X Ray Chest in CAP Dr G R Sethi

Questions  Does it confirm pneumonia?  Is it necessary for diagnosis of CAP?  What are the radiological patterns in CAP?  Can we differentiate Viral from Bacterial?  Can we identify individual/specific organism?  What are the mimickers of pneumonia?

Does it confirm pneumonia?  CAP is a clinical diagnosis.  X Ray Chest may be normal in some.

Is it necessary for diagnosis of CAP?  RTI guidelines suggest that It is not necessary in all cases particularly non severe cases It should be done if  If diagnosis is ambiguous  It is a complicated pneumonia  If child does not improve/deteriorates in 48 hours

What are the radiological patterns in CAP?  Airways  Air Spaces  Interstitium  Hyperaeration  Br wall thickening  Atelectasis  Irregular aeration  Parenchymal opacity  Acinar opacity  Airbronchogram  Fine linear markings  Interlobular septal thickening  Small nodular opacities

Can we differentiate Viral from Bacterial?  Radiographic – pathologic correlation is imperfect.  Alveolar airspace pneumonia is more likely to be bacterial  Hyperinflation with interstitial could mean viral  We can narrow down the etiologic possibilities by adding clinical and lab

Using combination of criteria  Total no. of cases of LRTI :80  Probable Viral etiology of LRTI : 65  Probable Bacterial etiology of LRTI : 05  Antibiotic added later during the course of treatment : 10

 Hb : 10.9 gm/dl  TLC : 9800  DLC : P 56 L 40 M 2 E 2  PC : 1.80 lakh  CRP : -VE

 Sadia, 6mo F  Fever, cough, Wheeze- 4 weeks  Treated with antibiotics because of infiltrates

 Hb : 9.7 gm/dl  TLC :  DLC : P 78 L 22 M 0 E 0  PC : 1.76 lakh  CRP : +VE

 Hb : 10.1 gm/dl  TLC :  DLC : P 56 L 42 M 2 E 0  PC : 1.76 lakh  CRP : -VE

DAY 4 Hb : 9.6 gm/dl TLC : DLC : P81L16M1E2 PC : 2.5 lakhs CRP : +VE

Localization  Position of opacity in AP/PA view  Silhouette sign  Lateral X Ray

 Hb : 10.7 gm/dl  TLC :  DLC : P 87 L 12 M 1 E 1  PC : 2.2 lakh  CRP : +VE

 Hb : 10.8 gm/dl  TLC :  DLC : P 80 L 17 M 1 E 2  PC : 2.2 lakh  CRP : +VE

Specific Bacterial Etiology  S Pneumoniae & Kliebsella  Mycoplasma S Aureus Gram –ve bacteria  Airspace, lobar  Bronchopneumonia, lobular Additiona findings in Kliebsella and Staph

Mimickers

 Thank you very much