What is the role of chest radiography in the diagnosis of Pseudomonas infections?

Updated: Dec 17, 2018
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Chest radiography

  • Patients with cystic fibrosis (CF) may have a small heart, depressed diaphragm, and increased anteroposterior chest diameter. Chest radiography may also reveal cyst formation, mucus plugging of dilated bronchi, generalized bronchiectasis, patchy atelectasis, peribronchial thickening, overaeration, or extensive peribronchial infiltration.

  • The classic presentation of bacteremic pseudomonal pneumonia includes rapid progression of radiographic findings. Chest radiography performed within 48-72 hours after initial fever onset reveals parenchymal involvement with interstitial and alveolar infiltrates. Cavitation appears after 48 hours.

  • Typical findings include (1) poorly-defined, hemorrhagic, often subpleural, nodular areas with a small central area of necrosis and (2) multiple, 2-mm to 15-mm, necrotic, umbilicated nodules with hemorrhagic parenchyma, representing the pulmonary component of an ecthyma gangrenosum (EG) skin lesion.

  • The typical progression of disease is from pulmonary vascular congestion to pulmonary edema to necrotizing bronchopneumonia.

  • Radiographs of patients with primary nonbacteremic pneumonia are similar to those from patients whose pneumonia is caused by Staphylococcus aureus. Among the common features are a diffuse bronchopneumonia (usually bilateral with distinctive nodular infiltrates with small areas of radiolucency) and pleural effusions; empyema or lobar consolidation is occasionally observed.

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