been the development of a large, thin-walled cystic space (arrow) (TIF 578 kb)
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Fig. e6.14 Pneumatocele. (b) In another patient, there are multiple thin-walled pneumatoceles bilaterally, more prominent on the right [1] (TIF 631 kb)
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Fig. e6.15 Pneumatoceles. In this fire eater, there is a dramatic change (arrows) before (a) and after (b) treatment (TIF 2212 kb)
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Fig. e6.15 Pneumatoceles. In this fire eater, there is a dramatic change (arrows) before (a) and after (b) treatment (TIF 2138 kb)
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Fig. e6.15 Pneumatoceles. (c) Multiple pneumatoceles (arrows) after recurrent infections in a patient with AIDS [5] (TIF 2424 kb)
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Fig. e6.16 Lung abscess (Proteus pneumonia). Large, thick-walled left upper lobe cavity with an air-fluid level (arrow) and associated consolidation [1] (TIF 873 kb)
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Fig. e6.17 Lung abscess (staphylococcal pneumonia). Multiple cavities with air-fluid levels (arrows) associated with diffuse air-space consolidation and a large pleural effusion [1] (TIF 883 kb)
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Fig. e6.18 Lung abscess (Pneumocystis jirovecii pneumonia). (a) Left upper lobe consolidation with an air-fluid level (arrows) in a young male with AIDS (TIF 881 kb)
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Fig. e6.18 Lung abscess (Pneumocystis jirovecii pneumonia). (b) CT scan confirms a large abscess in the superior segment of the left lower lobe, with thick nodular walls and an air-fluid level (arrow) [2] (TIF 588 kb)
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Fig. e6.19 Lung abscess. (a) Irregular-walled cavity in the right apex posteriorly (arrows), representing a lung abscess that developed following surgery for a non-small-cell lung cancer (TIF 622 kb)
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Fig. e6.19 Lung abscess. (b) Irregular-walled cavity in the right apex posteriorly (arrows), representing a lung abscess that developed following surgery for a non-small-cell lung cancer (TIF 996 kb)
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Fig. e6.20 Empyema. Large soft-tissue mass fills much of the left hemithorax [1] (TIF 823 kb)
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Fig. e6.21 Empyema. Large mottled opacity over the right upper hemithorax represents an extensive empyema that obscures the underlying parenchymal streptococcal pneumonia. The patchy air densities within the empyema indicate communication with the bronchial tree [1] (TIF 991 kb)
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Fig. e6.22 Bulging fissure sign (Haemophilus influenzae pneumonia) [1] (TIF 773 kb)
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Fig. e6.23 Septic emboli. Multiple nodular opacifications throughout both lungs in a patient with endocarditis (TIF 1283 kb)
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Fig. e6.24 Septic emboli. Multiple nodular lesions. Note the peripheral location of the nodules and the numerous cavitations (TIF 594 kb)
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Fig. e6.25 Septic emboli. (a) Scattered, mostly peripheral, poorly defined foci of air-space consolidation, many of which contain varying degrees of cavitation. Note that a number of these appear to be associated with “feeding” vessels (arrows), suggesting a hematogenous origin [1] (TIF 605 kb)
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Fig. e6.25 Septic emboli. (b) Scattered, mostly peripheral, poorly defined foci of air-space consolidation, many of which contain varying degrees of cavitation. Note that a number of these appear to be associated with “feeding” vessels (arrows), suggesting a hematogenous origin [1] (TIF 594 kb)
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Fig. e6.26 Chronic eosinophilic pneumonia. Air-space consolidation confined mainly to the periphery of the lung (reverse pulmonary edema pattern) [7] (TIF 774 kb)
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Fig. e6.27 Aspergillosis. Multiple cavities of various sizes are superimposed on a diffuse pulmonary infiltrate. A fungus ball almost fills the large cavity in the right upper lobe (arrows). A right pleural effusion also is seen in this patient with chronic lymphocytic leukemia [1] (TIF 703 kb)
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Fig. e6.28 Aspergillosis. Thin-walled cavitary nodule in the right lung of a patient with leukemia [1] (TIF 1792 kb)
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Fig. e6.29 Aspergillosis. Bilateral large upper lobe cavities containing fungus balls of different sizes in an elderly man with residual tuberculosis [1] (TIF 484 kb)
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Fig. e6.30 Invasive pulmonary aspergillosis. Nodule in the posterior segment of the right upper lobe is surrounded by a “halo” of ground-glass opacity (arrows) in this young neutropenic male [2] (TIF 817 kb)
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Fig. e6.31 Aspergilloma. (a) Soft-tissue mass within a cavity (air crescent sign) in the right upper lobe (TIF 636 kb)
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Fig. e6.31 Aspergilloma. (b) Supine and (c) prone axial CT images show that the curvilinear air moves to the nondependent position (TIF 545 kb)
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Fig. e6.31 Aspergilloma. (b) Supine and (c) prone axial CT images show that the curvilinear air moves to the nondependent position (TIF 1535 kb)
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Fig. e6.32 Fungal lung abscess. Large right apical, thick-walled cavitary lesion in an acutely ill patient with actinomycosis [1] (TIF 598 kb)
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Fig. e6.33 Fungal lung abscess. Large thin-walled cavity at the right base (arrow) containing a smooth, elliptical homogeneous mass (arrowheads), representing a mucormycosis fungus ball in a diabetic patient [1] (TIF 589 kb)
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Fig. e6.34 Pneumocystis jiroveci pneumonia. Severe, bilateral air-space consolidation with air bronchograms. The patient was undergoing immunosuppressive therapy for lymphoma and died shortly after this radiograph was made [1] (TIF 619 kb)
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Fig. e6.35 Pneumocystis jiroveci pneumonia. (a) Bilateral, symmetric, mostly perihilar opacities (TIF 1674 kb)
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Fig. e6.35 Pneumocystis jiroveci pneumonia. (b) CT image confirms the bilateral, widespread ground-glass opacities and also shows scattered lung cysts (arrow) [5] (TIF 1118 kb)
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Fig. e6.36 Pneumocystis jirovecii pneumonia. Bilateral ground-glass opacities containing multiple cysts in a young HIV-positive male [2] (TIF 824 kb)
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Fig. e6.37 Infectious mononucleosis. (a) Bilateral hilar lymphadenopathy [1] (TIF 795 kb)
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Fig. e6.37 Infectious mononucleosis. (b) Bilateral hilar lymphadenopathy [1] (TIF 1027 kb)
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Fig. e6.38 Varicella pneumonia. Multiple calcified nodules [1] (TIF 681 kb)
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Fig. e6.39 Tree-in-bud pattern (respiratory syncytial virus). Peripheral, poorly defined centrilobular nodules and “tree-in-bud” opacities bilaterally in a patient with leukemia. Note the scattered lung nodules surrounded by halos of ground-glass attenuation [1] (TIF 1572 kb)
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Fig. e6.40 Primary tuberculosis. Combination of a focal parenchymal lesion (arrows) and enlarged right hilar lymph nodes [1] (TIF 554 kb)
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Fig. e6.41 Primary tuberculosis. Unilateral right tuberculous pleural effusion without parenchymal or lymph node involvement [1] (TIF 739 kb)
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Fig e6.42 Inactive tuberculosis. (a) Calcified peripheral granuloma (Ghon lesion, black arrow) and calcified hilar lymph nodes (white arrows), combining to form a Ranke complex [8] (TIF 1681 kb)
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Fig e6.42 Inactive tuberculosis. (b) Calcified peripheral granuloma (Ghon lesion, black arrow) and calcified hilar lymph nodes (white arrows), combining to form a Ranke complex [8] (TIF 1521 kb)
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Fig e6.43 Inactive tuberculosis. Densely calcified hilar nodes and enlarged calcified node in the aorticopulmonary window (arrow) (TIF 1776 kb)
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Fig e6.44 Inactive tuberculosis. Apical pleural thickening (arrows) (TIF 1174 kb)
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Fig e6.45 Mediastinal tuberculous adenopathy. Multiple enlarged mediastinal lymph nodes with central areas of low attenuation and peripheral enhancement (arrows) [1] (TIF 608 kb)
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Fig. e6.46 Recurrent active tuberculosis. (a) Years after clearing of the process in Fig. 6.23, thee is the development of a new opacity in the left perihilar region (arrow) (TIF 1711 kb)
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Fig. e6.46 Recurrent active tuberculosis. (b) CT image confirms the changes as cavitation (black arrows) and also demonstrates a surrounding tree-in-bud pattern (white arrow) [3] (TIF 1282 kb)
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Fig. e6.47 Active tuberculosis. Large cavitary lesion with surrounding consolidation involving the apical posterior segment of the right upper lobe. (Courtesy of Diana Litmanovich, MD, Boston) (TIF 1496 kb)
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Fig e6.48 Active tuberculosis. Multiple large cavities with air-fluid levels in both upper lobes. Note the chronic fibrotic changes and upward retraction of the hila [1] (TIF 916 kb)
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Fig e6.49 Active tuberculosis. (a) Multiple areas of the “tree-in-bud” pattern (arrows) (TIF 519 kb)
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Fig e6.49 Active tuberculosis. (b) More inferior image shows larger nodular opacities (arrows), representing extension of the granulomatous infection into adjacent alveoli [1] (TIF 520 kb)
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Fig e6.50 Active tuberculosis with endobronchial spread. Typical appearance of numerous, diffuse, poorly defined nodules, some of which are perivascular and centrilobular [1] (TIF 845 kb)
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Fig. e6.51 Active tuberculosis with endobronchial spread. (a) Maximum intensity projections (MIPS) show generalized tree-in-bud opacities [9] (TIF 1346 kb)
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Fig. e6.51 Active tuberculosis with endobronchial spread. (b) Maximum intensity projections (MIPS) show generalized tree-in-bud opacities [9] (TIF 1889 kb)
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Fig e6.52 Healed active tuberculosis. Diffuse interstitial fibrosis pattern [1] (TIF 665 kb)
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Fig e6.53 Miliary tuberculosis. Numerous, well-defined, 1–2 mm nodules diffusely distributed through the right lower lobe. Some nodules appear septal (arrows) or subpleural, whereas others appear to be associated with small feeding vessels, suggesting a hematogenous origin [1] (TIF 928 kb)
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Fig e6.54 Miliary tuberculosis. Image at the level of the aortic arch shows numerous, 1–2 mm nodules randomly distributed throughout both lungs [2] (TIF 577 kb)

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ronald L. Eisenberg
    • 1
  1. 1.Department of RadiologyBeth Israel Deaconess Medical CenterBostonUSA

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