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How is pneumonia diagnosed?
Pneumonia is a clinical diagnosis based on history, physical examination, laboratory findings, and CXR findings. Consider microbiological studies and advanced diagnostics based on patient history, comorbidities, severity, and entity of pneumonia
List routine lab studies.
CBC, inflammatory markers: ↑ CRP, ↑ ESR, leukocytosis
↑ Serum procalcitonin (PCT): Procalcitonin is an acute phase reactant that can help to diagnose bacterial lower respiratory tract infections.
PCT can be used to guide antibiotic treatment but should not be used to decide if antibiotic therapy is necessary on its own.
PCT levels ≥ 0.25 mcg/L correlate with an increased probability of a bacterial infection.
Low PCT level after 2–3 days of antibiotic therapy can help facilitate the decision to discontinue antibiotics. [17]
ABG: ↓ PaO2
BMP, LFTs
List microbiological studies.
Describe the chest x-ray (posteroanterior and lateral) concerning indications and x-ray findings in pneumonia.
Lobar pneumonia
Opacity of one or more pulmonary lobes
Presence of air bronchograms: appearance of translucent bronchi inside opaque areas of alveolar consolidation
Bronchopneumonia
Poorly defined patchy infiltrates scattered throughout the lungs
Presence of air bronchograms
Atypical or interstitial pneumonia
Diffuse reticular opacity
Absent (or minimal) consolidation
Parapneumonic effusion
A new pulmonary infiltrate on chest x-ray in a patient with classic symptoms of pneumonia confirms the diagnosis.
Typical pneumonia usually appears as lobar pneumonia on x-ray, while atypical pneumonia tends to appear as interstitial pneumonia. However, the underlying pathogen cannot be conclusively identified based on imaging results alone.
List indications, advantages and findings of chest CT (non-contrast)
Indications
Inconclusive chest x-ray
Recurrent pneumonia
Poor response to treatment
Advantages: more reliable evaluation of circumscribed opacities, pleural empyema, or sites of consolidation
Findings:
Localized areas of consolidation (hyperdense)
Air bronchograms
Ground-glass opacities
Pleural effusion/empyema
Hyperdense fluid collection
Split pleura sign
Nodules
Large (e.g., in tuberculosis or fungal pneumonia)
Peribronchial (e.g., bronchopneumonia)
Disseminated (e.g., septic emboli or varicella-zoster pneumonia)
List indications for bronchoscopy.
Suspected mass (e.g., recurrent pneumonia)
Need for pathohistological diagnosis (e.g., biopsy of a central mass discovered on CT)
Inconclusive results on CT
Describe indications and findings for diagnostic thoracentesis.
Indications: consider if pleural effusion is present to evaluate for pleural empyema
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