TUGAS MAKALAH

PNEUMONIA

AMARAN JAGATHESEVARAN

09/290421/KU/13573

BAGIAN RADIOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA

YOGYAKARTA

2014

CONTENTS

TITLE PAGE..........................................................................................................i

CONTENTS..........................................................................................................ii

CHAPTER. I. INTRODUCTION..........................................................................1

I.1. BACKGROUND…………………………………………………………….1

I.2. PURPOSE……………………………………………………………………1

I.3. BENEFITS…………………………………………………………………...1

CHAPTER. II. LITERATURE REVIEW.............................................................2

II.1. DEFINITION.................................................................................................2

II.2. EPIDEMIOLOGY..........................................................................................2

II.3. ETIOLOGY................................................................................................2-4

II.4. PATOFISIOLOGI.......................................................................................4-5

II.5. RISK FACTORS............................................................................................5

II.6. SIGN AND SYMPTOMS………………………………………………...5-6

II.7. DIAGNOSIS...............................................................................................6-7

II.8 MANAGEMENT.......................................................................................7-10

II.9 PROGNOSIS.................................................................................................10

CHAPTER. III. DISCUSSION......................................................................11-12

CHAPTER. IV. CONCLUSION.........................................................................13

REFERENCE......................................................................................................14

ATTACHMENT.............................................................................................15-20

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CHAPTER I

INTRODUCTION

I.1. BACKGROUND

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up

of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual

has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits

oxygen intake. Pneumonia is the single largest cause of death in children worldwide. Every year, it

kills an estimated 1.1 million children under the age of five years, accounting for 18% of all deaths of

children under five years old worldwide. Pneumonia affects children and families everywhere, but is

most prevalent in South Asia and sub-Saharan Africa. Because pneumonia is common and is

associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly

recognizing any complications or underlying conditions, and appropriately treating patients are

important. Although in developed countries the diagnosis is usually made on the basis of radiographic

findings, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical

findings obtained by visual inspection and on timing of the respiratory rate. Children can

be protected from pneumonia, it can be prevented with simple interventions, and treated with low-

cost, low-tech medication and care.

I.2. PURPOSE

The purpose of this paper is to know more about pneumonia in terms of its pathophysiology, sign

and symptoms, management and etc. More importantly to know more about variety of radiological

features of this disease.

I.3. BENEFITS

The main benefit of this paper is it helps me and those who read this paper to know pneumonia

more in depth. Besides that it also makes diagnosing and treating pneumonia easier due to the range of

topics discussed in this paper especially about radiology because it is one of the main tools used to

diagnose pneumonia.

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CHAPTER II

LITERATURE REVIEW

II.1. DEFINITION

Pneumonia can be generally defined as inflammation of the lung parenchyma, in which

consolidation of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells,

and fibrin is characteristic.  Infection by bacteria or viruses is the most common cause, although

inhalation of chemicals, trauma to the chest wall, or infection by other infectious agents such as

rickettsiae, fungi, and yeasts may occur. Pneumonia is often a complication of a pre-existing

condition/infection and is triggered when a patient's defense system is weakened, most often by a simple

viral respiratory tract infection or a case of influenza, especially in the elderly. Pneumonia affects the

lungs in different ways. Lobar pneumonia affects a lobe of the lungs, and bronchial pneumonia can affect

patches throughout both lungs. 

II.2. EPIDEMIOLOGY

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age

groups. In children, many of these deaths occur in the newborn period. The World Health Organization

estimates that one in three newborn infant deaths are due to pneumonia. Over two million children under

five die each year worldwide. Over two million children under five die each year worldwide. WHO also

estimates that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria

''Streptococcus pneumoniae'', and over 90% of these deaths take place in developing countries. Mortality

from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at

particular risk for pneumonia and associated mortality. High burden of disease in developing countries

and because of a relatively low awareness of the disease in industrialized countries.

II.3. ETIOLOGY

There are five main causes of pneumonia namely bacteria, viruses, mycoplasmas, other infectious

agents, such as fungi including pneumocystis and various chemicals.

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Bacteria are the most common cause of community-acquired pneumonia (CAP), with Streptococcus

pneumoniae isolated in nearly 50% of cases. Other commonly isolated bacteria include Haemophilus

influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases

Staphylococcus aureus Moraxella catarrhalis Legionella pneumophila and Gram-negative bacilli in 1%

of cases. A number of drug-resistant versions of the above infections are becoming more common,

including drug-resistant Streptococcus pneumoniae (DRSP) and methicillin-resistant Staphylococcus

aureus (MRSA). The spreading of organisms is facilitated when risk factors are present. Alcoholism is

associated with Streptococcus pneumoniae, anaerobic organisms, and Mycobacterium tuberculosis.

Smoking facilitates the effects of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella

catarrhalis, and Legionella pneumophila. Exposure to birds is associated with Chlamydia psittaci farm

animals with Coxiella burnetti aspiration of stomach contents with anaerobic organisms and cystic

fibrosis with Pseudomonas aeruginosa and Staphylococcus aureus. Streptococcus pneumoniae is more

common in the winter and should be suspected in persons aspirating a large amount anaerobic organisms.

In adults, viruses account for approximately a third and in children for about 15% of pneumonia

cases. Commonly implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory

syncytial virus (RSV), adenovirus, and parainfluenza. Herpes simplex virus rarely causes pneumonia,

except in groups such as: newborns, persons with cancer, transplant recipients, and people with

significant burns. People following organ transplantation or those otherwise-immunocompromised

present high rates of cytomegalovirus pneumonia. Those with viral infections may be secondarily infected

with the bacteria Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae,

particularly when other health problems are present. Different viruses predominate at different periods of

the year; during influenza season, for example, influenza may account for over half of all viral cases.

Outbreaks of other viruses also occasionally occur, including hantaviruses and coronavirus.

Fungal pneumonia is uncommon, but occurs more commonly in individuals with weakened

immune systems due to AIDS, immunosuppressive drugs, or other medical problems. It is most often

caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and

Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and

coccidioidomycosis is most common in the Southwestern United States. The number of cases have been

increasing in the later half of the 20th century due to increasing travel and rates of immunosuppression in

the population.

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A variety of parasites can affect the lungs, including Toxoplasma gondii, Strongyloides stercoralis,

Ascaris lumbricoides, and Plasmodium malariae. These organisms typically enter the body through direct

contact with the skin, ingestion, or via an insect vector. Except for Paragonimus westermani, most

parasites do not affect specifically the lungs but involve the lungs secondarily to other sites. Some

parasites, in particular those belonging to the Ascaris and Strongyloides genera, stimulate a strong

eosinophilic reaction, which may result in eosinophilic pneumonia. In other infections, such as malaria,

lung involvement is due primarily to cytokine-induced systemic inflammation. In the developed world

these infections are most common in people returning from travel or in immigrants. Around the world,

these infections are most common in the immunodeficient.

Tuberculosis can cause pneumonia (tuberculosis pneumonia). It is a very serious lung infection and

extremely dangerous unless treated early. Pneumocystis carinii pneumonia (PCP) is caused by an

organism believed to be a fungus. PCP may be the first sign of illness in many persons with AIDS. PCP

can be successfully treated in many cases. It may recur a few months later, but treatment can help to

prevent or delay recurrence.

Other less common pneumonias may be quite serious and occur more often. Various special

pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi. Rickettsia (also

considered an organism somewhere between viruses and bacteria) cause Rocky Mountain spotted fever,

Q fever, typhus and psittacosis, diseases that may have mild or severe effects on the lungs.

Noninfectious pneumonia are a class of diffuse lung diseases. They include diffuse alveolar

damage, organizing pneumonia, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonia,

desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and usual

interstitial pneumonia.

II. 4. PATHOPHYSIOLOGY

The invading organism causes symptoms, in part, by provoking an overly exuberant immune

response in the lungs. The small blood vessels in the lungs (capillaries) become leaky, and protein-rich

fluid seeps into the alveoli. This results in a less functional area for oxygen-carbon dioxide exchange. The

patient becomes relatively oxygen deprived, while retaining potentially damaging carbon dioxide. The

patient breathes faster and faster, in an effort to bring in more oxygen and blow off more carbon dioxide.

Mucus production is increased, and the leaky capillaries may tinge the mucus with blood. Mucus plugs

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actually further decrease the efficiency of gas exchange in the lung. The alveoli fill further with fluid and

debris from the large number of white blood cells being produced to fight the infection.

Consolidation, a feature of bacterial pneumonias, occurs when the alveoli, which are normally hollow air

spaces within the lung, instead become solid, due to quantities of fluid and debris. Viral pneumonias, and

mycoplasma pneumonias, do not result in consolidation. These types of pneumonia primarily infect the

walls of the alveoli and the parenchyma of the lung.

II. 5. RISK FACTORS

Pneumonia can affect anyone. But the two age groups at highest risk are:

Infants and children younger than age 2 years, because their immune systems are still developing

People older than age 65

Other risk factors include:

Certain chronic diseases, such as asthma, chronic obstructive pulmonary disease and heart

disease.

Weakened or suppressed immune system, due to factors such as HIV/AIDS, organ transplant,

chemotherapy for cancer or long-term steroid use.

Smoking, which damages your body's natural defenses against the bacteria and viruses that cause

pneumonia.

Being placed on a ventilator while hospitalized.

II. 6. SIGN AND SYMPTOMS

The signs and symptoms of pneumonia vary from mild to severe, depending upon factors such as the

type of germ causing the infection and your age and overall health. Mild signs and symptoms often are

similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia include:

Fever, sweating and shaking chills

Lower than normal body temperature in people older than age 65, and in people with poor overall

health or weakened immune systems

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Cough, which may produce thick, sticky fluid

Chest pain when you breathe deeply or cough

Shortness of breath

Fatigue and muscle aches

Nausea, vomiting or diarrhea

Headache

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and

cough, appear restless or tired and without energy, or have difficulty breathing and eating. Older people

who have pneumonia sometimes have sudden changes in mental awareness.

II. 7. DIAGNOSIS

Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray.

However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish

between bacterial and non-bacterial origin. The World Health Organization has defined pneumonia in

children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest

indrawing, or a decreased level of consciousness. A rapid respiratory rate is defined as greater than 60

breaths per minute in children under 2 months old, 50 breaths per minute in children 2 months to 1 year

old, or greater than 40 breaths per minute in children 1 to 5 years old. In children, increased respiratory

rate and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope.

In general, in adults, investigations are not needed in mild cases. There is a very low risk of

pneumonia if all vital signs and auscultation are normal. In persons requiring hospitalization, pulse

oximetry, chest radiography and blood tests including a complete blood count, serum electrolytes, C-

reactive protein level, and possibly liver function tests are recommended. The diagnosis of influenza-like

illness can be made based on the signs and symptoms, however confirmation of an influenza infection

requires testing. Thus, treatment is frequently based on the presence of influenza in the community or a

rapid influenza test.

Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen

saturation. The respiratory rate may be faster than normal, and this may occur a day or two before other

signs. Examination of the chest may be normal, but it may show decreased chest expansion on the

affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung

are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) may be

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heard over the affected area during inspiration. Percussion may be dulled over the affected lung, and

increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion.

A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed

only in those with potential complications, those not having improved with treatment, or those in which

the cause is uncertain. If a person is sufficiently sick to require hospitalization, a chest radiograph is

recommended. Findings do not always match the severity of disease and do not reliably separate between

bacterial infection and viral infection. X-ray presentations of pneumonia may be classified as lobar

pneumonia, bronchopneumonia (also known as lobular pneumonia), and interstitial pneumonia. Bacterial,

community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is

known as lobar pneumonia. However, findings may vary, and other patterns are common in other types of

pneumonia. Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs

and on the right side. Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have

bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. Radiologic

findings may not be present in the early stages of the disease, especially in the presence of dehydration, or

may be difficult to be interpreted in the obese or those with a history of lung disease. A CT scan can give

additional information in indeterminate cases.

In patients managed in the community, determining the causative agent is not cost-effective and

typically does not alter management. For people that do not respond to treatment, sputum culture should

be considered, and culture for Mycobacterium tuberculosis should be carried out in persons with a

chronic productive cough. Testing for other specific organisms may be recommended during outbreaks,

for public health reasons. In those hospitalized for severe disease, both sputum and blood cultures are

recommended, as well as testing the urine for antigens to Legionella and Streptococcus. Viral infections

can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction

(PCR), among other techniques. The causative agent is determined in only 15% of cases with routine

microbiological tests.

II. 8. MANAGEMENT

In most cases of pneumonia in young, otherwise healthy people with strong immune systems,

treatment can be done at home. If home treatment does not help, if symptoms get worse, or if signs of

complications of pneumonia develop, have to go to the hospital.

Home Treatment:

Drink plenty of liquids (1 - 2 quarts daily).

7

Take oral temperature several times a day. Call your doctor if it does not come down with

treatment.

Do not suppress a cough. Coughing is an important reflex for clearing the lungs. Some doctors

advise taking expectorants to loosen mucus.

Mild pain can be treated with aspirin (in adults only), acetaminophen , or ibuprofen.

For severe pain, codeine or another stronger pain reliever may be prescribed. It should be noted,

however, that codeine and other narcotics suppress coughing, so they should be used with care in

pneumonia. Such pain relievers often require monitoring.

Finish entire course of antibiotics.

Don't smoke.

Hospitalization Guidelines:

 If the pneumonia is severe enough for hospitalization, the standard treatment is intravenous

antibiotics for 5 - 8 days. In cases of uncomplicated pneumonia, many patients may need only 2 or 3 days

of intravenous antibiotics followed by oral therapy. Antibiotics taken by mouth are prescribed when the

patient has improved substantially or leaves the hospital. Patients should remain in the hospital until all

their vital signs are stable. Most patients become stabilized in 3 days and can continue treatment at home.

Many experts use seven variables to measure stability and to determine whether the patient can go home:

Temperature. Some experts believe that patients can go home when their temperature drops to

101 °F. Stricter criteria require that it be at or close to 98.6 °F.

Respiration rate. The goal is a normal breathing rate, although expert opinion differs on the

degree of normality required for discharge.

Heart rate. The goal is 100 beats per minute or less.

Blood pressure. The goal is systolic blood pressure of 90 mmHg or greater.

Oxygenation. The doctor determines the goal.

The ability to eat. The goal is regular appetite.

Mental function. The goal is normal.

Chest therapy using incentive spirometry, rhythmic inhalation and coughing, and chest tapping are all

important techniques to loosen the mucus and move it out of the lungs. It should be used both in the

hospital and during recovery at home.

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The patient uses an incentive spirometer at regular intervals to improve breathing and loosen sputum.

The spirometer is a hand-held clear plastic device that includes a breathing tube and a container with a

movable gauge. The patient exhales, then inhales forcefully through the tube, using the pressure of the

inhalation to raise the gauge to the highest level possible. During recovery, the patient performs rhythmic

breathing and coughing every 4 hours:

Before starting the breathing exercise, the patient should tap lightly on the chest to loosen mucus in the

lung. If available, a caregiver should also tap on the patient's back.

The patient inhales rhythmically and deeply three or four times.

The patient then coughs as deeply as possible with the goal of producing sputum.

Patients who are not able to get enough oxygen into their cells and bloodstream may need oxygen

therapy. It may be done in the hospital or at home under medical supervision. Delivery systems include an

oxygen concentrator or more mobile cylinder option. Nasal prongs or a face mask will deliver the oxygen.

Oxygen levels will be monitored regularly. Anyone using oxygen should stay away from open flames,

including cigarettes.

Dozens of antibiotics are available for treating pneumonia, but selecting the best drug is sometimes

difficult. Patients with pneumonia need an antibiotic that is effective against the organism causing the

disease. When the organism is unknown, "empiric therapy" is given, meaning the doctor chooses which

antibiotic is likely to work based on factors such as the patient's age, health, and severity of the illness.

In adults, the choice of antibiotic therapy depends on the severity of infection and site of care. In all

cases, the more quickly antibiotic therapy is started once the diagnosis is made, the better the outcomes.

In most cases, the organism causing the pneumonia will not be known before antibiotic therapy is started,

so the doctor must choose an antibiotic regimen based on history and symptoms. Later, the therapy may

be altered when more information becomes available.

There are not as many choices for treating viral pneumonia. Oseltamivir (Tamiflu) and zanamivir

(Relenza) have been the recommended drugs for influenza A or B infections, but some strains of

influenza A are resistant. Generally, their use is only recommended if they are started in the first 48 hours

of symptoms. Taken early, these medications may be effective in reducing symptoms and duration of

illness. However, treatment initiated after 48 hours may benefit children with severe disease.

Patients with viral pneumonias are at risk for what are called "superinfections," which generally refers to

a secondary bacterial infection, usually caused by S. pneumoniae, S. aureus, or H. influenzae. Doctors

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most commonly recommend treatment with amoxicillin-clavulanate, cefpodoxime, cefprozil, cefuroxime,

or a newer fluoroquinolone if these secondary infections occur.

Patients with pneumonia caused by varicella-zoster and herpes simplex viruses are usually admitted to the

hospital and treated with intravenous acyclovir for 7 days.

No antiviral drugs have been proven effective in adults with RSV, parainfluenza virus, adenovirus,

metapneumovirus, the SARS coronavirus, or hantavirus. Treatment is largely supportive, with patients

receiving oxygen and ventilator therapy as needed.

Treatment of RSV in Children. Ribavarin is the first treatment approved for RSV pneumonia, although it

has only modest benefits. The American Academy of Pediatrics recommends this drug for certain

children who are at high risk for serious complications of RSV.

II. 9. PROGNOSIS

With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. It often takes a few

weeks before most symptoms resolve. X-ray finding typically clear within four weeks and mortality is

low (less than 1%). In the elderly or people with other lung problems, recovery may take more than 12

weeks. In persons requiring hospitalization, mortality may be as high as 10%, and in those requiring

intensive care it may reach 30–50%. Pneumonia is the most common hospital-acquired infection that

causes death. Before the advent of antibiotics, mortality was typically 30% in those that were

hospitalized. Complications may occur in particular in the elderly and those with underlying health

problems. This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute

respiratory distress syndrome, sepsis, and worsening of underlying health problems.

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CHAPTER III

DISCUSSION

The discovery of x-rays made it possible to determine the anatomic type of pneumonia without

direct examination of the lungs at autopsy and led to the development of a radiological classification.

Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or

viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays.

Certain x-ray findings can be used to help predict the course of illness, although it is not possible to

clearly determine the microbiologic cause of a pneumonia with x-rays alone.

Bronchopenumonia is a very common form of pneumonia. It presents differently than lobar

pneumonia on the chest film. Lobar pneumonia tend to start at the periphery and involve a single lobe of

the lung. However, bronchopneumonia starts centrally in the bronchi and may cause peripheral

consolidation which is due to either infection or to atelectasis. Thus, a bronchopneumonia tends to be

bilateral. There is associated peribronchial thickening and there are patchy areas of consolidation is

asymmetrical. It may involve a segment of the right upper lobe and another in the lingula. The

commonest organism to cause bronchopneumonia is S. aureus. Bronchopneumonias are also very

common in children.

For lobar pneumonia characteristically, there is homogenous opacification in a lobar pattern. The

opacification can be sharply defined at the fissures, although more commonly there is segmental

consolidation. The non-opacified bronchus within a consolidated lobe will result in the appearance of air

bronchograms. Strictly speaking, consolidation is not associated with volume loss, however atelectasis

can occur with small airway obstruction.

Plain film features are non specific for interstitial pneumonia. While chest radiographs can be

even be normal in patients with very early disease, in advanced disease, it may show decreased lung

volumes and subpleural reticular opacities that increase from the apex to the bases of the lungs.

Necrotising pneumonia (NP) refers to a pneumonia characterised by the development of the

necrosis within infected lung tissue. While the term has sometimes been used synonymously with a

cavitating pneumonia in some publications , not all necrotising pulmonary infections may be complicated

by cavitation. If a necrotising infection is suspected and CT evaluation is required, it may be better to give

to contrast as it allows appreciation of low attenuation and non enhancement within the necrosed portions.

CT imaging may show distinct areas of low attenuation with decreased parenchymal enhancement,

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(representing liquifaction) in all or parts of the affected area of infection (consolidation). Normal

pulmonary parenchymal architecture within the necrosed segment is often lost.

Bacterial pneumonias usually tend to be unilobar and have cavitary lesions and effusions. Atypical

pathogens can cause multilobar involvement with nodular or reticular infiltrates, lobar or segmental

collapse, or perihilar adenopathy.

Radiologic findings of adult viral pneumonia are variable and overlapping. The correlation between

pathologic and radiologic findings is good. Because the viruses are intracellular pathogens, most

pathologic changes in the setting of viral pneumonia occur in the epithelium and adjacent interstitial

tissue. According to the virulence and the rate of the development of infection, 2 types of pathologic

reactions and radiologic aspects can be observed: usual, long-standing, or insidious course of pneumonia;

and rapidly progressive or virulent pneumonia.

The usual form (long-standing or insidious course of pneumonia) is characterized by lymphatic

infiltrates in the alveolar septa. These sometimes extend to the lung adjacent to the terminal and

respiratory bronchioles or even throughout the lobule in rare cases. On radiologic studies, these findings

appear as 4- to 10-mm, poorly defined nodules and patchy areas of peribronchial ground-glass opacity

and airspace consolidation, with variable hyperinflation.

The rapidly progressive or virulent pneumonia with diffuse alveolar hemorrhage extends to the

interstitium and the air space (with interstitial infiltrate, airspace hemorrhage, edema, fibrin, type 2

pneumocytes hyperplasia, hyaline membrane formation). The chest radiograph shows the rapid

confluence of patchy, unilateral, or bilateral consolidations and ground-glass opacity or poorly defined

centrilobular nodules.

For mycoplasma pneumonia there can be variable chest radiographic features, although four

different patterns have been described. No pattern is however pathognomonic.

peribronchial and perivascular interstitial infiltrates - common ~ 49% (can be patchy with a

segmental or non segmental distribution)

airspace consolidation ~ 38%

reticulonodular opacification ~ 8%

nodular or mass-like opacification ~ 5%.

Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones have

also been described. Other reported plain film findings include bilateral lesions, pleural effusion

(uncommon - in approximately 25% of cases) and hilar lymphadenopathy.

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CHAPTER IV

CONCLUSION

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with

fluid or pus, causing cough with phlegm or pus, fever, chills and difficulty breathing. A variety of

organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in

seriousness from mild to life-threatening. It is most serious for infants and young children, people older

than age 65, and people with underlying health problems or weakened immune systems. Antibiotics and

antiviral medications can treat many common forms of pneumonia.

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REFERENCE

1. <www.who.int> accessed on 3rd October 2014.

2. < http://www.slideshare.net/mlacombe/chest-xrays-pneumonias> accessed on 3rd October

2014.

3. < http://www.medicinenet.com/pneumonia> accessed on 3rd October 2014.

4. < http://umm.edu/health/medical/reports/articles/pneumonia > accessed on 3rd October

2014.

5. < http://www.webmd.com/lung/tc/pneumonia> accessed on 3rd October 2014.

6. < http://www.mayoclinic.org/diseases-conditions/pneumonia/ > accessed on 3rd October

2014.

7. < http://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.html>

accessed on 3rd October 2014.

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ATTACHMENT

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