Pneumonia
Clinical presentation:
Young adult male with cough, pyrexia and rusty coloured sputum.
The Images
Features in the Image
There is an ill-defined density in the right lower zone with loss of the right diaphragm silhouette, but a visible right heart margin. The density contains the branching lucency of air-containing bronchi, but no basal vessel margins can be seen. Their silhouette is lost. The lateral view shows the location of the oblique fissure that bounds the upper margin of the density. Its margin is slightly concave towards the opacified lung.
General X-ray Features of Pneumonia
Pneumonia presents with white water density, fluffy margins with coalescence (cloud-like) and the presentation known as "Air Bronchogram." In Lobar Pneumonia, consolidation may involve an entire lobe, including bronchi and alveoli. The pneumonia is often nonsegmental, shows a mottled appearance when clearing, and the X-ray demonstration of clearance lags behind clinical improvement. Remember, treat the patient, not the film. Bronchopneumonia gives a patchy appearance, is often bilateral in the lower lobes and follows bronchial distribution and may never reach the alveoli.
Sillhouete Sign, featured in these images, is the loss of an interface between a soft tissue structure and the lung caused by opacification of the lung adjacent to the soft tissues. It is useful inlocating or confirming the presence of an abnormality.
Diagnosis
Lobar Pneumonia, consolidation in the right lower lobe.
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