0:00

The next category we will discuss is

0:02

infectious lung disorders.

0:05

Namely, we will talk about imaging findings

0:08

of viral infection versus asthma, bacterial infection,

0:13

mycobacterial infection, and some fungal infections.

0:19

Sometimes when patients present with symptoms such as fever,

0:22

cough, and difficulty breathing,

0:24

chest radiographs are ordered

0:27

and when they're ordered frequently, the main clinical

0:31

question is whether or not the patient has

0:32

what looks like a bacterial pneumonia.

0:35

So for the next several cases that I will show you,

0:38

I'll be showing cases that are not of bacterial pneumonia,

0:41

but rather viral pneumonias

0:44

or viral inflammatory syndromes,

0:46

which do not require imaging for treatment,

0:49

but rather to rule out bacterial pneumonia

0:52

that would require antibiotic treatment.

0:55

This first case is of a young child who presented with some

0:59

of those same symptoms, and the findings that we see here

1:03

with this viral pneumonia include streaky

1:07

and patchy perihilar opacities.

1:11

Sometimes we can see bronchial wall thickening.

1:13

If you zoom in, some of those central bronchial walls

1:17

might look a little thicken,

1:19

which I would argue is a bit subtle in this particular case.

1:22

But normal bronchial walls should look like

1:26

you drew them with a very thin, well sharpened pencil.

1:31

If they look thicker than that,

1:33

then they're a little too thick

1:34

and see some over on the right side here,

1:36

they look a little bit thick.

1:39

Additionally, you can look for hyperinflation

1:41

That can sometimes be a little bit difficult

1:43

to determine on frontal radiographs,

1:45

sometimes you can see separation

1:47

of the cardiac silhouette from the diaphragm quite a bit.

1:51

But what can be helpful on the lateral radiograph is to look

1:53

for flattening of the diaphragms.

1:56

That'll give you a sense of hyper aeration as opposed

1:59

to simply a good deep inspiratory breath.

2:03

So this patient has multiple findings.

2:06

They're on the milder side, at least radiographically,

2:09

but we see those streak opacities,

2:11

some broncho wall thickening,

2:12

and hyperinflation of the lungs.

2:15

And so this is a very typical look

2:17

for a viral viral inflammatory syndrome or viral pneumonia.

2:22

Now, one thing to be aware of is

2:24

that asthma can have identical imaging findings,

2:28

and in fact, asthma

2:29

and a viral inflammatory syndrome can also coexist.

2:32

So it is extremely difficult oftentimes to differentiate

2:35

between the two radiographically,

2:37

and so the clinicians will have additional information

2:40

to help them sort those out.

2:43

The next case is to show similar findings,

2:46

but a more severe case.

2:48

Here we can see more severe patchy

2:52

and streaky perihilar opacities extending out into

2:56

the more central lungs. We can even

2:58

See some silhouetting

3:01

of the cardiac margin on the left side.

3:04

If we zoom in again,

3:06

we can probably find some thickened bronchial walls.

3:11

And when we look at the lateral,

3:13

while we're not seeing flattening

3:14

of the diaphragm in this patient,

3:16

we're also confirming we don't see any focal consolidation

3:19

to suggest a bacterial pneumonia.

3:22

And so this is another case of a viral pneumonia

3:24

or viral inflammatory process.

3:28

The final case, I'll show you again,

3:30

similar imaging findings,

3:32

some srey patchy para high opacities,

3:35

but also much more obvious bronchial wall thickening.

3:40

Additionally, on the lateral we see flattening

3:42

of those diaphragms suggesting hyperinflation,

3:46

and all of these findings are indicative

3:48

of a viral inflammatory syndrome, possibly pneumonia.