0:01

So let's talk about pneumonia.

0:03

So in terms of the epidemiology, it can impact anyone.

0:06

We can also see it most commonly in kids younger than two or adults over 65.

0:12

Between 25 or so, out of 10,000 adults per year in the US.

0:18

Now, again, this does not include

0:20

the impact of COVID-19, which really would elevate that number.

0:25

Presentation includes shortness of breath,

0:26

productive cough, chest pain, fever, chill, loss of appetite, rales, dullness

0:32

to percussion, or egophony on clinical exam, you might have patients with elevated

0:36

white counts or elevated inflammatory markers.

0:39

In terms of imaging,

0:41

X-ray is the place to start and should be used in patients who are giving a clinical

0:46

history or have clinical findings suggestive of pneumonia.

0:50

Chest CT is not necessarily the immediate

0:52

go to, but it's helpful for problem solving or complicating factors.

0:57

So possible pleural effusions or abscess,

0:59

other causes that may not be explained on the X-ray, or things that are just

1:03

needing to be further characterized, such as post obstructive pneumonia.

1:08

Those things make sense for a starting point or a continuation of imaging

1:12

with chest CT. In terms of the imaging

1:14

findings, you'll look for airspace opacification, so it generally begins

1:19

very patchy, becomes much more confluent and dense as the disease progresses.

1:23

You might see air bronchograms, which is just pus-filled alveoli.

1:27

These opacities can be diffused or they can be localized.

1:30

So multifocal pneumonia versus lobar pneumonia.

1:33

These are things that can happen.

1:35

Pearls and pitfalls. Atelectasis may be mistaken for lobar pneumonia,

1:39

but remember that atelectasis is associated with volume loss.

1:44

Other things to consider is

1:45

that oftentimes lobar pneumonia is more associative of Strep. or Klebsiella versus

1:52

lobular, which tends to be associated with Staph. or Anaerobes.

1:56

Interstitial opacities are generally viral or mycoplasma.

2:00

This is here for your edification.

2:03

I generally don't try to speciate

2:05

my positive pneumonia cases, but some may find that helpful.

2:09

And here are some references for you.