How to Read a Chest Xray II : Pneumonia

Before Proceeding to How to Read Chest Xray of Pneumonia patient , read the sequential reading of chest Xray.

Terminologies:

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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