Figure 110-2 Diffuse viral bronchopneumonia in a 12-year-old boy with cough, fever, and wheezing. Frontal chest radiograph shows bilateral, perihilar, peribronchial thickening, and shaggy infiltrate. Focal airspace disease representing consolidation or atelectasis is present in the medial portion of the right upper lobe. The findings are typical of bronchopneumonia. (From Markowitz RI: Diagnostic imaging. In Jenson HB, Baltimore RS, editors: Pediatric Infectious Diseases: Principles and Practice, ed 2, Philadelphia, Saunders, 2002, p 132.)
C. pneumoniae, shows increased interstitial markings or bronchopneumonia (Fig. 110-3). Chest radiographs may be normal in early pneumonia, with infiltrates appearing during treatment as hydration is restored. Hilar lymphadenopathy is uncommon with bacterial pneumonia but may be a sign of tuberculosis, histoplasmosis, or an underlying malignant neoplasm. Decubitus views or ultrasound should be used to assess size of pleural effusions and whether they are freely mobile.
Figure 110-3 Mycoplasma pneumoniae infection (atypical pneumonia) in a 14-year-old boy with malaise, dry cough, and mild shortness of breath for 1 week. Frontal chest radiograph shows a diffuse pattern of increased interstitial markings, including Kerley lines. The heart is normal, and there are no focal infiltrates. Cold agglutinins were markedly elevated, and the patient responded to erythromycin. This radiographic pattern of reticulonodular interstitial disease is observed in 25% to 30% of patients with pneumonia caused by Mycoplasma pneumoniae. (From Baltimore RS: Pneumonia. In Jenson HB, Baltimore RS, editors: Pediatric Infectious Diseases: Principles and Practice, ed 2, Philadelphia, Saunders, 2002, p 808.)
Computed tomography (CT) is used to evaluate serious disease, pleural abscesses, bronchiectasis, and effusion characteristics. Unusual etiologies or recurrent pneumonias require special considerations (Table 110-2). Lung abscesses, pneumatoceles, and empyema all require special management.
Pneumonia must be differentiated from other acute pulmonary diseases, including allergic pneumonitis, asthma, and cystic fibrosis; cardiac diseases, such as pulmonary edema caused by heart failure; and autoimmune diseases, such as certain vasculitides and systemic lupus erythematosus. Radiographically pneumonia must be differentiated from lung trauma and contusion, hemorrhage, foreign body aspiration, and sympathetic effusion due to subdiaphragmatic inflammation.
Available @ StudentConsult.com
Therapy for pneumonia includes supportive and specific treatment and depends on the degree of illness, complications, and knowledge of the infectious agent likely causing the pneumonia. Most cases of pneumonia in healthy children can be managed on an outpatient basis. However children with hypoxemia, inability to maintain adequate hydration, or moderate to severe respiratory distress should be hospitalized. Hospitalization should be considered in infants under 6 months with suspected bacterial pneumonia, those in whom there is a concern for a pathogen with increased virulence (e.g., methicillin-resistant Staphylococcus aureus), or when concern exists about a family’s ability to care for the child and to assess symptom progression.