A 2 year old child with Bronchopneumonia

A 2 years old child was brought to radiology department for X-ray chest with cough and high fever over last 3 days. His X ray is shown below:

X-ray chest shows soft small ill-defined opacities scattered in both lung fields partially sparing the lower zones.

Comments And Explanation
On X-ray bronchopneumonia appears as small fluffy ill-defined acinar nodules, which coalesce and enlarge with time and may develop into segmental and lobar densities with volume loss from airway obstruction secondary to mucus plugging and bronchial narrowing.

Diagnosis: Bronchopneumonia.

Clinical Discussion
Bronchopneumonia is a combination of interstitial and alveolar disease.
In bronchopneumonia the insult begins in airways, involves bronchovascular bundle and trickles into alveoli, which may develop and contain edema fluid, blood, leukocytes, hyaline membranes and organisms.

The organisms which lead to bronchopneumonia are
(a) Staphylococcus aureus
(b) Pseudomonas pneumonia
(c) Streptococcus
(d) Klebsiella and
(e) Mycoplasma.

Antibiotic therapy is the mainstay of treatment of bacterial pneumonia. However, patients who have bronchospasm with infection benefit from inhaled bronchodilators, administered by means of a nebulizer metered dose inhaler.

Hospitalized patient should be initially placed on broad spectrum antibiotic and cover the likely causative organisms. Definitive therapy should be based on laboratory data, susceptibility patterns and clinical response.

Direct admission to an intensive care unit (ICU) is mandatory for any patient in septic shock with a requirement for vasopressors or with acute respiratory failure requiring intubation and mechanical ventilation.