Chest Imaging

Bronchopneumonia

a type of pneumonia which results when haematogeneous dissemination of organisms to the lung or colonization of airways with subsequent aspiration is responsible for pulmonary infection. As opposed to other acute bacterial or lobar pneumonias which begin in alveoli, bronchopneumonia originates in small bronchioles. Typical bacteria causing this form of infection include Staphylococcus aureus and Gram-negative organisms such as Pseudomonas aeruginosa. These organisms disseminate through the bloodstream and colonize the bronchial or bronchiolar epithelium, but then quickly cause acute inflammatory responses which extend outside the airway into adjacent alveoli. The initial inflammatory response consists largely of polymorphonuclear leukocytes which limit the extent of infection to the peribronchiolar region. Since multiple sites are involved simultaneously a scattered appearance of heterogeneous opacities is the usual pattern observed on chest films (Fig.1). Eventually more and more alveoli are affected and ultimately a homogeneous opacification simulating lobar pneumonia may be observed. Nevertheless, because there is greater airway involvement with bronchopneumonia, air bronchograms are infrequent and atelectasis is more common. Peribronchial interstitial thickening may also be seen early in the course of infection. Necrosis and cavitation are more frequent in this type of pneumonia. Pneumatocoeles are occasionally noted.

Clinically, patients present with fever and productive cough similar to other bacterial infections although physical findings typical of dense consolidation such as bronchophony and whispering pectoriloquy are not heard. Treatment with a variety of antibiotics usually results in rapid clinical and radiographic resolution.

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Fig.1

Poorly marginated large nodular areas of consolidation are seen in the periphery of both lungs. These findings are typical of bronchopneumonia. Air bronchograms are usually absent; pleural fluid may or may not be present. This patient had a staphylococcal infection.
Bronchopneumonia, Fig.1