Before Proceeding to How to Read Chest Xray of Pneumonia patient , read the sequential reading of chest Xray.
RUZ- Right Upper Zone
RMZ- Right Middle Zone
RLZ- Right Lower Zone
CP angle- Costophrenic Angle
Air Bronchogram- air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)
1. Pneumonia Lobar consolidation – usually Streptococcal pathology
These are PA film of RMZ pneumonia.
Features of Pneumonia are-
- Normal or Increased Volume
- No Shift of Trachea
- Consolidation, Air Space Process
- Not Centered at Hilum
While Reading it Start sequentially . Here the findings can be read as-
To the Sequence add the finding ” The Trachea is Central, There is no shifting of Mediastinum, The Costophrenic angles are sharp and clear. There is non-homogenous opacity involving right middle zone with visible air bronchograms and indistinct borders. There is silhouetting of Right cardiac border ( RML pneumonia). Cardiac size looks Normal.”
2. Interstitial pneumonia : Usually Viral, Atypical organisms
Involvement of the supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules.
Findings ” Central trachea and Mediastinum, Diffuse fine reticular opacities involving the entire lung field with Normal CP angles and Normal cardiac Shadow”
3. Bronchopneumonia: usually shows bilateral involvement with patchy infiltrates. Eg. Xray of patient with Mycoplasma with peribronchial cuffing leading to patchy infiltrates”
Reading ” Patchy opacities with peri-bronchial cuffing in the perihilar areas bilaterally”
4. Pneumatocoeles: are intrapulmonary air-filled cystic spaces that can have a variety of sizes and appearances. Features are- smooth inner margins,contain little if any fluid, wall (if visible) is thin and regular, persist despite absence of symptoms.
Reading “Multiple Cystic translucent areas in the RLZ”
Round Pneumonia ( Rarely important) : Cause Bacterial infection in Children.
Round pneumonias are round-ish and while they are well-circumscribed parenchymal opacities, they tend to have irregular margins. Most commonly are solitary. Air-bronchograms are often present.
Next Article will include Chest Xray reading for Pulmonary TB, Collapse, Effusion and Abscess in next article.
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