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• • What is it:
    • Bronchopneumonia refers to:
      • A radiological and pathological finding characterized by patchy areas of inflammation or infection within the lung parenchyma,
      • centered around the bronchi and bronchioles, and extending into adjacent alveoli.
    • It reflects:
      • A localized infectious or inflammatory process, most commonly caused by bacterial pathogens.
    • Non-specific term:
      • While typically associated with bacterial infection, bronchopneumonia may also describe:
        • Non-infectious inflammatory processes, or
        • Aspiration-related lung injury.
    • Coexistence with Atelectasis:
      • Bronchopneumonia can coexist with atelectasis due to:
        • Obstruction of airways by inflammatory exudates or mucus plugs, leading to lung segment collapse.
  • Etymology:
    • Derived from the Greek words bronchos (windpipe) and pneumon (lung), referring to lung infection involving the bronchi and surrounding parenchyma.
  • AKA:
    • Bronchial pneumonia, Patchy pneumonia.
  • How does it appear on each relevant imaging modality:
    • Chest X-ray:
      • Patchy opacities in a peribronchial distribution, often bilateral and asymmetric.
      • Poorly defined margins blending into surrounding lung tissue.
      • Areas of atelectasis may appear as linear opacities or volume loss adjacent to infected regions.
    • Chest CT:
      • Parts:
        • Multifocal areas of consolidation and ground-glass opacities, centered around the bronchi and bronchioles.
      • Size:
        • Patchy, typically affecting segments or subsegments.
      • Shape:
        • Ill-defined, irregular opacities.
      • Position:
        • Peribronchial and peribronchiolar, often involving dependent lung regions.
        • Coexisting atelectasis: Subsegmental or segmental collapse near bronchopneumonic areas.
      • Character:
        • Mixed alveolar and interstitial patterns.
        • Air bronchograms may be present within consolidated areas.
      • Time:
        • Rapid onset with infectious etiology; resolves or evolves with treatment.
    • Ultrasound:
      • Subpleural consolidations may be visible in accessible areas.
    • MRI:
      • Rarely used; may highlight peribronchial inflammation and associated consolidation.
  • These findings reflect:
    • Infectious causes:
      • Bacterial pneumonia:
        • Common pathogens: Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa.
      • Viral pneumonia:
        • Secondary bacterial infection complicating influenza or RSV.
    • Non-infectious causes:
      • Aspiration pneumonia.
      • Organizing pneumonia (secondary to infection or inflammation).
    • Atelectasis coexistence:
      • Associated with airway obstruction by mucus plugs or debris in bronchopneumonia.
  • Differential diagnosis:
    • Infectious mimics:
      • Viral pneumonias without consolidation.
      • Tuberculosis with patchy opacities.
    • Non-infectious mimics:
      • Aspiration-related pneumonitis.
      • Organizing pneumonia or ARDS.
    • Malignant processes:
      • Bronchoalveolar carcinoma with patchy consolidation.
  • Recommendations:
    • Correlate imaging findings with clinical history, including symptoms (e.g., fever, cough) and laboratory markers (e.g., leukocytosis, sputum cultures).
    • Use Chest CT for detailed characterization if findings are atypical or diagnostic uncertainty persists.
    • Assess for coexisting atelectasis, which may complicate ventilation and recovery.
    • Consider bronchoscopy if mucus plugs or airway obstruction are suspected as contributing to atelectasis.
  • Key points and pearls:
    • Patchy distribution distinguishes bronchopneumonia from lobar pneumonia.
    • Bronchopneumonia is more common in the elderly, immunocompromised, or individuals with aspiration risks.
    • Atelectasis coexisting with bronchopneumonia can result in volume loss and hypoxemia, requiring specific management.
    • Persistent findings may indicate organizing pneumonia or malignancy and warrant further evaluation.