bronchopneumonia

Bronchopneumonia, also sometimes known as lobular pneumonia, is a radiological pattern associated with suppurative peribronchiolar inflammation and subsequent patchy consolidation of one or more secondary lobules of a lung in response to bacterial pneumonia.

Epidemiology

Pneumonia is the most common cause of death due to infectious diseases in the United States, with an incidence of 11.6/1000 persons/year reported in one study . Incidence is higher at the extremes of age. Bronchopneumonia is a common hospital-acquired infection .

Clinical presentation

The presentation of bronchopneumonia depends on the severity of the disease, host factors and the presence of complications. Bronchopneumonia may present with a productive cough, dyspnea, pyrexia/fevers, rigors, malaise, pleuritic pain and occasionally hemoptysis .

Pathology

Bronchopneumonia is precipitated by inhalation (or rarely haematogenous spread) of a causative organism. This results in peribronchiolar inflammation, which can spread through the pores of Kohn to create consolidation throughout an entire secondary pulmonary lobule .

The radiological appearance of bronchopneumonia is not specific to any single causative organism, although there are organisms which classically have a radiological presentation of bronchopneumonia and hence the identification of bronchopneumonia can provide information regarding the likely etiological pathogens . Causative organisms of a bronchopneumonia pattern include :

Microscopic appearance

Histologically, multiple small foci of inflammation can be demonstrated. Extensive congestion and dilation of blood vessels and areas of poorly circumscribed consolidation can be seen in affected areas . These areas of inflammation are separated by areas of normal lung parenchyma .

Radiographic features

Plain radiograph

Bronchopneumonia is characterized by multiple small nodular or reticulonodular opacities which tend to be patchy and/or confluent. This represents areas of the lung where there are patches of inflammation separated by normal lung parenchyma. .

The distribution is often bilateral and asymmetric and predominantly involves the lung bases .

CT

Multiple foci of opacity can be seen in a lobular pattern, centered at centrilobular bronchioles. This may result in a tree-in-bud appearance. These foci of consolidation can overlap to create a larger heterogeneous confluent area of consolidation or 'patchwork quilt' appearance .

See also 

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