Lobar pneumonia

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Lobar pneumonia
Lobar pneumonia illustrated.jpg
Figure A shows the location of the lungs and airways in the body. This figure also shows pneumonia affecting the lower lobe of the left lung. Figure B shows normal alveoli. Figure C shows infected alveoli.
Specialty Pulmonology   OOjs UI icon edit-ltr-progressive.svg

Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung. [1] [2]

Contents

It is one of three anatomic classifications of pneumonia (the other being bronchopneumonia and atypical pneumonia). In children round pneumonia develops instead because the pores of Kohn which allow the lobar spread of infection are underdeveloped. [3]

Mechanism

The invading organism starts multiplying, thereby releasing toxins that cause inflammation and edema of the lung parenchyma. This leads to the accumulation of cellular debris within the lungs. This leads to consolidation or solidification, which is a term that is used for macroscopic or radiologic appearance of the lungs affected by pneumonia. Bacterial pneumonia is mainly classified into lobar and diffuse depending on the degree of lung irritation or damage.[ citation needed ]

Stages

Micrograph of lobar pneumonia, H&E stain. Lung biopsy showing lobar pneumonia 10X.jpg
Micrograph of lobar pneumonia, H&E stain.

Lobar pneumonia usually has an acute progression. Classically, the disease has four stages: [1]

In children

The openings between the alveoli known as the pores of Kohn, and the collateral airways of the canals of Lambert, are undeveloped in children. Spread of infection that would otherwise occur is prevented and can result in round pneumonia, most commonly caused by S. pneumoniae . This clinically presents with an initial mild respiratory infection, followed by fever. On imaging it presents an opaque pulmonary consolidation which is unusually round, and can resemble a lung mass. However it quickly resolves with antibiotics. [4]

Diagnosis

The most common organisms which cause lobar pneumonia are Streptococcus pneumoniae , also called pneumococcus, Haemophilus influenzae and Moraxella catarrhalis . Mycobacterium tuberculosis , the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not treated promptly. Other organisms that cause lobar pneumonia are Legionella pneumophila and Klebsiella pneumoniae. [2]

Like other types of pneumonia, lobar pneumonia can present as community acquired, in immune suppressed patients or as nosocomial infection. However, most causative organisms are of the community acquired type. Pathological specimens to be obtained for investigations include:

  1. Sputum for culture, AAFBS and gram stain
  2. Blood for full hemogram/complete blood count, ESR and other acute phase reactants
  3. Procalcitonin test, more specific

On a posteroanterior and lateral chest radiograph, an entire lobe will be radiopaque, which is indicative of lobar pneumonia. [5]

The identification of the infectious organism (or other cause) is an important part of modern treatment of pneumonia. The anatomical patterns of distribution can be associated with certain organisms, [6] and can help in selection of an antibiotic while waiting for the pathogen to be cultured.

Related Research Articles

Lung Organ for breathing air

The lungs are the primary organs of the respiratory system in humans and most animals including a few fish, and some snails. In mammals and most other vertebrates, two lungs are located near the backbone on either side of the heart. Their function in the respiratory system is to extract oxygen from the air and transfer it into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere, in a process of gas exchange. Respiration is driven by different muscular systems in different species. Mammals, reptiles and birds use their different muscles to support and foster breathing. In earlier tetrapods, air was driven into the lungs by the pharyngeal muscles via buccal pumping, a mechanism still seen in amphibians. In humans, the main muscle of respiration that drives breathing is the diaphragm. The lungs also provide airflow that makes vocal sounds including human speech possible.

Pneumonia Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

Pulmonary alveolus Hollow cavity found in the lungs

A pulmonary alveolus also known as an air sac or air space is one of millions of hollow, distensible cup-shaped cavities in the lungs where oxygen is exchanged for carbon dioxide. Alveoli make up the functional tissue of the lungs known as the lung parenchyma, which takes up 90 percent of the total lung volume.

Sputum Mucus that is coughed up from the lower airways

Sputum is mucus that is coughed up from the lower airways. In medicine, sputum samples are usually used for naked eye exam, microbiological investigation of respiratory infections and cytological investigations of respiratory systems. It is crucial that the specimen not include any mucoid material from the nose.

Bronchus Airway in the respiratory tract

A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi to branch from the trachea at the carina are the right main bronchus and the left main bronchus. These are the widest bronchi, and enter the right lung, and the left lung at each hilum. The main bronchi branch into narrower secondary bronchi or lobar bronchi, and these branch into narrower tertiary bronchi or segmental bronchi. Further divisions of the segmental bronchi are known as 4th order, 5th order, and 6th order segmental bronchi, or grouped together as subsegmental bronchi. The bronchi when too narrow to be supported by cartilage are known as bronchioles. No gas exchange takes place in the bronchi.

Atypical pneumonia, also known as walking pneumonia, is any type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease, it is called primary atypical pneumonia (PAP).

Bacterial pneumonia is a type of pneumonia caused by bacterial infection.

Radiology (X-rays) is used in the diagnosis of tuberculosis. Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of TB, but can be used to rule out pulmonary TB.

Atelectasis Collapse or closure of a lung resulting in reduced or absent gas exchange

Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct from pulmonary consolidation, in which they are filled with liquid. It is often called a collapsed lung, although that term may also refer to pneumothorax.

Chest radiograph Projection X-ray of the chest

A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medicine.

Bronchopneumonia Human disease

Bronchopneumonia is a subtype of pneumonia. It is the acute inflammation of the bronchi, accompanied by inflamed patches in the nearby lobules of the lungs.

Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.

Cryptogenic organizing pneumonia Medical condition

Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia (BOOP), is an inflammation of the bronchioles (bronchiolitis) and surrounding tissue in the lungs. It is a form of idiopathic interstitial pneumonia.

The pores of Kohn are discrete holes in walls of adjacent alveoli. Cuboidal type II alveolar cells, which produce surfactant, usually form part of aperture.

Pulmonary consolidation Medical condition

A pulmonary consolidation is a region of normally compressible lung tissue that has filled with liquid instead of air. The condition is marked by induration of a normally aerated lung. It is considered a radiologic sign. Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood. Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation.

Alveolar lung disease Medical condition

Alveolar lung diseases, are a group of diseases that mainly affect the alveoli of the lungs.

Hepatization is conversion into a substance resembling the liver; a state of the lungs when gorged with effuse matter, so that they are no longer pervious to the air. Red hepatization is when there are red blood cells, neutrophils, and fibrin in the pulmonary alveolus/ alveoli; it precedes gray hepatization, where the red cells have been broken down leaving a fibrinosuppurative exudate. The main cause is lobar pneumonia. Transformation from Red hepatization to gray hepatization is an example for acute inflammation turning into a chronic inflammation.

Classification of pneumonia Medical condition

Pneumonia can be classified in several ways, most commonly by where it was acquired, but may also by the area of lung affected or by the causative organism. There is also a combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease or systemic disease and whether the person has recently been hospitalized.

Ground-glass opacity Radiologic sign on radiographs and computed tomography scans

Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. When a substance other than air fills an area of the lung it increases that area's density. On both x-ray and CT, this appears more grey or hazy as opposed to the normally dark-appearing lungs. Although it can sometimes be seen in normal lungs, common pathologic causes include infections, interstitial lung disease, and pulmonary edema.

Emphysema Medical condition

Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces (pneumatoses) in the lung, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli and they replace the spongy lung parenchyma. This reduces the total alveolar surface available for gas exchange leading to a reduction in oxygen supply for the blood. Emphysema usually affects the middle aged or older population because it takes time to develop with the effects of smoking, and other risk factors. Alpha-1 antitrypsin deficiency is a genetic risk factor that may lead to the condition presenting earlier.

References

  1. 1 2 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 749. ISBN   0-7216-0187-1.
  2. 1 2 Le, Tao (2017). First Aid for the USMLE Step 1 2018. New York: McGraw-Hill Education. p. 664.
  3. Weerakkody, Yuranga. "Round pneumonia | Radiology Reference Article | Radiopaedia.org". Radiopaedia.
  4. https://radiopaedia.org/articles/round-pneumonia-1?lang=us
  5. E., Weinberger, Steven (2019). Principles of pulmonary medicine. Cockrill, Barbara A.,, Mandel, Jess,, Preceded by : Weinberger, Steven E. (Seventh ed.). Philadelphia, PA. ISBN   9780323523738. OCLC   1020498796.
  6. "Lobar Pneumonia" . Retrieved 2008-11-16.