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- What is it:
- Bronchopneumonia refers to:
- A radiological and pathological finding
- characterized by
- patchy areas of
- inflammation or
- infection within the
- lung parenchyma,
- centered around the bronchi and bronchioles, and extending into adjacent alveoli.
- It reflects:
- A localized infectious or inflammatory process, most commonly caused by bacterial pathogens.
- Non-specific term:
- While typically associated with bacterial infection, bronchopneumonia may also describe:
- Non-infectious inflammatory processes, or
- Aspiration-related lung injury.
- Coexistence with Atelectasis:
- Bronchopneumonia can coexist with atelectasis due to:
- Obstruction of airways by inflammatory exudates or mucus plugs, leading to lung segment collapse.
- Etymology:
- Derived from the Greek words bronchos (windpipe) and pneumon (lung), referring to lung infection involving the bronchi and surrounding parenchyma.
- AKA:
- Bronchial pneumonia, Patchy pneumonia.
- How does it appear on each relevant imaging modality:
- Chest X-ray:
- Patchy opacities in a peribronchial distribution, often bilateral and asymmetric.
- Poorly defined margins blending into surrounding lung tissue.
- Areas of atelectasis may appear as linear opacities or volume loss adjacent to infected regions.
- Chest CT:
- Parts:
- Multifocal areas of consolidation and ground-glass opacities, centered around the bronchi and bronchioles.
- Size:
- Patchy, typically affecting segments or subsegments.
- Shape:
- Ill-defined, irregular opacities.
- Position:
- Peribronchial and peribronchiolar, often involving dependent lung regions.
- Coexisting atelectasis: Subsegmental or segmental collapse near bronchopneumonic areas.
- Character:
- Mixed alveolar and interstitial patterns.
- Air bronchograms may be present within consolidated areas.
- Time:
- Rapid onset with infectious etiology; resolves or evolves with treatment.
- Ultrasound:
- Subpleural consolidations may be visible in accessible areas.
- MRI:
- Rarely used; may highlight peribronchial inflammation and associated consolidation.
- These findings reflect:
- Infectious causes:
- Bacterial pneumonia:
- Common pathogens: Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa.
- Viral pneumonia:
- Secondary bacterial infection complicating influenza or RSV.
- Non-infectious causes:
- Aspiration pneumonia.
- Organizing pneumonia (secondary to infection or inflammation).
- Atelectasis coexistence:
- Associated with airway obstruction by mucus plugs or debris in bronchopneumonia.
- Differential diagnosis:
- Infectious mimics:
- Viral pneumonias without consolidation.
- Tuberculosis with patchy opacities.
- Non-infectious mimics:
- Aspiration-related pneumonitis.
- Organizing pneumonia or ARDS.
- Malignant processes:
- Bronchoalveolar carcinoma with patchy consolidation.
- Recommendations:
- Correlate imaging findings with clinical history, including symptoms (e.g., fever, cough) and laboratory markers (e.g., leukocytosis, sputum cultures).
- Use Chest CT for detailed characterization if findings are atypical or diagnostic uncertainty persists.
- Assess for coexisting atelectasis, which may complicate ventilation and recovery.
- Consider bronchoscopy if mucus plugs or airway obstruction are suspected as contributing to atelectasis.
- Key points and pearls:
- Patchy distribution distinguishes bronchopneumonia from lobar pneumonia.
- Bronchopneumonia is more common in the elderly, immunocompromised, or individuals with aspiration risks.
- Atelectasis coexisting with bronchopneumonia can result in volume loss and hypoxemia, requiring specific management.
- Persistent findings may indicate organizing pneumonia or malignancy and warrant further evaluation.
