What is Bronchopneumonia?
Bronchopneumonia is a pattern of pneumonia characterized by inflammation centered in the bronchioles and adjacent alveoli, representing a descriptive radiographic and pathologic term rather than a distinct clinical entity. 1
Clinical Definition and Context
Bronchopneumonia describes an inflammatory process affecting the bronchioles and surrounding lung parenchyma, typically presenting with patchy, multifocal consolidation rather than lobar involvement. 1 This term is primarily anatomic and pathologic in nature, distinguishing it from lobar pneumonia based on the distribution of infection within the lung tissue.
Key Clinical Features
The presentation of bronchopneumonia aligns with general pneumonia criteria:
- Acute illness with cough as the predominant symptom, accompanied by at least one additional lower respiratory tract finding (sputum production, dyspnea, wheeze, or chest discomfort) 2
- Fever, purulent sputum, and leukocytosis in bacterial cases 3, 4
- New lung infiltrates on chest radiography with clinical evidence supporting infection 4
- Decline in oxygenation in more severe presentations 3
Etiologic Considerations
Bronchopneumonia can result from multiple pathogens:
- Bacterial causes include Streptococcus pneumoniae (most common in adults), Haemophilus influenzae, Staphylococcus aureus, and gram-negative bacilli 2
- Viral pathogens account for significant cases, particularly in children under 5 years (respiratory syncytial virus, parainfluenza) 2
- Mixed infections occur in approximately 20% of cases with both bacterial and viral components 5
Diagnostic Approach
Diagnosis requires integration of clinical presentation, radiographic findings, and microbiological data:
- Obtain chest radiograph (posteroanterior and lateral views) showing patchy infiltrates in dependent lung segments 3
- Collect lower respiratory tract specimens before antibiotic initiation for Gram stain and culture 3
- Obtain two sets of blood cultures (specificity high when positive, though sensitivity <25%) 3
- Consider CT imaging in complex cases for better detection of parenchymal changes 3
Important Clinical Distinctions
Bronchopneumonia differs from acute bronchitis, which occurs without chronic lung disease and lacks radiographic infiltrates. 2 When chest radiograph shadowing consistent with infection is present in patients with COPD or bronchiectasis exacerbations, the diagnosis shifts to community-acquired pneumonia rather than simple exacerbation. 2
Common Pitfalls
- Clinical criteria alone (fever, purulent secretions, leukocytosis, infiltrates) have high sensitivity but low specificity for pneumonia diagnosis 3
- Upper respiratory tract colonization in hospitalized patients makes culture interpretation challenging, particularly with endotracheal intubation 3
- Radiographic resolution lags behind clinical improvement, so repeat imaging should not guide treatment duration in uncomplicated cases 2
The term "bronchopneumonia" is increasingly replaced in clinical practice by more specific classifications (community-acquired pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia) that better guide antimicrobial selection and management. 4, 6