Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases.

This article reviews roles of imaging examinations in the management of community-acquired pneumonia (CAP), imaging diagnosis of specific CAP and discrimination between CAP and noninfectious diseases. Chest radiography is usually enough to confirm the diagnosis of CAP, whereas computed tomography is required to suggest specific pathogens and to discriminate from noninfectious diseases. Mycoplasma pneumoniae pneumonia, tuberculosis, Pneumocystis jirovecii pneumonia and some cases of viral pneumonia sometimes show specific imaging findings. Peribronchial nodules, especially tree-in-bud appearance, are fairly specific for infection. Evidences of organization, such as concavity of the opacities, traction bronchiectasis, visualization of air bronchograms over the entire length of the bronchi, or mild parenchymal distortion are suggestive of organizing pneumonia. We will introduce tips to effectively make use of imaging examinations in the management of CAP.

[1]  J. Staveley,et al.  Primary Atypical Pneumonia , 1946, British medical journal.

[2]  B. Berris,et al.  PULMONARY ASPIRATION OF GASTRIC ACID--MENDELSON'S SYNDROME. , 1965, Canadian Medical Association journal.

[3]  C. Carrington,et al.  THE EOSINOPHILIC PNEUMONIAS , 1969, Medicine.

[4]  R. D. Meyer,et al.  Radiographic features of Legionnaires' disease. , 1979, Chest.

[5]  K. Kulig.  Radiographic features of Legionnaires' disease: Kirby BD, Peck H, Meyer RD, Chest 76:562–565, 1979 , 1980 .

[6]  P. Heckerling.  The need for chest roentgenograms in adults with acute respiratory illness. Clinical predictors. , 1986, Archives of internal medicine.

[7]  Mayo,et al.  Chronic eosinophilic pneumonia: CT findings in six cases. , 1989, AJR. American journal of roentgenology.

[8]  J P Ornato,et al.  Clinical prediction rule for pulmonary infiltrates. , 1990, Annals of internal medicine.

[9]  E. Fishman,et al.  Pneumocystis carinii pneumonia: spectrum of parenchymal CT findings. , 1990, Radiology.

[10]  E. Fishman,et al.  Pulmonary septic emboli: diagnosis with CT. , 1990, Radiology.

[11]  W. Travis,et al.  Thin-walled cavities, cysts, and pneumothorax in Pneumocystis carinii pneumonia: further observations with histopathologic correlation. , 1990, Radiology.

[12]  P. Kim,et al.  Endobronchial tuberculosis: CT features. , 1991, Journal of computer assisted tomography.

[13]  E. Fishman,et al.  Lymphoma of the lung: CT findings in 31 patients. , 1991, AJR. American journal of roentgenology.

[14]  N. Müller,et al.  Primary tuberculosis in childhood: radiographic manifestations. , 1992, Radiology.

[15]  K S Lee,et al.  Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. , 1993, AJR. American journal of roentgenology.

[16]  J. Im,et al.  Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. , 1993, Radiology.

[17]  V L Yu,et al.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. , 1993 .

[18]  N. Müller,et al.  Cryptogenic organizing pneumonia: CT findings in 43 patients. , 1994, AJR. American journal of roentgenology.

[19]  Y. Oh,et al.  High‐Resolution CT Appearance of Miliary Tuberculosis , 1994, Journal of computer assisted tomography.

[20]  T. File,et al.  Radiographic appearance of Chlamydia pneumoniae (TWAR strain) respiratory infections. CBPIS Study Group. Community-based Pneumonia Incidence Study. , 1994, Radiology.

[21]  K. S. Lee,et al.  CT-pathology correlation of pulmonary tuberculosis. , 1995, Critical reviews in diagnostic imaging.

[22]  K. Masuda,et al.  Noncalcified Pulmonary Tuberculomas: CT Enhancement Patterns with Histological Correlation , 1995, Journal of thoracic imaging.

[23]  J. Dalphin,et al.  Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. , 1996, The European respiratory journal.

[24]  T. Matsumoto,et al.  High resolution CT findings in community-acquired pneumonia. , 1996, Journal of computer assisted tomography.

[25]  L. Mandell,et al.  Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies: A consensus statement , 1996 .

[26]  Toshio Kishimoto,et al.  ELISA法による抗Chlamydia pneumoniae特異抗体の測定 : 1. 外膜複合体を用いたELISA法キットの評価 , 1996 .

[27]  D. Asmuth,et al.  Changing patterns of infections in patients with AIDS: a study of 279 autopsies of prison inmates and nonincarcerated patients at a university hospital in eastern Texas, 1984-1993. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  C. Park,et al.  High-resolution CT findings of varicella-zoster pneumonia. , 1999, AJR. American journal of roentgenology.

[29]  K. S. Lee,et al.  Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation. , 1999, Journal of computer assisted tomography.

[30]  J. Erasmus,et al.  The many faces of pulmonary aspiration. , 1999, AJR. American journal of roentgenology.

[31]  T. Matsushima,et al.  [Assay of specific anti-Chlamydia pneumoniae antibodies by ELISA method. 3. Setting of serological criteria]. , 1999 .

[32]  N. Müller,et al.  Mycoplasma pneumoniae pneumonia: radiographic and high-resolution CT features in 28 patients. , 2000, AJR. American journal of roentgenology.

[33]  T. Franquet,et al.  Aspiration diseases: findings, pitfalls, and differential diagnosis. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[34]  P. Gutiérrez,et al.  Severe acute lung injury caused by Mycoplasma pneumoniae: potential role for steroid pulses in treatment. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  P. Marik,et al.  Aspiration Pneumonitis and Aspiration Pneumonia , 2001 .

[36]  Y Nakajima,et al.  Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. , 2001, AJR. American journal of roentgenology.

[37]  S. Park,et al.  CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. , 2001, The British journal of radiology.

[38]  N. Müller,et al.  Pneumonia: high-resolution CT findings in 114 patients , 2003, European Radiology.

[39]  M. Mckendrick,et al.  Varicella pneumonia in adults , 2003, European Respiratory Journal.

[40]  Young Cheol Yoon,et al.  Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. , 2003, AJR. American journal of roentgenology.

[41]  N. Müller,et al.  Pulmonary cryptococcosis in immunocompetent patients: CT findings in 12 patients. , 2005, AJR. American journal of roentgenology.

[42]  Y. Kim,et al.  Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia , 2006, European Radiology.

[43]  S. Matsumoto,et al.  Chlamydia pneumoniae Pneumonia and Mycoplasma pneumoniae Pneumonia: Comparison of Clinical Findings and CT Findings , 2005, Journal of computer assisted tomography.

[44]  J. Cordier.  Cryptogenic organising pneumonia , 2006, European Respiratory Journal.

[45]  T. Araki,et al.  Chlamydia pneumoniae: comparison with findings of Mycoplasma pneumoniae and Streptococcus pneumoniae at thin-section CT. , 2006, Radiology.

[46]  D. Guay.  Guidelines for the management of adults with health care-associated pneumonia: implications for nursing facility residents. , 2006, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[47]  T. Johkoh,et al.  Computed Tomographic Features of Legionella pneumophila Pneumonia in 38 Cases , 2007, Journal of computer assisted tomography.

[48]  Shuichi Tanoue,et al.  Clinical/pathologic correlations in 553 patients with primary centrilobular findings on high-resolution CT scan of the thorax. , 2007, Chest.

[49]  I. Yamadori,et al.  Pulmonary capillary hemangiomatosis-like foci detected by high resolution computed tomography. , 2010, Internal medicine.

[50]  K. Sepkowitz,et al.  Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[51]  V. Cottin,et al.  Eosinophilic lung diseases. , 2012, Immunology and allergy clinics of North America.

[52]  M. Truong,et al.  The reversed halo sign: update and differential diagnosis. , 2012, The British journal of radiology.

[53]  A. Torres,et al.  Pneumonic and nonpneumonic exacerbations of COPD: inflammatory response and clinical characteristics. , 2013, Chest.

[54]  Y. Yazdanpanah,et al.  Quinolones versus macrolides in the treatment of legionellosis: a systematic review and meta-analysis. , 2014, The Journal of antimicrobial chemotherapy.

[55]  R. Agarwal,et al.  Reversed Halo Sign: A Systematic Review , 2014, Respiratory Care.