Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Mar;20(1):230186.
doi: 10.1183/20734735.0186-2023. Epub 2024 Apr 9.

Imaging in pulmonary infections of immunocompetent adult patients

Affiliations
Review

Imaging in pulmonary infections of immunocompetent adult patients

Svitlana Pochepnia et al. Breathe (Sheff). 2024 Mar.

Abstract

Pneumonia is a clinical syndrome characterised by fever, cough and alveolar infiltration of purulent fluid, caused by infection with a microbial pathogen. It can be caused by infections with bacteria, viruses or fungi, but a causative organism is identified in less than half of cases. The most common type of pneumonia is community-acquired pneumonia, which is caused by infections acquired outside the hospital. Current guidelines for pneumonia diagnosis require imaging to confirm the clinical suspicion of pneumonia. Thus, imaging plays an important role in both the diagnosis and management of pneumonia, with each modality having specific advantages and limitations. Chest radiographs are commonly used but have limitations in terms of sensitivity and specificity. Lung ultrasound shows high sensitivity and specificity. Computed tomography scans offer higher diagnostic accuracy but involve higher radiation doses. Radiological patterns, including lobar, lobular and interstitial pneumonia, provide valuable insights into causative pathogens and treatment decisions. Understanding these radiological patterns is crucial for accurate diagnosis. In this review, we will summarise the most important aspects pertaining to the role of imaging in pneumonia and will highlight the imaging characteristics of the most common causative organisms.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: S. Pochepnia has received honoraria from Boehringer Ingelheim outside the scope of this article. H. Prosch has received honoraria from AstraZeneca, BMS, Boehringer Ingelheim, Bracco, Daiichi Sankyo, Janssen, MSD, Novartis, Roche, Sanofi, Siemens Healthineers and Takeda outside the scope of this article. E.M. Grabczak, E. Johnson, F.O. Eyuboglu and O. Akkerman declare no potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
a) Chest radiograph (CXR) of a patient with Streptococcus pneumonia showing homogeneous consolidation with positive air bronchogram in the right lower lung field (arrow). b) Coronal reformation of the computed tomography (CT) of the same patient showing homogeneous consolidation with positive air bronchogram of the right lower lobe (arrow). c) CXR of a patient with Streptococcus pneumonia showing ill-defined nodules in the right middle and lower lung field (arrows). d) Coronal reformation of the CT of the same patient showing tree-in-bud as well as ill-defined bronchocentric nodules (arrow). e) CXR of a patient with Mycoplasma pneumonia showing faint micronodular opacities in the left lower lung field (arrow). f) Coronal reformation of the CT of the same patient showing tree-in-bud in the right upper lobe and left lower lobe (arrows), compatible with bronchiolitis. g) CXR of a patient with Influenza A pneumonia showing faint ground-glass opacities in the left lower lung field (arrow). h) Coronal reformation of the CT of the same patient showing extensive ground-glass opacities in both lungs with a predominance in the right upper and left lower lobe (arrows).
FIGURE 2
FIGURE 2
a) Chest radiograph (CXR) of a patient with Streptococcus pneumonia showing homogeneous consolidation with positive air bronchogram in the left upper lung field (arrow). b) Coronal reformation of the computed tomography (CT) of the same patient showing homogeneous consolidation with positive air bronchogram of the upper lobe (*) and bronchocentric ground glass in the lower lobe (arrow). c) Axial reformation of the CT of the same patient showing homogeneous consolidation with positive air bronchogram of the left upper lobe (arrow). d) CXR of a patient with Klebsiella pneumonia showing extensive consolidation in the left upper lobe with expansion of the affected lobe and the development of the bulging fissure sign (arrow). e) Chest CT of the same patient showing complete consolidation of the left upper lobe with a positive air bronchogram (arrow). f) Follow-up CXR performed 6 days later showing significant progression of the disease with complete consolidation of the left lung. g) CXR of a patient with Legionella pneumonia showing subtotal consolidation of the right upper lobe (arrow). h) Coronal and i) axial reformation of the CT of the same patient performed 3 days later showing inhomogeneous consolidation of the right upper lobe and extensive ground-glass opacities in the left upper and lower lobes.
FIGURE 3
FIGURE 3
a) Chest computed tomography (CT) of a patient with Streptococcus pneumonia showing bilateral bronchial wall thickening and centrilobular nodules (arrow). b) Chest CT of a patient with Mycoplasma pneumonia in the left lower lobe showing tree-in-bud (arrow). c) Chest CT of a patient with Haemophilus influenzae pneumonia showing centrilobular nodules (arrow) with interlobular septal thickening and small consolidations in the middle lobe. d) Chest CT of a patient with a thick-walled cavity in the right upper lobe (white arrow) due to a sternoclavicular septic arthritis (black arrow) with Staphylococcus aureus. e) Chest CT of a patient with septic S. aureus showing multiple ill-defined nodules and cavities (arrows). f) Chest CT of a patient with co-infection of H. influenzae, Streptococcus agalactiae and Streptococcus pneumoniae and human rhinovirus.
FIGURE 4
FIGURE 4
a) Chest computed tomography (CT) of a patient with Influenza A pneumonia showing bronchocentric ill-defined nodules in both lower lobes (arrows). b) Chest CT of a patient with Influenza A pneumonia on the left side showing patchy ground-glass opacification associated with multiple irregular areas of consolidation, predominantly in a peribronchial distribution (arrow). c) Chest CT of a patient with coronavirus disease 2019 pneumonia showing peripheral ground glass in both lower lobes (arrows). d) Chest CT of a patient with respiratory syncytial virus pneumonia showing extensive bronchocentric ground-glass opacities in both lungs. e) Chest CT of a patient with human metapneumovirus pneumonia showing extensive centrilobular ground-glass opacities in both lungs (arrow). f) Chest CT of a patient with varicella-zoster virus pneumonia showing multiple soft-tissue density nodules measuring 5–10 mm in diameter with a surrounding ground-glass attenuation halo (arrows). g) Chest CT of a patient with measles virus pneumonia showing bilateral multifocal ground-glass opacities located perihilarly or centrally, along with patchy consolidation. h) Chest CT of a patient with Hantavirus pneumonia showing septal lines (arrow) in both lungs.
FIGURE 5
FIGURE 5
a) Axial computed tomography (CT) in soft tissue window of a patient with lobar pneumonia on the left side and parapneumonic effusion (*) showing a rounded hypodense area (arrow) within the well-enhancing lobar pneumonia, corresponding to an area of necrosis. b) Coronal CT in soft tissue window of a patient with lobar pneumonia on the right side showing an encapsulated hypodense area (arrow) within the consolidated lung, corresponding to an abscess. The abscess penetrated through the diaphragm into the liver (*). c) Coronal CT in soft tissue window of a patient with lobar pneumonia and an encapsulated pleural effusion (*), which was confirmed to be an empyema.

Similar articles

Cited by

References

    1. Torres A, Cilloniz C, Niederman MS, et al. . Pneumonia. Nat Rev Dis Primers 2021; 7: 25. doi:10.1038/s41572-021-00259-0 - DOI - PubMed
    1. Jain S, Self WH, Wunderink RG, et al. . Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373: 415–427. doi:10.1056/NEJMoa1500245 - DOI - PMC - PubMed
    1. Martin-Loeches I, Torres A, Nagavci B, et al. . ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med 2023; 49: 615–632. doi:10.1007/s00134-023-07033-8 - DOI - PMC - PubMed
    1. Choi MH, Kim D, Lee KH, et al. . Changes in the prevalence of pathogens causing hospital-acquired bacterial pneumonia and the impact of their antimicrobial resistance patterns on clinical outcomes: a propensity-score-matched study. Int J Antimicrob Agents 2023; 62: 106886. doi:10.1016/j.ijantimicag.2023.106886 - DOI - PubMed
    1. Rosenthal VD, Maki DG, Mehta Y, et al. . International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am J Infect Control 2014; 42: 942–956. doi:10.1016/j.ajic.2014.05.029 - DOI - PubMed

LinkOut - more resources