A 45 year old lady presents with right sided chest pain on breathing , cough and phlegm, weakness, fever and chills since last 7 days

 A 45 year old lady presents with right sided chest pain on breathing , cough and phlegm, weakness, fever and chills since last 7 days.

She has a fever of 37.8 C.

Onexamination, there is reduced air entry on right side . Chest X ray is done which is shown below.

1. What are the findings on Chest X ray?

2. What is the most likely Diagnosis?

3. What are the causes of this disease?

4. Which further investigations should be performed ?

5. How would you manage this patient?

Copy right reserved with author.

Data anonymized , consent taken for teaching purposes.

Answers given in comments section.

1. What are the findings on Chest X ray? 

Right basal consolidation / Right lower lobe consolidation.

2. What is the most likely Diagnosis? 

Right Lower lobe pneumonia. 

Lobular pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung.

3. What are the causes of this disease? 

The most common organisms which cause lobar pneumonia are Streptococcus pneumoniae, also called pneumococcus, Haemophilus influenzae and Moraxella catarrhalis. 

Mycobacterium tuberculosis, the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not treated promptly. Other organisms that cause lobar pneumonia are Legionella pneumophila and Klebsiella pneumoniae.

Like other types of pneumonia, lobar pneumonia can present as community acquired, in immune suppressed patients or as nosocomial infection. However, most causative organisms are of the community acquired type.

4. Which further investigations should be performed ? 

Pathological specimens to be obtained for investigations include:

Sputum for culture, Acid Fast bacilli and gram stain.

Blood for full hemogram/complete blood count, ESR and other acute phase reactants.

Procalcitonin levels < Chest X ray and CT chest if needed for further evaluation. 

Pulse oximetry measures the oxygen level in patients blood. 

Pneumonia can prevent lungs from moving enough oxygen into the bloodstream. 

Pleural fluid culture may be needed for further evaluation.

5. How would you manage this patient? 

Principles of management include : 

Medications / antibiotics to eleminate the mico organism responsible for causing pneumonia after results of Culture and sensitivity and srology are obtained. 

Analgesics and antipyretics to control pain and fever respectively. 

Oxygen may be needed if Oxygen saturations are low. 

Inflammatory markers should be monitored to determine if antibiotics and treatment is working or not.

https://go.urtrackinglink.com/aff_c?offer_id=1404&aff_id=24051