A 35-year-old male presented with fever, cough, and purulent sputum for one week. His Chest X ray is shown below:
The CXR shows a focal shadow in the right lower lobe with air bronchograms suggestive of pneumonia. It is clearly in the right lower lobe because the right hemidiaphragm is effaced. Right middle lobe shadows would efface the right heart border.
The presence of air bronchograms indicates pathology in the alveoli, as the conducting airways remain patent with air.
Water or blood can also occupy the alveoli as a result of pulmonary edema or pulmonary hemorrhage respectively. There should be other supporting signs such as cardiomegaly, upper lobe diversion, and
Kerley B lines with pulmonary edema.
The differential diagnoses of a focal shadow with air bronchograms include
- bronchoalveolar cell carcinoma and
- lymphoma.
It is important to follow-up the CXR to ensure that total resolution of infection occurs. This may take up to three months in the elderly but generally some improvement usually occurs within a week.