Pneumonia – ChestDB.com

Case 46

Emergency & Trauma, Infectious/Inflammatory / Age 31-60, Consolidation, Infection, Lobar Pneumonia, Pneumonia

This radiograph demonstrates a right upper lobe consolidation most consistent with lobar pneumonia in this patient with a cough and elevated white count. The consolidation has poorly defined margins with the exception of the inferior margin, which is sharp and linear. This is due to the consolidation abutting the minor fissure. The position of the consolidation superior to the minor fissure definitively localizes it to the right upper lobe. Uncomplicated community acquired lobar pneumonia does not typically cross fissures. While malignancy is not entirely excluded, a mass would be unlikely to respect the fissural boundary without exerting mass effect.

The exam is otherwise unremarkable.

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Case 40

Emergency & Trauma, Infectious/Inflammatory / Age 31-60, Pneumonia

This case demonstrates multiple poorly defined opacities in the right lung. In a clinical setting suspicious for infection, this finding is most consistent with multifocal pneumonia as was the case here.

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Case 32

Infectious/Inflammatory / Age 31-60, Pneumonia, Silhouette Sign

This radiograph demonstrates a lingular consolidation concerning for pneumonia. The location of the consolidation can be localized to the lingula even without a lateral radiograph using silhouette sign. There is a loss of sharpness and definition, or “silhouetting,” of the left heart border at the location of the consolidation, indicating that the consolidated lung makes direct contact with the left heart. Anatomically the pulmonary lobe that has the greatest area of contact with the left heart is the left upper lobe, specifically the inferior left upper lobe (the lingula), making the silhouette sign a reliable method of localization. The lingula is a relatively common location for pneumonia.

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Case 17

Infectious/Inflammatory / Age 31-60, Consolidation, Parapneumonic Effusion, Pleural Effusion, Pneumonia

This radiograph demonstrates patchy mixed ground-glass and consolidative airspace opacities in the left lung with an associated moderate pleural effusion. In this patient with a cough and a white count, this appearance is consistent with pneumonia with parapneumonic effusion.

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Case 11

Infectious/Inflammatory / Age 31-60, Pneumonia, Silhouette Sign

This radiograph demonstrates a poorly defined focal opacity in the left inferior lung field consistent with pneumonia. The opacity silhouettes the left heart border, which localizes it to the lingular segment. There is a high degree of soft tissue attenuation consistent with obesity. The exam is otherwise unremarkable.

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