DAVID SUTTON PICTURES ONLY FOR STUDY

1. 5 PULMONARY INFECTIONS
DAVID SUTTON

2. DAVID SUTTON PICTURES
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig. 5.1 (A) Pneumococcal pneumonia. Lingular and right upper
lobe consolidation with sparing of the apex. (B) CT image from a
different patient demonstrating air bronchograms in an area of
peripheral consolidation due to an organising pneumonia.

4. • Fig. 5.2 Staphylococcal pneumonia of the
right upper lobe with abscess formation.

5. • Fig. 5.3 (A) Haematogenous staphylococcal abscess
formation in an intravenous drug abuser. There are
multiple thin-walled cavities and an associated left pleural
effusion. (B) Multiple large thin-walled pneumatoceles in a
different intravenous drug abuser with staphylococcal
tricuspid endocarditis.

6. • Fig. 5.4
Staphylococcal
bronchopneumoni
a. A pneumatocele
has developed in
the right upper
lobe. The
radiograph
eventually
returned to

7. • Fig. 5.5 (A, B) Klebsiella pneumonia. There is
consolidation in the right lower lobe with associated
loss of volume evident on the lateral view.

8. Fig. 5.6 (A, B) Klebsiella pneumonia. There is a large
cavity in the right lower lobe following cavitation of
pneumonic consolidation. An aortic valve replacement
is present.

9. • Fig. 5.7 Klebsiella septicaemia. There is
diffuse patchy alveolar shadowing
• with air bronchograms.

10. • Fig:5.8 : Legionnaires disease. There is
bilateral consolidation, more marked on right.

11. • Fig. 5.9 Haemophilus
infection.
Widespread small
nodular opacities are
evident.

12. • Fig. 5.10 Tularaemia. There is right hilar nodal
involvement and perihilar consolidation.

13. • Fig. 5.11
Mycoplasma
pneumonia. There
is a patch of left mid
zone consolidation
obscuring the left
heart border.

14. • Fig. 5.12 Adenovirus chest infection. There is
reticulonodular infiltrate, most marked in a
bronchovascular distribution at the right base.

15. • Fig. 5.13 CMV pneumonia in a 21-month-old
child. There is reticular nodular shadowing
throughout both lungs.

16. • Fig. 5.14 Influenza A. Haemorrhagic
consolidation was present at postmortem.

17. Fig. 5.15 Chickenpox pneumonia occurring during
pregnancy. There is widespread, predominantly
nodular shadowing throughout both lungs. The
patient made a complete recovery.

18. • Fig. 5.16 Multiple
calcified varicella
scars.

19. • Fig. 5.17 Measles giant cell pneumonia.
Extensive ill-defined opacities with air
bronchograms. The changes are more marked on
the right than the left.

20. • Fig. 5.18 (A) Lung abscess. There was poor
dental hygiene. Mixed anaerobic growth. (B)
Several weeks later a thin-walled
pneumatocele remains.

21. • Fig. 5.19 (A) Staphylococcal abscess in a patient with
adult respiratory distress syndrome. A cavity with a
fluid level is present within a dense area of
consolidation. (B) Lung abscess in a different patient
developing in a large necrotic adenocarcinoma.
Percutaneous aspiration revealed a mixed growth of
Hoemophilus and Streptococcus.

22. • Fig. 5.20 (A) Lipoid pneumonia. Aspiration of liquid
paraffin. (B) Eight years later there has been
significant clearing but severe residual fibrosis is now
present.

23. • Fig. 5.21 Mendelson's syndrome.
Postoperative aspiration of gastric contents.
Note the subdiaphragmatic air following
laparotomy.

24. • Fig. 5.22 Tuberculous pneumonia. Air bronchograms
are present in the left upper lobe consolidation. Less
marked right upper lobe consolidation is also present.

25. • Fig. 5.23 Tuberculosis. There is left hilar
enlargement and perihilar consolidation.

26. • Fig. 5.24 Healed tuberculosis. There is bilateral upper lobe fibrosis
with elevation of both hila. Basal emphysema has developed. There
are multiple calcified granulomas in the mid and upper zones.

27. • Fig. 5.25 Tuberculosis. Dense non-homogeneous
opacities. Contracted right upper lobe.

28. • Fig. 5.26 : Tuberculosis. Minimal right apical
region

29. Fig. 5.27 Tuberculosis. (A, B) Chest radiograph and
CT scan demonstrating almost complete
destruction of the right lung due to pulmonary
tuberculosis. The CT reveals bronchopneumonic
spread to the opposite lung.

30. • Fig. 5.28
Tuberculosis. There
is fibrotic shrinkage
of the left upper
lobe with mediastinal
and hilar
displacement an in
which case the
differential diagnosis
includes lymphoma
and d apical pleural
thickening.

31. • Fig. 5.29 Right apical aspergilloma in a
patient with previous TB. Note the mycetoma
material lying free in the dependent part of
the cavity as well as the nodules adherent to
the cavity walls anteriorly.

32. • Fig. 5.30 Extensive bronchopneumonic
spread of tuberculosis in an HIV-positive
patient.

33. • Fig. 5.31 Miliary tuberculosis. There are
innumerable well-defined nodules present.

34. • Fig. 5.32 Tuberculoma. A well-defined cavity
is projected adjacent to the right hilum.

35. • Fig. 5.33 Tuberculosis. There is right hilar
lymph node enlargement.

36. • Fig. 5.34 : Tuberculosis.
There is generalized
pleural thickening with
extensive pleural
calcification.

37. • Fig. 5.35 Tuberculous lymphadenopathy. (A) There is
mediastinal and left hilar lymph node enlargement
causing some narrowing of the left main bronchus. (B) One
month later appearances have significantly progressed with
enlargement of the hilar and mediastinal nodes and
increased left main bronchial narrowing.

38. • Fig. 5.36 Actinomycosis. There is a dense
mass-like area of consolidation in the right
mid zone.

39. Fig. 5.37 Nocardia asteroides pneumonia. There
are multiple cavities within the right lung, one of
which has cavitated.

40. • Fig. 5.38 Nocardiosis. There is non-
homogeneous consolidation in the right
upper lobe.

41. • Fig. 5.39 Histoplasmosis. Calcified nodules of
varying size are present in both lungs.
Calcified hilar nodes are also present.

42. • Fig. 5.40 Histoplasmosis. Incidental finding of
multiple calcified pulmonary nodules.

43. • Fig. 5.41 Histoplasmosis. CT examination
through a right lower lobe histoplasmoma
that demonstrates central calcification. Patient
is being examined in the prone position prior
to percutaneous needle biopsy.

44. • Fig. 5.42 Acute histoplasmosis following massive
exposure whilst visiting a bat-infested cave. There are
widespread bilateral well-defined 3-5-mm nodules.

45. • Fig. 5.43 Fibrosing mediastinitis following
histoplasmosis. (A) Chest X-ray shows widening of the
upper mediastinum. (B) Right arm phlebogram
demonstrating compression of the right innominate
vein. There is also a degree of tracheal narrowing.

46. • Fig. 5.44 Coccidioidomycosis. (A) A non-specific patch
of consolidation is present in the left lower lobe. (B)
One year later a thin-walled cavity is evident.

47. • Fig. 5.45 Cryptococcus. A pleurally based mass-
like area of consolidation in the left upper lobe is
present in a patient who also had cryptococcal
meningitis.

48. • Fig. 5.46 Invasive aspergillosis. There is widespread
bronchopneumonic change in a patient receiving
chemotherapy for oat cell carcinoma.

49. • Fig. 5.47 Invasive aspergillosis. HRCT through a left
upper lobe nodule demonstrating a halo of increased
attenuation. Pathologically this correlates with a
surrounding zone of haemorrhagic necrosis.

50. • Fig. 5.48 Invasive aspergillosis in a patient
with acute lymphoblastic leukaemia. A
necrotising pneumonia in both lower zones
has cavitated, mimicking the formation of
fungus balls.

51. • Fig. 5.49 Asthmatic with allergic
bronchopulmonary aspergillosis. Mucus plugging
has resulted in collapse of the right upper lobe.
Complete resolution followed treatment.

52. Fig. 5.50 Allergic bronchopulmonary
aspergillosis. HRCT scan demonstrating
finger-like opacities due to dilated mucus-
filled bronchi.

53. • Fig. 5.51 Allergic bronchopulmonary
aspergillosis. HRCT demonstrating
widespread bronchiectasis of the medium and
large airways.

54. • Fig. 5.52 Pulmonary hydatid disease. (A) Well-
defined right basal pulmonary mass. (B) The CT
scan reveals the well-defined wall and cystic
contents. (C) This patient also had a large hepatic
hydatid cyst.

55. • Fig. 5.52 Pulmonary hydatid disease. (A) Well-
defined right basal pulmonary mass. (B) The CT
scan reveals the well-defined wall and cystic
contents. (C) This patient also had a large hepatic
hydatid cyst.

56. • Fig. 5.53 Pulmonary sequestration. (A) The chest
radiograph demonstrates a cavitating mass-like lesion
in the right lower lobe. Note the preservation of the
heart border and diaphragm. (B) Angiogram
demonstrating the typical blood supply from a side
branch of the Subdiaphragmatic aorta.

57. • Fig. 5.54 Candida albicans bronchopneumonia.
Mixed infection with Gram-negative organisms.
Chronic alcoholic. Postmortem confirmation.

58. • Fig. 5.55 Mucormycosis. The patient was an alcoholic.
Fungal infection followed Rocky Mountain spotted
fever. Mixed infection with Gram-negative organisms.
Postmortem confirmation.

59. • Fig. 5.56 Disseminated cryptococcosis. Mixed
infection with Gram negative organisms.
Patient on steroids for systemic lupus.

60. • Fig. 5.57 Pneumocystis carinii pneumonia.
There is widespread bilateral mid and lower
zone ground-glass infiltrate.

61. • Fig. 5.58 Pneumocystis carinii pneumonia.
Extensive bilateral consolidation.

62. • Fig. 5.59 Pneumocystis carinii pneumonia.
HRCT image through the upper lung zones
demonstrating bronchocentric ground-glass
infiltrate with a degree of asymmetry.

63. • Fig. 5.60 HRCT scan through the lungs
demonstrating multiple areas of cystic
destruction following repeated Pneumocystis
infection. (Courtesy of C. D. R. Flower,
Addenbrooke's Hospital, Cambridge.)

64. • Fig. 5.61 Pneumocystis carinii pneumonia. Chest
radiograph (A) and CT scan (B) demonstrating
extensive mediastinal and surgical emphysema
with bilateral pneumothoraces.

65. • Fig. 5.62 Pneumocystis carinii pneumonia.
Asymmetrical interstitial infiltrate in the right
apex, barely visible on the chest radiograph, in
a patient on aerosolised pentamidine.

66. • Fig. 5.63 Pneumocystis carinii pneumonia. Chest
radiograph demonstrating bilateral apical
infiltrates in a patient on aerosolised pentamidine
prophylaxis.

67. • Fig. 5.64 Pneumocystis carinii pneumonia
causing miliary shadowing. Appearances
resolved on appropriate treatment.

68. • Fig. 5.65 Tuberculous lymph node
enlargement in a patient with AIDS. There is a
central low-density area surrounded by a rim
of enhancing nodal material.

69. • Fig. 5.66 Cytomegalovirus in AIDS. Although
CMV is rarely a cause of pneumonia in isolation,
on occasion other organisms are not identified.

70. • Fig. 5.67 Right upper lobe cavity colonised by
aspergillus in an AIDS patient.

71. • Fig. 5.68 Kaposi's sarcoma. (A) Multiple poorly defined pulmonary
nodules are present bilaterally in a patient with bronchial and
cutaneous Kaposi's sarcoma. (B, C). CT scans of two different
patients demonstrating multiple poorly defined pulmonary nodules
with a mid and lower zone and peribronchovascular predominance.

72. • Fig. 5.68 Kaposi's sarcoma. (A) Multiple poorly
defined pulmonary nodules are present bilaterally in
a patient with bronchial and cutaneous Kaposi's
sarcoma. (B, C). CT scans of two different patients
demonstrating multiple poorly defined pulmonary
nodules with a mid and lower zone and
peribronchovascular predominance.

73. • Fig. 5.69 Lymphocytic interstitial pneumonitis. (A) Chest X-ray
demonstrating bilateral mid and lower zone 2-5-mm nodules. (B)
Three years later there is an extensive mid and lower zone
pulmonary infiltrate. (C) HRCT scan demonstrating the
bronchovascular distribution of confluent infiltrate with more
peripheral discrete nodules. Transbronchial biopsy confirmed the
diagnosis of lymphocytic interstitial pneumonitis.

74. • Fig. 5.69 Lymphocytic interstitial pneumonitis. (A) Chest X-ray
demonstrating bilateral mid and lower zone 2-5-mm nodules. (B)
Three years later there is an extensive mid and lower zone
pulmonary infiltrate. (C) HRCT scan demonstrating the
bronchovascular distribution of confluent infiltrate with more
peripheral discrete nodules. Transbronchial biopsy confirmed the
diagnosis of lymphocytic interstitial pneumonitis.

75. • Fig. 5.70 Non-specific interstitial pneumonitis. A
nodular infiltrate with patches of confluence is
present in addition to widespread bronchiectasis,
most marked in the middle lobe. The
appearances have been slowly evolving over 3
years.

76. • Fig. 5.71 AIDS-related lymphoma. There is a
well-defined mass in the left mid zone.
Percutaneous needle biopsy was undertaken to
confirm the diagnosis.

77. • Fig. 5.72 AIDS-related lymphoma causing
extensive consolidation in the right upper
lobe. Infiltration of the left lower lobe in
association with a pleural effusion is also
evident.