Lobular pneumonia, also known as bronchopneumonia, is more common in infants, older adults, and extremely debilitated patients, or may be a postoperative complication.
Clinical presentation and pathology
The lesion often involves the lobular bronchi through the upper respiratory tract and spread to the adjacent areas centered on the lobule, producing inflammatory exudates in the lobular bronchi and alveoli. The lesion is lobular, scattered bilaterally, and can fuse into large areas. Inflammatory congestion and edema of the bronchioles may result in obstruction, forming lobular emphysema or atelectasis. The clinical manifestations are mainly fever, which may be accompanied by cough, mucus expectoration, thoracodynia, dyspnea, and cyanosis.
Imaging manifestations
X-ray
The lesion is mostly in the inner and middle zones of the middle and lower fields of both lungs along the lung markings. The manifestations are multiple, scattered, poorly marginated, inhomogeneous, patchy opacities that can fuse into massive opacities. Congestion and edema of the bronchial wall cause increased and hazy lung markings.
Figure 1 Lobular pneumonia
Chest x-ray film shows increased and hazy lung markings in the inner and middle zones of both lungs and patchy hazy opacities along the lung markings.
CT
Thickening of the local bronchovascular bundles can be seen in the middle and lower parts of both lungs; there are variously sized, poorly marginated, nodular or patchy opacities. Lobular bronchial obstruction may be accompanied by lobular emphysema or atelectasis. After treatment, lobular pneumonia can completely subside, or few irregular linear opacities may remain.
Diagnosis and differential diagnosis
Lobar pneumonia has significant clinical symptoms. If imaging manifestations have certain characteristics, a diagnosis can often be readily established. In patients with protracted course or recurrent episodes, CT examination can determine whether there is complicated bronchiectasis.