From the Guidelines
Differentiating Pneumonia from Pulmonary Congestion on Chest X-Ray
Pneumonia and pulmonary congestion can be differentiated on chest x-ray by looking for key distinguishing features, with pneumonia typically presenting with air bronchograms and lobar consolidation, whereas pulmonary congestion typically presents with perihilar opacities, Kerley B lines, and cardiomegaly 1.
- Key features of pneumonia on chest x-ray include:
- Air bronchograms
- Lobar consolidation
- Key features of pulmonary congestion on chest x-ray include:
- Perihilar opacities
- Kerley B lines
- Cardiomegaly In cases of suspected pneumonia, a course of antibiotics such as azithromycin 500mg orally daily for 5-7 days or ceftriaxone 1g intravenously every 24 hours for 5-7 days may be initiated, whereas pulmonary congestion may be managed with diuretics such as furosemide 40mg intravenously every 12 hours as needed 1. A follow-up chest x-ray after 48-72 hours of treatment can help confirm the diagnosis and assess response to therapy 1.
From the Research
Differentiating Pneumonia from Pulmonary Congestion on Chest X-ray
- Differentiating pneumonia from pulmonary congestion on chest x-ray can be challenging, but certain features can help in distinguishing between the two conditions 2, 3.
- Kerley B lines in the lung apex are a distinct CT sign for pulmonary congestion, and their presence can help in differentiating pulmonary congestion from interstitial lung disease (ILD) 2.
- Peribronchial cuffing is also more frequent in cardiac insufficiency than in renal insufficiency or ILD, and can be used as a distinguishing feature 2.
- CT features of community-acquired pneumonia (CAP) include lobar pneumonia, lobular pneumonia, unilobar infra-segmental consolidation, bronchiolitis, atelectasis, and interstitial pneumonia, and these features can be used to differentiate CAP from pulmonary congestion 3.
- Chest CT is more sensitive than chest x-ray in detecting CAP, especially in cases with lobular pneumonia or unilobar infra-segmental consolidation 3.
CT Features of Pneumonia and Pulmonary Congestion
- CT features of pneumonia include ground-glass opacity, consolidation, and air-space consolidation, while pulmonary congestion is characterized by Kerley B lines, peribronchial cuffing, and cardiomegaly 2, 3.
- CT-textural features, such as heterogeneity and uniformity of skewness, can also be used to differentiate between alveolar hemorrhage and pneumocystis jirovecii pneumonia (PJP) 4.
- The presence of bronchiectasis and a high parenchymal involvement of consolidation on initial chest CT are associated with a worse response to corticosteroids in patients with organizing pneumonia 5.
Texture Analysis in Chest X-ray Images
- Texture analysis of chest x-ray images can be used to evaluate COVID-19 pneumonia, and machine learning models can be trained to differentiate between COVID-19 pneumonia and other conditions 6.
- The use of texture analysis and machine learning models can improve the diagnostic performance of chest x-ray images in patients with clinical suspicion of COVID-19 related pneumonia 6.