Infecciones pulmonares hraepy

Infecciones Pulmonares
Dr.Héctor Domínguez Hernández
Médico Residente
Imagenología, Diagnóstica y Terapéutica

Introducción
• Mecanismo de defensa.
• Activación de sistemas inmunitario y humoral.
• Neumonía.
Fundamentals of Diagnostic Radiology. Fourth Edition. William E. Brant. Clyde A Helms. 2012

Figures 1-21A and B Schematic of acini and alveolus
A Bography of the Lungs: A Practical Guide
es 1-21A and B Schematic of acini and alveolus
B
Figure 1-23 Schematics of secondary pulmonary lobule and alveoli
UNIDAD FUNCIONAL BÁSICA
" Lobar pneumonia
" Bronchopneumonia
" Focal pneumonia
The following section will examine the basic “alveolar” pattern
(Fig. 3.5). First, the radiologic term “alveolar shadow” requires
some explanation. “Alveolar” describes changes leading to in-
creased attenuation in the region of the alveoli or caused by dis-
orders of the alveolar space. Causes include:
" Intra-alveolar edema (Fig. 3.6)
" Inflammatory alveolar congestion (Fig. 3.8)
" Other consolidation of the alveolar space such as proteinosis or
tumor spread (Fig. 3.7)
The radiograp
ty are rarely d
problems espe
lar infiltrate (a
" The classic
" Blurring of
" Ground-gla
" Homogene
" With or wi
The most imp
" Ground-gla
" Area conso
In defining th
a differential
The same app
Acinar Patte
Acinar pattern
nated occurre
that individua
radiograph. T
radiographic
perimposed lo
The acinar pa
changes due t
ratory bronch
bronchitis).
Alveolar space
Alveolar space
Alveolar space
1
2
3
4
Fig. 3.5 Interstitial and alveolar compartments. The air-filled alveolar space
is subdivided by the interstitium, a space filled with collagen connective tissue
between blood and lymph vessels.

• Patologías que cursan con infiltrados difusos crónicos: proteinosis alveolar,
neoplasias (carcinoma bronquioloalveolar y linfoma pulmonar), sarcoidosis.
Images for this section:
Fig. 1
Patrón Alveolar Pulmonar. Un reto diagnóstico para el Radiólogo General. SERAM. 2012

Patrón Alveolar
• Aparece cuando el aire del alveolo respiratorio es sustituido por otro
material de mayor densidad.
• Signos radiológicos: Bordes mal deﬁnidos/algodonosos.
• Nódulo acinar. 5 a 10mm.
• Tendencia a la coalescencia.
• Broncograma aéreo.
• Alveolograma aéreo.
• Ocultación de vasos.
• Volumen pulmonar conservado.

Distribución.
• Focal (lobar o segmentaria) en : Neumonías
bacterianase
• Multifocal. Bronconeumonías y Hongos.
• Difusa. Neumonías atípicas (pneumocystis
jirovecci, legionella, vírica).

FIEBRE, DOLOR TORÁCICO Y TOSBacterias Gram +
Ancianos y Alcohólicos
Esplenectomía
Lóbulos inferiores (LI)
Segmentos Posteriores (LS)
Distribución no segmentaria.
Empiema o Derrame 50% de los casos.
J.Manuel Cardoso. Pulmón, Pleura y Mediastino. 1999.
Representa el 80% de las NAC.
10% de las Hospitalarias.
Neumococo

Chest Radiology: A residents Manual. 2011

field. The patient is a
ver. The posteroante-
e left lower lung field

ph shows a
sharp hori-
nt). The right
ragm is pre-

Bacterias Gram +
Estafilococo
Niños y Ancianos.
Hospitalizados.
Endocarditis o Catéteres.
Drogas IV.
Opacidades Parcheadas.
Bilateral.
Abscesos 25-75%.
Derrame y Empiema 50%
Fístulas broncopleurales
Representa el 10% de las NAC.
Neumonía Lobulillar

ﬁs-
obic
ses,
nua-
osis,
rast
usu-
tion
main
h is
pos-
obe
ene
Figure 8. Lung infection with Staphylococcus secreting Panton-
Valentine leukodicin. Axial view with lung window. Bilateral alveolar
consolidation predominating on the right side with multiple cavities.Lung infections: The radiologist´s perspective. ELSEVIER. 2012.

50% DE LAS NEUMONIAS
HOSPITALARIAS.
Nódulos pequeños.
Bilateral y Multifocal.
Lóbulos Inferiores.
Abscesos y Cavitaciones.
Derrame y Empiema.
Bacterias Gram -
Enterobacterias (Klebsiella
E. Coli.
Proteus)
Haemophilus Influenzae
Alcohólicos y Ancianos
Ventilación MecánicaPseudomona Aeruginosa
EPOC.
Alcoholismo.
Esplenectomía.
AncianosLegionella Pneumophila Opacificación periférica sublobular.
Progresión Rápida Bilateral.
Derrame en el 30%.
No se ve cavitación.

Chapter 16: Pulmonary Infec:tion 437
l
FIGURE 16.2. A. Frontal radiograph
of an HIV-positive man with fever and progressive respiratory symptoms
shows multifoc:al airspace opacities with de.o.se apical opacification withcavi-
tation (m"TOWs).B. A CI'scan through the apicesshows airspace opacification
with left apical cavitatio.D. C. A sc:an at the level ofthe tracheal cariJ1a shows
airspace disease in the anterior segments of right and left upper lobes with
sparing of the dependent portions of lung. Bronchoscopy revealed
PseudomottaS.
pyogena. Acute streptococcal pneumonia is
rarely seen today, though it can occasionally complicate viral
infection orstreptococcal pharyngitis. Its radiographic appear-
ance is similar to that ofstaphylococcal pneumonia, with lob-
ular or segmental lower lobe opacities. The process may be
are related to the underlying pathology of hemorrhagic
lymphadenitis and mediastinitis accompanied by hemorrhagic
pleural effusions. Conventional radiographs demonstrate
mediastinal widening, hilar enlargement, and often pleural
effusion. Frank areas of consolidation are not usually present
FIGURE 16.2. A. Frontal r
of an HIV-positive man with fever and progressive respiratory
shows multifoc:al airspace opacities with de.o.se apical opacification
tation (m"TOWs).B. A CI'scan through the apicesshows airspace op
with left apical cavitatio.D. C. A sc:an at the level ofthe tracheal car
airspace disease in the anterior segments of right and left upper
sparing of the dependent portions of lung. Bronchoscopy
PseudomottaS.
Chapter 16: Pulmonary Infec:tion 437
l
FIGURE 16.2. A. Frontal radiograph
of an HIV-positive man with fever and progressive respiratory symptoms
shows multifoc:al airspace opacities with de.o.se apical opacification withcavi-
tation (m"TOWs).B. A CI'scan through the apicesshows airspace opacification
with left apical cavitatio.D. C. A sc:an at the level ofthe tracheal cariJ1a shows
airspace disease in the anterior segments of right and left upper lobes with
sparing of the dependent portions of lung. Bronchoscopy revealed
PseudomottaS.
pyogena. Acute streptococcal pneumonia is
rarely seen today, though it can occasionally complicate viral
infection orstreptococcal pharyngitis. Its radiographic appear-
ance is similar to that ofstaphylococcal pneumonia, with lob-
ular or segmental lower lobe opacities. The process may be
complicated by abscess formation and cavitation; empyema is
are related to the underlying pathology of hemorrhagic
lymphadenitis and mediastinitis accompanied by hemorrhagic
pleural effusions. Conventional radiographs demonstrate
mediastinal widening, hilar enlargement, and often pleural
effusion. Frank areas of consolidation are not usually present
but peribronchial opacities may be seen. CT scans of recent
Sin broncograma aéreo.
Bilaterales.
Predominantemente
Lóbulos Inferiores.
PSEUDOMONA

ilus inﬂuenzae bronchopneumonia and herpes virus in a nosocomial infection
n MIP view 5 mm thick. There are centrilobular micronodules with branching opa
which are better visualised on MIP (b).
ﬂuenzae bronchopneumonia and herpes virus in a nosocomial infection: a: na
ew 5 mm thick. There are centrilobular micronodules with branching opacities a
are better visualised on MIP (b).
Haemophilus Influenzae

basal lower lobes. The m
thoracic vertebrae beca

INFECCIONES MICOBACTERIANAS
Aumento asimétrico del tamaño
ganglios linfáticos.
Reacción granulomatosa.
Complejo de Ranke.
Mycobacterium tuberculosis
Primaria
Reactivación segmentos apicales y
posteriores de los lóbulos
superiores.
Areas de consolidación de
focos múltiples.
Cavitación.
Posprimaria
Fibrosis, Bronquiectasias y
Pérdida de Volumen.
Hipertensión Arterial
Pulmonar.
Hemoptisis.
Micetoma.
Miliar
El signo radiológico más común es la
consolidación homogénea y
unilateral

FISTULA BRONCOPLEURAL
Bronchopleural ﬁstula and the role of contemporary imaging. Puja Gaur, MD, Ruth Dunne, MD, Yolonda L. Colson, MD, and Ritu R. Gill, MD. The Journal of Thoracic and Cardiovascular
Surgery Volume 148, Number 1:341-7.

Neumonía Vírica
Hallazgos inespecíficosDx Exclusión
Influenza
Varicela Zóster
Embarazadas y
Ancianos
Niños
Virus Sincital
Respiratorio
Inmunodeprimidos
Adenovirus
Opacificación parchada.
en los lóbulos inferiores que suele ser
bilateral.**
**Consolidación lobar
Derrame
Cavitación
Opacidades nodulares mal definidas
bilaterales y difusas de 5 a 10 mm de
diámetro.
INICIO MÁS GRADUAL, TOS NO PRODUCTIVA Y SÍNTOMAS EXTRAPULMONARES.
Engrosamiento de la pared bronquial.
Neumonía Intersticial

T
Fi
in
di
cr
di
th
ou
co
ter
gla
cr
Ju
H
Virus Influenza CViral Pneumonias in Adults. Radiographics. 2002

B organisms cause influenza virus pneumonia
Figure 3. Pneumonia due to influenza virus in a
21-year-old man with a cough. (a) Initial chest ra-
diograph shows poorly defined nodules (arrows) and
reticular areas of increased opacity in both lungs.
(b, c) Thin-section (1-mm collimation) CT scans
obtained at the levels of the aortic arch (b) and su-
prahepatic inferior vena cava (c) show multifocal
peribronchovascular or subpleural consolidation
and ground-glass attenuation in both lungs. Some
lesions have a lobular distribution (arrows). Note
the acinar nodules (arrowheads). (Case courtesy of
Jin Mo Goo, MD, PhD, Seoul National University
Hospital, Korea.)
Figure 3. Pneumonia due to influenza virus in a
S140 October 2002 RG f Volume 22 ● Special Issue
Virus Influenza CViral Pneumonias in Adults. Radiographics. 2002

Varicela Zoster
persis
tered
Hi
well-d
throu
surro
groun
are al
rently
chem
Cyto
Cytom
herpe
toma
Figure 8. Pneumonia due to varicella-zoster virus in
a 30-year-old man with a fever and skin rash. Thin-
section (1-mm collimation) CT scan obtained at the
level of the bronchus intermedius shows multiple 1–2-
RG f Volume 22 ● Special Issue
RadioGraphics
Viral Pneumonias in Adults. Radiographics. 2002

nfiltrates is very rare (48). Splenomegaly is com-
mon and may be seen in up to 47% of chest ra-
diographic examinations (49).
A rapidly progressive respiratory illness in in-
ectious mononucleosis has rarely been reported
5. Palmer SM Jr, Henshaw NG, Howell DN, Miller
SE, Davis RD, Tapson VF. Community respira-
tory viral infection in adult lung transplant recipi-
ents. Chest 1998; 113:944–950.
6. Tillett HE, Smith JW, Clifford RE. Excess mor-
bidity and mortality associated with influenza in
Table 2
Summary of CT Findings in Viral Pneumonias
Cause of Pneumonia
Centrilobular
Nodules
Ground-Glass
Attenuation
with Lobular
Distribution
Segmental
Consolidation
Thickened
Interlobular
Septa
Diffuse
Ground-Glass
Attenuation
Influenza virus ϩϩϩ ϩϩϩ ϩ . . . ϩ
Measles virus ϩϩ ϩ ϩ . . . ϩ
Hantavirus . . . . . . ϩϩ ϩ ϩϩϩ
Adenovirus ϩϩ ϩ ϩϩϩ . . . . . .
Herpes simplex virus ϩ ϩϩϩ ϩϩϩ . . . ϩ
Varicella-zoster virus ϩϩϩ ϩ . . . . . . . . .
Cytomegalovirus ϩϩ ϩϩ ϩ ϩ ϩϩ
Epstein-Barr virus ϩ ϩ ϩ . . . ϩ
Note.—Plus signs indicate the relative frequency of the findings from lowest (ϩ) to highest (ϩϩϩ).
S148 October 2002 RG f Volume 22 ● Special Issue
Viral Pneumonias in Adults. Radiographics. 2002

Neumonía Fúngica
Hallazgos inespecíficos
Histoplasma
Coccidiodes
Blastomyces
Inmunocompetentes Inmunodeprimidos
Aspergillus
Candida
Cryptococcus
Reacción granulomatosa necrotizante.

Neumonía Fúngica
Histoplasmosis
Campesinos
RX. Consolidaciones de focos múltiples.
Afecta los lóbulos superiores.
Nódulos calcificados <1cm.
Ganglios calcificados.
Histoplasmoma LI.
Primaria
Crónica
Pulmonar Diseminada.
FIEBRE, TOS , PERDIDA DE PESO, ESPLENOMEGALIA Y ADENOPATÍAS.

Neumonía Fúngica
Aspergillus
Inmunocomprometidos
Aspergiloma o Micetoma.
Aspergilosis broncopulmonar alérgica.
Crónica necrotizante o semi-invasiva.
Invasiva.
Bronquiectasias centrales y taponamiento
bronquial.
Bronconeumonía necrotizante de focos múltiples
y áreas infectadas hemorrágicas o infartos con
nódulos simples o múltiples.

Fig. 3.56 Secondary aspergilloma (fungus ball in a preexisting cavity). The
patient is a 76-year-old man with a history of many years of COPD. Status post pul-
monary tuberculosis in the postwar years. Preoperative chest image in the presence
of rectal carcinoma. A solid lobulated mass measuring 3 cm in diameter and largely
surrounded by air is seen within a thin-walled cavity in the severely scarred right
upper lobe.
Fig. 3.55 “Foolʼs cap bell” in aspergilloma (detail). The patient is a 79-year-old
man with severe COPD and emphysema, now presenting with dyspnea, fever, and
productive cough. In addition to extensive bronchopneumonia of the right upper
lobe, the radiograph also demonstrates a mass 4 cm in diameter with an apical air
crescent (white arrows).
Opportunistic Lung Infections
Fig. 3.54 “Foolʼs cap bell” as a sign of aspergilloma.
Fig. 3.53 Pathophysiologic differentiation of primary and secondary aspergil-
loma. In a primary aspergilloma (right diagrams), invasion of the pulmonary artery
by hyphae leads to local infarction and cavitation. Here, hyphae later grow to the
fungus ball. In a secondary aspergilloma (left diagrams), a preexisting cavity is colo-
nized by hyphae.
3
130
Signo del menisco.

Fig. 3.56 Secondary aspergilloma (fungus ball in a preexisting cavity). The
patient is a 76-year-old man with a history of many years of COPD. Status post pul-
monary tuberculosis in the postwar years. Preoperative chest image in the presence
of rectal carcinoma. A solid lobulated mass measuring 3 cm in diameter and largely
surrounded by air is seen within a thin-walled cavity in the severely scarred right
upper lobe.
old
nd
er
air
Aspergiloma secundario

Aspergilosis Angioinvasiva Recuperación
SIGNO DEL HALO
2 semanas

Neumonía Parasitaria
Pneumocystis carinni
SIDA
Patrón reticular lineal perihiliar que
progresa a una consolidación
homogénea.

Opportunistic Lung Infectio

Fig. 3.8 Alveolar opacities in infection. Ground-glass opacities sparing the pe-
riphery of the lung and the bronchovascular spaces in Pneumocystis carinii pneumo-
nia. The densities correlate with the increasing filling of the alveoli with foamy
exudate and pathogens as the disease progresses.

Aspiración
Localizadas por efecto de
gravedad.
Cavitación y Abscesos.
(50%).
Empiema.
Anaerobias
Bacteroides y Fusobacterium
Mycoplasma
Extracción dentaria.Actinomyces Israelí
(Actinomicosis)
Niños y Adolescentes.
10-30% de las Neumonías
Extrahopitalarias.
Miringitis ampollosa y
exantema.
Atípicas
Opacidades no
segmentarias.
Periferia de Lóbulos
inferiores.
Patrón reticular fino.
Opacidades parcheadas.
Consolidación lobular.
Arbol en gemación.
NEUMONÍAS NECROTIZANTES
FIEBRE DE BAJO GRADO
TOS PRODUCTIVA
HEMOPTISIS

Absceso Pulmonar
Lesiones cavidades pulmonares.. Una aproximación al diagnóstico. 2012. SERAM

Fig. 3.26 Abscesses in lobar pneumonia. Area consolidation is seen in the right
upper lobe, which already shows hypoventilation. Other findings include central
hypodense areas (black arrow) and air inclusions.
dation in
Loss of
pneumo-
Alveolar Pneumonia

441
Necrotizing Pneumonia: v/s Lung Abscess
Very controversial topic because for many authors
is considered as one entity
Lozano, J. Complicaciones Asociadas a Neumonia Bacteriana. Neumologia Pediatrica. 2010; 5(Sup1): 70-75.
44
Necrotizing Pneumonia Lung Abscess
Severe complication causing necrosis
of lung parenchyma
Supurative process with a well‐
defined fibrous wall
Low contrast enhancing wall in Chest
CT
Contrast enhancing wall in Chest CT
Thick wall > 2 cm with or without air‐
fluid level
Thick wall > 2cm, with air‐fluid level
Loss of normal lung parenchyma Normal pulmonary parenchyma
architecture
Lozano, J. Complicaciones Asociadas a Neumonia Bacteriana. Neumologia Pediatrica. 2010; 5(Sup1): 70-75.

Infecciones pulmonares hraepy

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