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Updated: Jun 12 2021


  • Snapshot
    • A 77-year-old man is brought in by EMS after waking up in the middle of the night covered in sweat, with a high fever, and a coughing up yellow sputum. A chest xray is shown.
  • Introduction
    • Definition
      • infection of lung parenchyma that usually occurs in defined lobar patterns, though may also present more diffusely
      • Clinically defined as fever, cough and new infiltrate on CXR
    • Pathophysiology
      • See Microbiology of Pneumonia topic
    • Risk factors
      • impaired cough reflex
      • damage to respiratory cilia
      • mucus plugs
  • Classification
    • Classic patterns include
      • lobar
        • intra-alveolar exudate which consolidates
        • may involve entire lung or be confined to 1 lobe
      • brochopnuemonia
        • acute inflammatory infiltrates from bronchioles into adjacent alveoli
        • patchy distribution
        • involves ≥ 1 lobes
      • interstitial
        • diffuse patchy inflammation localized to interstitial areas of alveolar walls
        • distribution involving ≥ 1 lobes
        • generally less severe than lobar or bronchopneumonia
  • Presentation
    • Symptoms
      • classically presents with sudden-onset of
        • fever
        • productive cough
          • purulent yellow-green
          • hemoptysis
        • dyspnea
        • night sweats
        • pleuritic chest pain
      • atypical presentations are gradual in onset and flu-like
        • dry cough
        • headaches
        • myalgias
        • sore throat
    • Physical exam
      • auscultation of the lungs reveals
        • decreased or bronchial breath sounds
        • crackles/rales
        • wheezing
        • E-to-A egophany
          • with consolidation
      • percussion reveals
        • dullness over affected lobe(s)
        • tactile fremitus
          • increased with consolidation
          • decreased with pleural effusion
  • Evaluation
    • CXR
      • may show lung opacification/consolidation in affected lobe(s)
      • establishes diagnosis in combination with Gram stain or culture
    • CBC
      • elevated WBC count
    • Sputum Gram stain and cultures
      • identify pathogen
      • directs antimicrobial therapy
  • Treatment
    • Pharmacologic
      • empiric antibiotics directed at most likely pathogens (depends on clinical scenario)
      • organism-specific antibiotics if organism identified
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