Pneumonia is an infection in one or both of the lungs that causes the air sacs of the lungs to fill up with fluid or pus. It can be very serious and even life threatening. Learn about the symptoms of pneumonia, how it's treated, and how to prevent it.
Pneumonia - Cross Section of Alveoli filled with fluid
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Pneumonia
Co2 in the alveoli / Mucus in the alveoli
Healthy Lungs vs Pneumonia
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Co2 in the alveoli / Mucus in the alveoli
Healthy Lungs vs Pneumonia
1) Co2 in the alveoli
2) Mucus in the alveoli
Interactive by TheVisualMD
Pneumonia
What is pneumonia?
Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.
What causes pneumonia?
Bacterial, viral, and fungal infections can cause pneumonia.
Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including:
Streptococcus pneumoniae
Legionella pneumophila; this pneumonia is often called Legionnaires' disease
Mycoplasma pneumoniae
Chlamydia pneumoniae
Haemophilus influenzae
Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include:
Respiratory syncytial virus (RSV)
Some common cold and flu viruses
SARS-CoV-2, the virus that causes COVID-19
Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include:
Pneumocystis pneumonia (PCP)
Coccidioidomycosis, which causes valley fever
Histoplasmosis
Cryptococcus
Who is at risk for pneumonia?
Anyone can get pneumonia, but certain factors can increase your risk:
Age; the risk is higher for children who are age 2 and under and adults age 65 and older
Exposure to certain chemicals, pollutants, or toxic fumes
Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
Having a lung disease
Having a weakened immune system
Have trouble coughing or swallowing, from a stroke or other condition
Recently being sick with a cold or the flu
What are the symptoms of pneumonia?
The symptoms of pneumonia can range from mild to severe and include:
Fever
Chills
Cough, usually with phlegm (a slimy substance from deep in your lungs)
Shortness of breath
Chest pain when you breathe or cough
Nausea and/or vomiting
Diarrhea
The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.
Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.
What other problems can pneumonia cause?
Sometimes pneumonia can cause serious complications such as:
Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
Lung abscesses, which are collections of pus in cavities of the lungs
Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
Kidney failure
Respiratory failure
How is pneumonia diagnosed?
Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.
Your health care provider may use many tools to make a diagnosis:
A medical history, which includes asking about your symptoms
A physical exam, including listening to your lungs with a stethoscope
Various tests, such as
A chest x-ray
Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream
If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as:
Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
Bronchoscopy, a procedure used to look inside your lungs' airways
What are the treatments for pneumonia?
Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:
Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
In some cases, your provider may prescribe antiviral medicines for viral pneumonia
Antifungal medicines treat other types of fungal pneumonia
You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.
It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.
Can pneumonia be prevented?
Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.
Source: NIH: National Heart, Lung, and Blood Institute
Additional Materials (22)
Managing Hospital Acquired Pneumonia / Ventilator Associated Pneumonia in the ICU
Video by MSH-UHN ASP/YouTube
PART I - Pneumonia (Overview, Lobar and Bronchopneumonia)
Video by Armando Hasudungan/YouTube
Pneumonia: Symptoms, Diagnosis, Treatment, and Prevention | Merck Manual Consumer Version
Video by Merck Manuals/YouTube
Bacterial Pneumonia - Pathogenesis
Video by PhysioPathoPharmaco/YouTube
What is pneumonia? | Respiratory system diseases | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Pneumonia diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Pneumonia – A Serious Condition to be Taken Seriously
Video by Pfizer/YouTube
What is Pneumonia
Video by Daniel Izzo/YouTube
PART II - Pneumonia (Transmission, Causative Agents, Investigations, Management)
Video by Armando Hasudungan/YouTube
Is Walking Pneumonia Contagious
Video by Get Science & Technology/YouTube
Understanding Pneumococcal Pneumonia
Video by American Lung Association/YouTube
PNEUMONIA
Video by ambobag/YouTube
The Signs and Dangers of Pneumonia
Video by ClearCareMD/YouTube
What is Pneumonia Medical Course
Video by Abiezer Abigail/YouTube
When Pneumonia Walks - Dr. Julie Philley
Video by UT Health Science Center at Tyler/YouTube
The Coughing Child and Pneumonia
Video by iheed/YouTube
Pneumonia Discharge
Video by Covenant Health/YouTube
Pneumocystis Pneumonia & Pneumocystis Jirovecii
Video by Paul Cochrane/YouTube
Walking Pneumonia in Children
Video by ehowhealth/YouTube
Pneumonia, Animation
Video by Alila Medical Media/YouTube
What Is Pneumonia?
Video by Institute of Human Anatomy/YouTube
Here's Why Pneumonia Is Still So Deadly
Video by Seeker/YouTube
4:24
Managing Hospital Acquired Pneumonia / Ventilator Associated Pneumonia in the ICU
MSH-UHN ASP/YouTube
15:28
PART I - Pneumonia (Overview, Lobar and Bronchopneumonia)
Armando Hasudungan/YouTube
1:08
Pneumonia: Symptoms, Diagnosis, Treatment, and Prevention | Merck Manual Consumer Version
Merck Manuals/YouTube
4:36
Bacterial Pneumonia - Pathogenesis
PhysioPathoPharmaco/YouTube
9:50
What is pneumonia? | Respiratory system diseases | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
10:15
Pneumonia diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
4:04
Pneumonia – A Serious Condition to be Taken Seriously
Pfizer/YouTube
0:27
What is Pneumonia
Daniel Izzo/YouTube
12:44
PART II - Pneumonia (Transmission, Causative Agents, Investigations, Management)
Armando Hasudungan/YouTube
5:03
Is Walking Pneumonia Contagious
Get Science & Technology/YouTube
1:43
Understanding Pneumococcal Pneumonia
American Lung Association/YouTube
4:02
PNEUMONIA
ambobag/YouTube
1:58
The Signs and Dangers of Pneumonia
ClearCareMD/YouTube
3:16
What is Pneumonia Medical Course
Abiezer Abigail/YouTube
4:45
When Pneumonia Walks - Dr. Julie Philley
UT Health Science Center at Tyler/YouTube
3:24
The Coughing Child and Pneumonia
iheed/YouTube
6:12
Pneumonia Discharge
Covenant Health/YouTube
3:13
Pneumocystis Pneumonia & Pneumocystis Jirovecii
Paul Cochrane/YouTube
3:14
Walking Pneumonia in Children
ehowhealth/YouTube
3:05
Pneumonia, Animation
Alila Medical Media/YouTube
13:17
What Is Pneumonia?
Institute of Human Anatomy/YouTube
5:14
Here's Why Pneumonia Is Still So Deadly
Seeker/YouTube
Types
Respiratory Tract
Inflammation of the Lungs
Infection of the Lungs
1
2
3
Normal vs Inflammation vs Infected Lungs
Interactive by TheVisualMD
Respiratory Tract
Inflammation of the Lungs
Infection of the Lungs
1
2
3
Normal vs Inflammation vs Infected Lungs
1) Healthy Lungs - Lungs of a healthy individual
2) Inflammation - Inflammation in the lungs
3) Infection - Infection in the lungs
Interactive by TheVisualMD
Types of Pneumonia
Pneumonia is named for the way in which a person gets the infection or for the germ that causes it.
Community-Acquired Pneumonia
Community-acquired pneumonia (CAP) occurs outside of hospitals and other health care settings. Most people get CAP by breathing in germs (especially while sleeping) that live in the mouth, nose, or throat.
CAP is the most common type of pneumonia. Most cases occur during the winter. About 4 million people get this form of pneumonia each year. About 1 out of every 5 people who has CAP needs to be treated in a hospital.
Hospital-Acquired Pneumonia
Some people catch pneumonia during a hospital stay for another illness. This is called hospital-acquired pneumonia (HAP). You're at higher risk of getting HAP if you're on a ventilator (a machine that helps you breathe).
HAP tends to be more serious than CAP because you're already sick. Also, hospitals tend to have more germs that are resistant to antibiotics (medicines used to treat pneumonia).
Health Care-Associated Pneumonia
Patients also may get pneumonia in other health care settings, such as nursing homes, dialysis centers, and outpatient clinics. This type of pneumonia is called health care-associated pneumonia.
Other Common Types of Pneumonia
Aspiration Pneumonia
This type of pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs. This may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs.
Aspiration pneumonia can cause pus to form in a cavity in the lung. When this happens, it's called a lung abscess (AB-ses).
Atypical Pneumonia
Several types of bacteria—Legionella pneumophila,Mycoplasma pneumoniae, and Chlamydia pneumoniae—cause atypical pneumonia, a type of CAP. Atypical pneumonia is passed from person to person.
Source: National Heart, Lung, and Blood Institute (NHLBI)
This image depicted an anteroposterior (AP) chest x-ray, revealing the pathologic changes of the lung fields in a case of a patient with mycoplasma pneumonia, caused by the bacterium, Mycoplasma pneumoniae.
Image by CDC/ H. Bruce Dull, M.D.
This image depicted an anteroposterior (AP) chest x-ray, revealing the pathologic changes of the lung fields in a case of a patient with mycoplasma pneumonia, caused by the bacterium, Mycoplasma pneumoniae.
This image depicted an anteroposterior (AP) chest x-ray, revealing the pathologic changes of the lung fields in a case of a patient with mycoplasma pneumonia, caused by the bacterium, Mycoplasma pneumoniae. Note the infiltrate that had spread throughout the left middle and lower lobes, as well as the bilateral hilar involvement, indicating hilar adenopathy.
Image by CDC/ H. Bruce Dull, M.D.
Atypical Pneumonia
Pneumonia is an infection of the lungs that viruses, bacteria, and fungi can cause. A common cause of typical bacterial pneumonia is Streptococcus pneumoniae. Before modern diagnostic tests were available, researchers noticed that some pneumonias had different characteristics compared to “typical” pneumonias, such as
Caused slightly different symptoms than typical pneumonia
Appeared different on a chest X-ray than typical pneumonia or
Responded differently to antibiotics that were used for typical bacteria
They called these “atypical”. Now researchers usually consider bacteria as being “atypical” if they are hard to detect through standard bacterial methods. These “atypical” bacteria include
Chlamydia pneumoniae
Chlamydia psittaci
Legionella pneumophila
Mycoplasma pneumoniae
Even though these infections are called “atypical,” they are not uncommon.
Common Types of Pneumonia Caused by Atypical Bacteria
Chlamydia pneumoniae Infection This illness, caused by Chlamydiapneumoniae, is most common in school-aged children and usually develops into mild pneumonia or bronchitis…
Psittacosis People get this sometimes serious illness, caused by Chlamydiapsittaci, from infected pet birds (parrots, parakeets) and poultry (turkeys, ducks)…
Legionnaires’ Disease Legionnaires’ disease is a severe type of pneumonia that is caused by a type of bacteria called Legionella…
Mycoplasma pneumoniae Infection This generally mild illness is a common cause of “walking pneumonia”…
How Do You Say That?
Find pronunciation guides below for common words associated with atypical pneumonia.
Bronchitis — brahn-KITE-uss
Chlamydia — klah-MID-e-a
Legionella — lee-juh-NELL-a
Legionnaires — lee-juh-NAIRS
Mycoplasma — MY-ko-plaz-ma
Pneumonia — noo-MOAN-yah
Pneumoniae — noo-MOAN-e-a
Psittaci — SIT-ah-see
Psittacosis — sit-ah-KOH-sis
Pneumophila — noo-MAH-fil-ah
Streptococcus — strep-toe-KAH-kuss
Tracheobronchitis — TRAY-key-o-brahn-KITE-uss
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (4)
Atypical Pneumonia
Video by DrER.tv/YouTube
This illustration depicted a three-dimensional (3D), computer-generated image, of a group of Mycoplasma pneumoniae, bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery.
Image by CDC/ Sarah Bailey Cutchin - Illustrator: Dan Higgins
Mycoplasma Pneumonia (Walking Pneumonia)
Mycoplasma pneumoniae cells attached to ciliated mucosal cells, 1 (A) Scanning electron microscopy of filamentous M. pneumoniae. (B) Transmission electron microscopy of flask-shaped M. pneumoniae (M) attached by the terminal tip organelle (arrow) to ciliated mucosal cells. Magnification: A, x10,000; B, x36,000.
Image by Rottem et al.
Mycobacterium
Mycobacterial Infection, Duodenum : This is an HIV-positive patient who showed nodules in the duodenal mucosa on endoscopic exam. Microscopically, the lamina propria was stuffed with wall-to-wall histiocytes.
Image by Ed Uthman from Houston, TX, USA
2:47
Atypical Pneumonia
DrER.tv/YouTube
This illustration depicted a three-dimensional (3D), computer-generated image, of a group of Mycoplasma pneumoniae, bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery.
CDC/ Sarah Bailey Cutchin - Illustrator: Dan Higgins
Mycoplasma Pneumonia (Walking Pneumonia)
Rottem et al.
Mycobacterium
Ed Uthman from Houston, TX, USA
Risk Factors
Smoking and Exposed Respiratory System
Image by ThevisualMD
Smoking and Exposed Respiratory System
Smoking and Exposed Respiratory System
Image by ThevisualMD
Pneumonia - Risk Factors
Your risk of pneumonia may be higher because of your age, environment, lifestyle habits, and other medical conditions.
Age
Pneumonia can affect people of all ages. However, two age groups are at higher risk of developing pneumonia and having more serious pneumonia.
Babies and children, 2 years old or younger, because their immune systems are still developing. The risk is higher for premature babies.
Older adults, age 65 or older, because their immune systems generally weaken as they age. Older adults are also more likely to have other chronic (long-term) health conditions that raise the risk of pneumonia.
Babies, children, and older adults who do not get the recommended vaccines to prevent pneumonia have an even higher risk.
Environment or occupation
Most people get pneumonia when they catch an infection from someone else in their community. Your chance of getting pneumonia is higher if you live or spend a lot of time in a crowded place such as a military barrack, prison, homeless shelter, or nursing home.
Your risk is also higher if you regularly breathe in air pollution or toxic fumes.
Some germs that cause pneumonia can infect birds and other animals. You are most likely to encounter these germs if you work in a chicken or turkey processing center, pet shop, or veterinary clinic.
Lifestyle habits
Smokingcigarettes can make you less able to clear mucus from your airways.
Using drugs or alcohol can weaken your immune system. You are also more likely to accidentally inhale saliva or vomit into your windpipe if you are sedated or unconscious from an overdose.
Other medical conditions
You may have an increased risk of pneumonia if you have any of the following medical conditions.
Brain disorders, such as a stroke, a head injury, dementia, or Parkinson’s disease. These conditions can affect your ability to cough or swallow. This can lead to food, drink, vomit, or saliva going down your windpipe instead of your esophagus and getting into your lungs.
Conditions that weaken your immune system, such as pregnancy, HIV/AIDS, or an organ or bone marrow transplant. Chemotherapy, which is used to treat cancer, and long-term use of steroid medicines can also weaken your immune system.
Critical diseases that require hospitalization. Receiving treatment in a hospital intensive care unit raises your risk of hospital-acquired pneumonia. Your risk is higher if you cannot move around much or are sedated or unconscious. Using a ventilator raises the risk of a type called ventilator-associated pneumonia.
Lung diseases, such as asthma, bronchiectasis, cystic fibrosis, or COPD.
Other serious conditions, such as malnutrition, diabetes, heart failure, sickle cell disease, or liver or kidney disease.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (1)
PART II - Pneumonia (Transmission, Causative Agents, Investigations, Management)
Video by Armando Hasudungan/YouTube
12:44
PART II - Pneumonia (Transmission, Causative Agents, Investigations, Management)
Armando Hasudungan/YouTube
Causes
Legionnaires' Disease
Image by CDC/ Sarah Bailey Cutchin; Photo credit: Illustrator: Dan Higgins
Legionnaires' Disease
This illustration depicts a three-dimensional (3D) computer-generated image of a group of Gram-negative, Legionella pneumophila, bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery.
Image by CDC/ Sarah Bailey Cutchin; Photo credit: Illustrator: Dan Higgins
Pneumonia - Causes
Most of the time your body filters germs out of the air that you breathe. Sometimes germs, such as bacteria, viruses, or fungi, get into your lungs and cause infections.
When these germs get into your lungs, your immune system, which is your body's natural defense against germs, goes into action. Immune cells attack the germs and may cause inflammation of your air sacs, or alveoli. Inflammation can cause your air sacs to fill up with fluid and pus and cause the symptoms of pneumonia.
Bacteria
Bacteria are a common cause of pneumonia in adults. Many types of bacteria can cause pneumonia, but Streptococcus pneumoniae (also called pneumococcus bacteria) is the most common cause in the United States.
Some bacteria cause pneumonia with different symptoms or other characteristics than “typical” pneumonia. This infection is called atypical pneumonia.For example, Mycoplasma pneumoniae causes a mild form of pneumonia often called “walking pneumonia.” Legionella pneumophila causes a severe type of pneumonia called Legionnaires’ disease. Bacterial pneumonia can happen on its own or develop after you have had a cold or the flu.
Viruses
Viruses that infect your lungs and airways can cause pneumonia. The flu (influenza virus) and the common cold (rhinovirus) are usually the most common causes of viral pneumonia in adults. Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in young children.
Many other viruses can cause pneumonia, including SARS-CoV-2, the virus responsible for COVID-19.
Fungi
Fungi such as Pneumocystis jirovecii may cause pneumonia, particularly in people who have weakened immune systems. Some fungi found in the soil in the southwestern United States and in the Ohio and Mississippi River valleys can cause pneumonia.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Pneumonia - Bacterial Infections of the Respiratory Tract
Bacterial Pneumonia
Pneumonia is a general term for infections of the lungs that lead to inflammation and accumulation of fluids and white blood cells in the alveoli. Pneumonia can be caused by bacteria, viruses, fungi, and other organisms, although the vast majority of pneumonias are bacterial in origin. Bacterial pneumonia is a prevalent, potentially serious infection; it caused more 50,000 deaths in the United States in 2014. As the alveoli fill with fluids and white blood cells (consolidation), air exchange becomes impaired and patients experience respiratory distress (Figure). In addition, pneumonia can lead to pleurisy, an infection of the pleural membrane surrounding the lungs, which can make breathing very painful. Although many different bacteria can cause pneumonia under the right circumstances, three bacterial species cause most clinical cases: Streptococcus pneumoniae, H. influenzae, and Mycoplasma pneumoniae. In addition to these, we will also examine some of the less common causes of pneumonia.
A chest radiograph of a patient with pneumonia shows the consolidations (lesions) present as opaque patches. (credit: modification of work by Centers for Disease Control and Prevention)
Pneumococcal Pneumonia
The most common cause of community-acquired bacterial pneumonia is Streptococcus pneumoniae. This gram-positive, alpha hemolytic streptococcus is commonly found as part of the normal microbiota of the human respiratory tract. The cells tend to be somewhat lancet-shaped and typically appear as pairs (Figure). The pneumococci initially colonize the bronchioles of the lungs. Eventually, the infection spreads to the alveoli, where the microbe’s polysaccharide capsule interferes with phagocytic clearance. Other virulence factors include autolysins like Lyt A, which degrade the microbial cell wall, resulting in cell lysis and the release of cytoplasmic virulence factors. One of these factors, pneumolysin O, is important in disease progression; this pore-forming protein damages host cells, promotes bacterial adherence, and enhances pro-inflammatory cytokine production. The resulting inflammatory response causes the alveoli to fill with exudate rich in neutrophils and red blood cells. As a consequence, infected individuals develop a productive cough with bloody sputum.
(a) This micrograph of Streptococcus pneumoniae grown from a blood culture shows the characteristic lancet-shaped diplococcal morphology. (b) A colorized scanning electron micrograph of S. pneumoniae. (credit a: modification of work by Centers for Disease Control and Prevention; credit b: modification of work by Janice Carr, Centers for Disease Control and Prevention)
Pneumococci can be presumptively identified by their distinctive gram-positive, lancet-shaped cell morphology and diplococcal arrangement. In blood agar cultures, the organism demonstrates alpha hemolytic colonies that are autolytic after 24 to 48 hours. In addition, S. pneumoniae is extremely sensitive to optochin and colonies are rapidly destroyed by the addition of 10% solution of sodium deoxycholate. All clinical pneumococcal isolates are serotyped using the quellung reaction with typing antisera produced by the CDC. Positive quellung reactions are considered definitive identification of pneumococci.
Antibiotics remain the mainstay treatment for pneumococci. β-Lactams like penicillin are the first-line drugs, but resistance to β-lactams is a growing problem. When β-lactam resistance is a concern, macrolides and fluoroquinolones may be prescribed. However, S. pneumoniae resistance to macrolides and fluoroquinolones is increasing as well, limiting the therapeutic options for some infections. There are currently two pneumococcal vaccines available: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). These are generally given to the most vulnerable populations of individuals: children younger than 2 years and adults older than 65 years.
Haemophilus Pneumonia
Encapsulated strains of Haemophilus influenzae are known for causing meningitis, but nonencapsulated strains are important causes of pneumonia. This small, gram-negative coccobacillus is found in the pharynx of the majority of healthy children; however, Haemophilus pneumonia is primarily seen in the elderly. Like other pathogens that cause pneumonia, H. influenzae is spread by droplets and aerosols produced by coughing. A fastidious organism, H. influenzae will only grow on media with available factor X (hemin) and factor V (NAD), like chocolate agar (Figure). Serotyping must be performed to confirm identity of H. influenzae isolates.
Infections of the alveoli by H. influenzae result in inflammation and accumulation of fluids. Increasing resistance to β-lactams, macrolides, and tetracyclines presents challenges for the treatment of Haemophilus pneumonia. Resistance to the fluoroquinolones is rare among isolates of H. influenzae but has been observed. As discussed for AOM, a vaccine directed against nonencapsulated H. influenzae, if developed, would provide protection against pneumonia caused by this pathogen.
Culture of Haemophilus influenzae on a chocolate agar plate. (credit: modification of work by Centers for Disease Control and Prevention)
WHY ME?
Tracy is a 6-year old who developed a serious cough that would not seem to go away. After 2 weeks, her parents became concerned and took her to the pediatrician, who suspected a case of bacterial pneumonia. Tests confirmed that the cause was Haemophilus influenzae. Fortunately, Tracy responded well to antibiotic treatment and eventually made a full recovery.
Because there had been several other cases of bacterial pneumonia at Tracy’s elementary school, local health officials urged parents to have their children screened. Of the children who were screened, it was discovered that greater than 50% carried H. influenzae in their nasal cavities, yet all but two of them were asymptomatic.
Why is it that some individuals become seriously ill from bacterial infections that seem to have little or no effect on others? The pathogenicity of an organism—its ability to cause host damage—is not solely a property of the microorganism. Rather, it is the product of a complex relationship between the microbe’s virulence factors and the immune defenses of the individual. Preexisting conditions and environmental factors such as exposure to secondhand smoke can make some individuals more susceptible to infection by producing conditions favorable to microbial growth or compromising the immune system. In addition, individuals may have genetically determined immune factors that protect them—or not—from particular strains of pathogens. The interactions between these host factors and the pathogenicity factors produced by the microorganism ultimately determine the outcome of the infection. A clearer understanding of these interactions may allow for better identification of at-risk individuals and prophylactic interventions in the future.
Mycoplasma Pneumonia (Walking Pneumonia)
Primary atypical pneumonia is caused by Mycoplasma pneumoniae. This bacterium is not part of the respiratory tract’s normal microbiota and can cause epidemic disease outbreaks. Also known as walking pneumonia, mycoplasma pneumonia infections are common in crowded environments like college campuses and military bases. It is spread by aerosols formed when coughing or sneezing. The disease is often mild, with a low fever and persistent cough. These bacteria, which do not have cell walls, use a specialized attachment organelle to bind to ciliated cells. In the process, epithelial cells are damaged and the proper function of the cilia is hindered (Figure).
Mycoplasma grow very slowly when cultured. Therefore, penicillin and thallium acetate are added to agar to prevent the overgrowth by faster-growing potential contaminants. Since M. pneumoniae does not have a cell wall, it is resistant to these substances. Without a cell wall, the microbial cells appear pleomorphic. M. pneumoniae infections tend to be self-limiting but may also respond well to macrolide antibiotic therapy. β-lactams, which target cell wall synthesis, are not indicated for treatment of infections with this pathogen.
The micrograph shows Mycoplasma pneumoniae using their specialized receptors to attach to epithelial cells in the trachea of an infected hamster. (credit: modification of work by American Society for Microbiology)
Chlamydial Pneumonias and Psittacosis
Chlamydial pneumonia can be caused by three different species of bacteria: Chlamydophila pneumoniae (formerly known as Chlamydia pneumoniae), Chlamydophila psittaci (formerly known as Chlamydia psittaci), and Chlamydia trachomatis. All three are obligate intracellular pathogens and cause mild to severe pneumonia and bronchitis. Of the three, Chlamydophila pneumoniae is the most common and is transmitted via respiratory droplets or aerosols. C. psittaci causes psittacosis, a zoonotic disease that primarily affects domesticated birds such as parakeets, turkeys, and ducks, but can be transmitted from birds to humans. Psittacosis is a relatively rare infection and is typically found in people who work with birds. Chlamydia trachomatis, the causative agent of the sexually transmitted disease chlamydia, can cause pneumonia in infants when the infection is passed from mother to baby during birth.
Diagnosis of chlamydia by culturing tends to be difficult and slow. Because they are intracellular pathogens, they require multiple passages through tissue culture. Recently, a variety of PCR- and serologically based tests have been developed to enable easier identification of these pathogens. Tetracycline and macrolide antibiotics are typically prescribed for treatment.
Health Care-Associated Pneumonia
A variety of opportunistic bacteria that do not typically cause respiratory disease in healthy individuals are common causes of health care-associated pneumonia. These include Klebsiella pneumoniae, Staphylococcus aureus, and proteobacteria such as species of Escherichia, Proteus, and Serratia. Patients at risk include the elderly, those who have other preexisting lung conditions, and those who are immunocompromised. In addition, patients receiving supportive therapies such as intubation, antibiotics, and immunomodulatory drugs may also be at risk because these interventions disrupt the mucociliary escalator and other pulmonary defenses. Invasive medical devices such as catheters, medical implants, and ventilators can also introduce opportunistic pneumonia-causing pathogens into the body.
Pneumonia caused by K. pneumoniae is characterized by lung necrosis and “currant jelly sputum,” so named because it consists of clumps of blood, mucus, and debris from the thick polysaccharide capsule produced by the bacterium. K. pneumoniae is often multidrug resistant. Aminoglycoside and cephalosporin are often prescribed but are not always effective. Klebsiella pneumonia is frequently fatal even when treated.
Pseudomonas Pneumonia
Pseudomonas aeruginosa is another opportunistic pathogen that can cause serious cases of bacterial pneumonia in patients with cystic fibrosis (CF) and hospitalized patients assisted with artificial ventilators. This bacterium is extremely antibiotic resistant and can produce a variety of exotoxins. Ventilator-associated pneumonia with P. aeruginosa is caused by contaminated equipment that causes the pathogen to be aspirated into the lungs. In patients with CF, a genetic defect in the cystic fibrosis transmembrane receptor (CFTR) leads to the accumulation of excess dried mucus in the lungs. This decreases the effectiveness of the defensins and inhibits the mucociliary escalator. P. aeruginosa is known to infect more than half of all patients with CF. It adapts to the conditions in the patient’s lungs and begins to produce alginate, a viscous exopolysaccharide that inhibits the mucociliary escalator. Lung damage from the chronic inflammatory response that ensues is the leading cause of mortality in patients with CF.
Source: CNX OpenStax
Additional Materials (11)
Communicating in a Crisis: Biological Attack
Document by Ready Campaign/Department of Homeland Security
Mycoplasma pneumoniae (Walking Pneumonia)
Video by Southern Stacker/YouTube
Mycoplasma pneumoniae
Video by Osmosis/YouTube
Pneumococcal Disease & Streptococcus pneumoniae
Video by Paul Cochrane/YouTube
Microbiology - Streptococcus species
Video by Armando Hasudungan/YouTube
Chlamydophila pneumoniae and Chlamydophila psitacci
Video by Maureen Richards Immunology & Microbiology/YouTube
Pneumonitis
Image by BruceBlaus
Chlamydophila psittaci FA stain
This direct FA stained mouse brain impression smear reveals the presence of the bacterium Chlamydia psittaci. 400X. Psittacosis is acquired by inhaling dried secretions from infected birds containing P. ureae bacteria that incubate for 6 to 19 days. Although all birds are susceptible, pet birds and poultry are most frequently involved in transmission to humans.
Image by CDC/Dr. Vester Lewis
Streptococcus Pyogenes
This scanning electron micrograph of Streptococcus pyogenes shows the characteristic cellular phenotype resembling chains of cocci.
Image by Centers for Disease Control and Prevention
Group B streptococcus bacteria
Image by NIAID
Streptococcus Pyogenes (Group A Strep)
Creative rendition of Group A Streptococcus bacteria. Based on 3D print models that were created using a scanning electron micrograph image as reference (see 3dprint.nih.gov/discover/3DPX-004652). Note: not to scale.
Image by NIAID
Communicating in a Crisis: Biological Attack
Ready Campaign/Department of Homeland Security
4:07
Mycoplasma pneumoniae (Walking Pneumonia)
Southern Stacker/YouTube
6:24
Mycoplasma pneumoniae
Osmosis/YouTube
3:52
Pneumococcal Disease & Streptococcus pneumoniae
Paul Cochrane/YouTube
7:14
Microbiology - Streptococcus species
Armando Hasudungan/YouTube
8:06
Chlamydophila pneumoniae and Chlamydophila psitacci
The signs and symptoms of pneumonia can be mild or serious. Young children, older adults, and people who have serious health conditions are at risk for developing more serious pneumonia or life-threatening complications.
Signs and symptoms
The signs and symptoms of pneumonia may include:
Chest pain when you breathe or cough
Chills
Cough with or without mucus
Fever
Low oxygen levels in your blood, measured with a pulse oximeter
Shortness of breath
You may also have other symptoms, including a headache, muscle pain, fatigue (extreme tiredness), nausea (feeling sick to your stomach), vomiting, and diarrhea.
Older adults and people who have serious illnesses or weakened immune systems may not have typical symptoms. They may have a lower than normal temperature instead of a fever. Older adults who have pneumonia may feel weak or suddenly confused.
Sometimes babies don’t have typical symptoms either. They may vomit, have a fever, cough, or appear restless or tired and without energy. Babies may also show the following signs of breathing problems:
Bluish tone to the skin and lips
Grunting
Pulling inward of the muscles between the ribs when breathing
Rapid breathing
Widening of the nostrils with each breath
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (8)
Pneumonia: Symptoms & Examinations – Respiratory Medicine | Lecturio
Video by Lecturio Medical/YouTube
The Signs and Dangers of Pneumonia
Video by ClearCareMD/YouTube
Pneumonia: Symptoms, Diagnosis, Treatment, and Prevention | Merck Manual Consumer Version
Video by Merck Manuals/YouTube
Walking Pneumonia Symptoms in Adults
Video by Medical Symptoms TV/YouTube
Walking Pneumonia Signs and Symptoms
Video by Medical Symptoms TV/YouTube
What are the symptoms of pneumonia?
Video by Premier Health/YouTube
The Coughing Child and Pneumonia
Video by iheed/YouTube
8 Signs Your Cough Could Actually Be Pneumonia | Health
Video by Health Magazine/YouTube
3:55
Pneumonia: Symptoms & Examinations – Respiratory Medicine | Lecturio
Lecturio Medical/YouTube
1:58
The Signs and Dangers of Pneumonia
ClearCareMD/YouTube
1:08
Pneumonia: Symptoms, Diagnosis, Treatment, and Prevention | Merck Manual Consumer Version
Merck Manuals/YouTube
4:44
Walking Pneumonia Symptoms in Adults
Medical Symptoms TV/YouTube
6:46
Walking Pneumonia Signs and Symptoms
Medical Symptoms TV/YouTube
0:40
What are the symptoms of pneumonia?
Premier Health/YouTube
3:24
The Coughing Child and Pneumonia
iheed/YouTube
2:28
8 Signs Your Cough Could Actually Be Pneumonia | Health
Often, people who have pneumonia can be successfully treated and do not have complications. Complications from pneumonia are more common in children, older adults, and people with other serious diseases.
Complications of pneumonia that may be life-threatening include:
Acute respiratory distress (ARDS)andrespiratory failure, which are common complications of serious pneumonia.
Kidney, liver, and heart damage, which happens when these organs don’t get enough oxygen to work properly or when your immune system responds negatively to the infection.
Necrotizing pneumonia, a condition that develops when your infection causes your lung tissue to die and form lung abscesses (pockets of tissue filled with pus). It also makes your pneumonia harder to treat. You may need surgery or drainage with a needle to remove the pus.
Pleural disorders. The tissues that cover the outside of your lungs may become inflamed, and the chest cavity around your lungs may fill with fluid and pus.
Sepsis, which happens when bacteria from your lungs gets into your blood and causes inflammation throughout your body.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (6)
Pneumonia – A Serious Condition to be Taken Seriously
Video by Pfizer/YouTube
The Signs and Dangers of Pneumonia
Video by ClearCareMD/YouTube
Here's Why Pneumonia Is Still So Deadly
Video by Seeker/YouTube
What is Acute Respiratory Distress Syndrome? (Wet Lung)
Video by David Geffen School of Medicine at UCLA/YouTube
Pleurisy
Figure A shows the location of the lungs, airways, pleura, and diaphragm. The inset image shows a detailed view of the two pleural layers and pleural space. Figure B shows lungs with pleurisy and pneumothorax. The inset image shows a detailed view of an infected lung with thickened and inflamed pleural layers.
Image by National Heart Lung and Blood Institute
4:04
Pneumonia – A Serious Condition to be Taken Seriously
Pfizer/YouTube
1:58
The Signs and Dangers of Pneumonia
ClearCareMD/YouTube
5:14
Here's Why Pneumonia Is Still So Deadly
Seeker/YouTube
2:36
What is Acute Respiratory Distress Syndrome? (Wet Lung)
CT chest in pneumonia with abscesses caverns and effusions
Image by
CT_chest_in_pneumonia_with_abscesses_caverns_and_effusions_d0.jpg: Christaras A
derivative work: Pierpao.lo (listening)
/Wikimedia
CT chest in pneumonia with abscesses caverns and effusions
Computed tomography (CT) scan of chest showing bilateral pneumonia with abscesses, effusions, and caverns. 37 year old male.
Image by
CT_chest_in_pneumonia_with_abscesses_caverns_and_effusions_d0.jpg: Christaras A
derivative work: Pierpao.lo (listening)
/Wikimedia
Pneumonia - Diagnosis
Your doctor will diagnose pneumonia based on your medical history, a physical exam, and test results. Sometimes pneumonia is hard to diagnose because your symptoms may be the same as a cold or flu. You may not realize that your condition is more serious until it lasts longer than these other conditions.
Medical history and physical exam
Your doctor will ask about your signs and symptoms and when they began. Your doctor will also ask whether you have any risk factors for pneumonia. Your doctor also may ask about:
Exposure to sick people at home, school, or work or in a hospital
Flu or pneumonia vaccinations
Medicines you take
Past and current medical conditions and whether any have gotten worse recently
Recent travel
Exposure to birds and other animals
Smoking
During your physical exam, your doctor will check your temperature and listen to your lungs with a stethoscope.
Diagnostic tests and procedures
If your doctor thinks you have pneumonia, he or she may do one or more of the following tests.
Chest X-ray to look for inflammation in your lungs. A chest X-ray is often used to diagnose pneumonia.
Blood tests, such as a complete blood count (CBC) to see whether your immune system is fighting an infection.
Pulse oximetry to measure how much oxygen is in your blood. Pneumonia can keep your lungs from moving enough oxygen into your blood. To measure the levels, a small sensor called a pulse oximeter is attached to your finger or ear.
If you are in the hospital, have serious symptoms, are older, or have other health problems, your doctor may do other tests to diagnose pneumonia.
Blood gas test. If you are very sick, your doctor may need to measure your blood oxygen levels using a blood sample from an artery, usually in your wrist. This is called an arterial blood gas test.
Sputum test. Your doctor may test a sample of sputum (spit) or mucus from your cough to find out what germ is causing your pneumonia.
Blood culture. This test can identify the germ causing your pneumonia and also show whether a bacterial infection has spread to your blood.
Polymerase chain reaction (PCR) test. This test quickly checks your blood or sputum sample to find the DNA of germs that cause pneumonia.
Bronchoscopy. If your treatment is not working well, your doctor may use this procedure to look inside your airways. During the procedure, your doctor may also collect samples of your lung tissue and fluid from your lungs to help find the cause of your pneumonia.
Chest computed tomography (CT) scan. This test can show how much of your lungs are affected by pneumonia. It can also show whether you have complications such as lung abscesses or pleural disorders. A CT scan shows more detail than a chest X-ray.
Pleural fluid culture. In this procedure, called thoracentesis, your doctor uses a needle to take a sample of fluid from the pleural space between your lungs and chest wall. The fluid is then tested for bacteria.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Pneumonia diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
3:55
Pneumonia: Symptoms & Examinations – Respiratory Medicine | Lecturio
Lecturio Medical/YouTube
X-ray and CT of ground glass opacities and pneumothorax in pneumocystis pneumonia
Carolyn M. Allen, Hamdan H. AL-Jahdali, Klaus L. Irion, Sarah Al Ghanem, Alaa Gouda, and Ali Nawaz Khan
CT slide of biopsy-proven bronchiolitis obliterans organizing pneumonia (biopsy-proven)
MBq
Human Metapneumovirus Test
Human Metapneumovirus Test
Also called: HMPV
The human metapneumovirus (HMPV) is a recently (2001) discovered agent of viral respiratory infections. Clinical presentation ranges from the common cold to pneumonia. Co-infection with other respiratory viruses is common.
Human Metapneumovirus Test
Also called: HMPV
The human metapneumovirus (HMPV) is a recently (2001) discovered agent of viral respiratory infections. Clinical presentation ranges from the common cold to pneumonia. Co-infection with other respiratory viruses is common.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
A negative result means you likely don't have a human metapneumovirus infection, and that some other virus is probably causing your symptoms. Your health care provider may order more tests before making a diagnosis.
Related conditions
Human metapneumovirus (HMPV) can cause upper and lower respiratory disease in people of all ages, especially among young children, older adults, and people with weakened immune systems. Discovered in 2001, HMPV is in the paramyxovirus family along with respiratory syncytial virus (RSV). Broader use of molecular diagnostic testing has increased identification and awareness of HMPV as an important cause of upper and lower respiratory infection.
Symptoms commonly associated with HMPV include cough, fever, nasal congestion, and shortness of breath. Clinical symptoms of HMPV infection may progress to bronchitis or pneumonia and are similar to other viruses that cause upper and lower respiratory infections. The estimated incubation period is 3 to 6 days, and the median duration of illness can vary depending upon severity but is similar to other respiratory infections caused by viruses.
Infection with HMPV can be confirmed usually by:
direct detection of viral genome by polymerase chain reaction assays, and
direct detection of viral antigens in respiratory secretions using immunofluorescence or enzyme immunoassay.
NREVSS | Human Metapneumovirus Clinical Features | CDC [accessed on Nov 16, 2018]
Metapneumovirus - hMPV | ARUPConsult Lab Test Selection [accessed on Nov 16, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Pulse Oximetry Test
Pulse Oximetry Test
Also called: Pulse Ox, Oxygen Saturation Monitor, Oxygen Saturation by Pulse Oximetry, Peripheral Oxygen Saturation, SpO2, Finger Pulse Oximeter
Pulse oximetry is a quick and painless test that measures blood oxygen levels. Your organs need a steady supply of blood oxygen to work properly. This test can help people with serious or chronic lung disease get quick treatment if their oxygen level gets too low.
Pulse Oximetry Test
Also called: Pulse Ox, Oxygen Saturation Monitor, Oxygen Saturation by Pulse Oximetry, Peripheral Oxygen Saturation, SpO2, Finger Pulse Oximeter
Pulse oximetry is a quick and painless test that measures blood oxygen levels. Your organs need a steady supply of blood oxygen to work properly. This test can help people with serious or chronic lung disease get quick treatment if their oxygen level gets too low.
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Use the slider below to see how your results affect your
health.
%
92
95
Your result is Normal.
In healthy people, the oxygen level runs between 95-100%.
Related conditions
Pulse oximetry is a test that uses a small, clip-like device called a pulse oximeter to measure oxygen levels in the blood. When you breathe, your lungs take in oxygen and send it into your bloodstream. This oxygen-rich blood is carried into your heart, which pumps it to the rest of your body. If your blood oxygen level (oxygen saturation) is too low, it can make it hard for your body to work properly. It can put a dangerous strain on your vital organs.
Pulse oximetry is a painless and quick way to find out if your oxygen level is too low. Quick treatment of low blood oxygen may help you avoid serious complications.
Pulse oximetry is used to check your blood oxygen level. The test may be done in a provider's office, clinic, hospital, or even your own home. An at-home pulse oximeter may be useful if you have a serious and/or chronic lung disease.
Your provider may give you a pulse-oximetry test as part of a routine checkup, or if you:
Have a condition that affects lung function. These include chronic obstructive pulmonary disease (COPD), lung cancer, heart failure, and COVID-19.
Are taking medicine to treat lung disease. The test can show how well the medicine is working.
Are having surgery. Your blood oxygen level may be checked before, during, and after your procedure.
Have sleep apnea. This condition causes you to briefly stop breathing during sleep. You may have repeated episodes of breathing interruptions during a single night's sleep There can be as many as 30 episodes per hour.
During pulse oximetry:
A small electronic device called a pulse oximeter will be clipped to a part of your body, usually a fingertip.
The oximeter uses a special type of light that passes through your skin and into your blood.
A sensor on the oximeter measures the amount of light. That measurement is used to figure out your blood oxygen level.
After a few seconds, the oximeter will provide a readout of your heart rate and oxygen level.
If you have a condition that affects lung function, your health care provider may recommend you use an at-home finger pulse oximeter or other oximeter to monitor your condition. Your provider will guide you on how to purchase and use your at-home device.
If you or your provider is using a finger pulse oximeter, you should remove any fingernail polish. Nail polish can block the light emitted from the oximeter.
There is no known risk to having pulse oximetry.
Results are often given as oxygen saturation levels. A normal oxygen saturation level ranges between 95 percent and 100 percent. Saturation levels may be somewhat lower and considered acceptable if you have a lung disease such as COPD or pneumonia. Levels may also be lower if you live in an area with higher elevation.
If you are using an at-home oximeter, you should contact your health care provider if your oxygen saturation level is 92 percent or lower. If it falls to 88 percent or lower, seek immediate medical attention.
If you have questions about your results, talk to your health care provider.
Pulse oximetry results may be 2 to 4 percent higher or lower than your actual blood oxygen level. For a more accurate result, your provider may do a blood test called an arterial blood gas.
But this test can be painful. It also cannot be used at home or for continuous monitoring. You may need both types of tests to manage your condition.
http://dodd.ohio.gov/HealthandSafety/Documents/Cat1O2SaturationMonitorHRAOCT2017.pdf [accessed on Dec 18, 2018]
https://www.thoracic.org/patients/patient-resources/resources/pulse-oximetry.pdf [accessed on Dec 18, 2018]
Pulse Oximetry - Health Encyclopedia - University of Rochester Medical Center [accessed on Dec 18, 2018]
He pushed for pulse ox screening. Then his grandson’s pulse ox level was dangerously low. | American Heart Association [accessed on Dec 18, 2018]
Pulse Oximetry & O2 Saturation: What Do You Need to Know? | Inogen [accessed on Dec 18, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (15)
Pulse, Hand, Health Care Providers
Image by backy3723/Pixabay
Blood circulation: Red = oxygenated (arteries), Blue = deoxygenated (veins)
Oximetry - Blood circulation: Red = oxygenated (arteries), Blue = deoxygenated (veins)
Image by User:Sansculotte
How To: Check Your Pulse
Video by Baylor College of Medicine/YouTube
The Fitness Model Without a Pulse
Video by Great Big Story/YouTube
Vital Signs- For Beginners
Video by Stephanie Rodriguez/YouTube
"Pulse Oximetry" by Traci Wolbrink, MD, MPH for OPENPediatrics
Video by OPENPediatrics/YouTube
Pulse Oximeter | How to Use It? How does Pulse Oximetry Work?
Video by Respiratory Therapy Zone/YouTube
Clinical Skills: Pulse oximetry
Video by Osmosis/YouTube
Pulse Oximetry NEJM
Video by បូ សុធា/YouTube
Oxygen Content and Oxygen Saturation
Video by Medicosis Perfectionalis/YouTube
Measuring oxygenation in poorly perfused patients
Video by Philips Healthcare/YouTube
Pulse Oximetry for Newborns
Video by Lee Health/YouTube
OxyWatch C20 Pulse Oximeter
A finger mounted pulse oximeter with pulse bar taking measurement through the fingernail.
Image by Thinkpaul/Wikimedia
Pulse oximetry spectrum
Hemoglobin absorbance spectrum in pulse oximetry
Image by Paweł Ziemian/Wikimedia
Pulse Ox, Oximetry, Oxygenation
Image by kkirkemtp/Pixabay
Pulse, Hand, Health Care Providers
backy3723/Pixabay
Blood circulation: Red = oxygenated (arteries), Blue = deoxygenated (veins)
User:Sansculotte
2:48
How To: Check Your Pulse
Baylor College of Medicine/YouTube
2:24
The Fitness Model Without a Pulse
Great Big Story/YouTube
3:20
Vital Signs- For Beginners
Stephanie Rodriguez/YouTube
16:07
"Pulse Oximetry" by Traci Wolbrink, MD, MPH for OPENPediatrics
OPENPediatrics/YouTube
10:25
Pulse Oximeter | How to Use It? How does Pulse Oximetry Work?
Respiratory Therapy Zone/YouTube
4:12
Clinical Skills: Pulse oximetry
Osmosis/YouTube
16:06
Pulse Oximetry NEJM
បូ សុធា/YouTube
13:30
Oxygen Content and Oxygen Saturation
Medicosis Perfectionalis/YouTube
6:46
Measuring oxygenation in poorly perfused patients
Philips Healthcare/YouTube
1:53
Pulse Oximetry for Newborns
Lee Health/YouTube
OxyWatch C20 Pulse Oximeter
Thinkpaul/Wikimedia
Pulse oximetry spectrum
Paweł Ziemian/Wikimedia
Pulse Ox, Oximetry, Oxygenation
kkirkemtp/Pixabay
Sputum Culture
Sputum Culture
Also called: Sputum cytology, Deep cough sputum, Respiratory culture, Bacterial sputum culture, Routine sputum culture
A sputum culture is a test that helps diagnose infections of the lungs or airways. Sputum is a thick mucus made in your lungs. It is not the same as spit or saliva. You may cough up sputum if you have an infection or chronic illness of the respiratory system.
Sputum Culture
Also called: Sputum cytology, Deep cough sputum, Respiratory culture, Bacterial sputum culture, Routine sputum culture
A sputum culture is a test that helps diagnose infections of the lungs or airways. Sputum is a thick mucus made in your lungs. It is not the same as spit or saliva. You may cough up sputum if you have an infection or chronic illness of the respiratory system.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
If your results were normal, it means no harmful bacteria or fungi were found. A normal sputum sample result is negative for malignancy.
Related conditions
A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting the lungs or airways, it can make you cough up sputum.
Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in your lungs or airways. The thickness of sputum helps trap the foreign material. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out.
Sputum can be one of several different colors. The colors can help identify the type of infection you may have or if a chronic illness has become worse:
Clear. This usually means no disease is present, but large amounts of clear sputum may be a sign of lung disease.
White or gray. This may also be normal, but increased amounts may mean lung disease.
Dark yellow or green. This often means a bacterial infection, such as pneumonia. Yellowish-green sputum is also common in people with cystic fibrosis. Cystic fibrosis is an inherited disease that causes mucus to build up in the lungs and other organs.
Brown. This often shows up in people who smoke. It is also a common sign of black lung disease. Black lung disease is a serious condition that can happen if you have long-term exposure to coal dust.
Pink. This may be a sign of pulmonary edema, a condition in which excess fluid builds up in the lungs. Pulmonary edema is common in people with congestive heart failure.
Red. This may be an early sign of lung cancer. It may also be a sign of a pulmonary embolism, a life-threatening condition in which a blood clot from a leg or other part of the body breaks loose and travels to the lungs. If you are coughing up red or bloody sputum, call 911 or seek immediate medical attention.
A sputum culture is most often used to:
Find and diagnose bacteria or fungi that may be causing an infection in the lungs or airways.
See if a chronic illness of the lungs has worsened.
See if treatment for an infection is working.
A sputum culture is often done with another test called a Gram stain. A Gram stain is a test that checks for bacteria at the site of a suspected infection or in body fluids such as blood or urine. It can help identify the specific type of infection you may have.
You may need this test if you have symptoms of pneumonia or another serious infection of the lungs or airways. These include:
Cough which produces a lot of sputum
Fever
Chills
Shortness of breath
Chest pain that gets worse when you breathe deeply or cough
Fatigue
Confusion, especially in older people
Your health care provider will need to get a sample of your sputum. During the test:
A health care provider will ask you to breathe deeply and then cough deeply into a special cup.
Your provider may tap you on the chest to help loosen sputum from your lungs.
If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist that can help you cough more deeply.
If you still can't cough up enough sputum, your provider may perform a procedure called a bronchoscopy. In this procedure, you'll first get a medicine to help you relax, and then a numbing medicine so you won't feel any pain.
Then a thin, lighted tube will be put through your mouth or nose and into the airways.
Your provider will collect a sample from your airway using a small brush or suction.
You may need to rinse your mouth out with water before the sample is taken. If you will be getting a bronchoscopy, you may be asked to fast (not eat or drink) for one to two hours before the test.
There is no risk to providing a sputum sample into a container. If you had a bronchoscopy, your throat may feel sore after the procedure.
If your results were normal, it means no harmful bacteria or fungi were found. If your results were not normal, it may mean you have some kind of bacterial or fungal infection. Your provider may need to do more tests to find the specific type of infection you have. The most common types of harmful bacteria found in a sputum culture include those that cause:
Pneumonia
Bronchitis
Tuberculosis
An abnormal sputum culture result may also mean a flare-up of a chronic condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD). COPD is a lung disease that makes it hard to breathe.
If you have questions about your results, talk to your health care provider.
Sputum may be referred to as phlegm or mucus. All terms are correct, but sputum and phlegm only refer to the mucus made in the respiratory system (lungs and airways). Sputum (phlegm) is a type of mucus. Mucus can also be made elsewhere in the body, such as the urinary or genital tract.
Sputum Cytology | LungCancer.net [accessed on Jan 01, 2019]
Sputum cytology in suspected cases of carcinoma of lung (Sputum cytology a poor man's bronchoscopy!) [accessed on Jan 01, 2019]
Sputum examination for early detection of lung cancer [accessed on Jan 01, 2019]
Sputum Cytology [accessed on Jan 01, 2019]
Lung Cancer Screening and Tests: LDCT, Biopsy, Bronchoscopy, and More [accessed on Jan 01, 2019]
Lung disease | womenshealth.gov [accessed on Jan 11, 2019]
009076: Sputum Cytology Series | LabCorp [accessed on Jan 11, 2019]
Sputum Culture and Cytology Study - MidMichigan Health [accessed on Jan 17, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (5)
Phlegm
Sputum
Image by Zhangmoon618
Mycobacterium tuberculosis
This illustration depicts a photomicrograph of a sputum specimen, processed using the Ziehl-Neelsen staining method, and revealed the presence of numerous, Mycobacterium tuberculosis bacteria. This bacterium can attack any part of the body, though usually the lungs, causing tuberculosis, and is spread through inhalation of infected sputum from a coughing, or sneezing individual.
Image by CDC
Sputum
Video by MSREducators/YouTube
How to Identify Haemophilus influenzae in a Sputum Culture
Video by Suzanne Clark/YouTube
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Image by Bobjgalindo
Phlegm
Zhangmoon618
Mycobacterium tuberculosis
CDC
4:18
Sputum
MSREducators/YouTube
8:03
How to Identify Haemophilus influenzae in a Sputum Culture
Suzanne Clark/YouTube
Staph sputum - Staphylococcus aureus: Gram positive cocci under the microscope (40x) from a sputum sample.
Bobjgalindo
Legionella Tests
Legionella Tests
Also called: Legionnaires' disease testing, Legionellosis testing, Legionella pneumophila Tests
Legionella tests look for legionella bacteria in urine, sputum, or blood. Legionella bacteria can cause a severe form of pneumonia known as Legionnaires' disease. While the disease can be fatal, most cases can be treated successfully with antibiotics.
Legionella Tests
Also called: Legionnaires' disease testing, Legionellosis testing, Legionella pneumophila Tests
Legionella tests look for legionella bacteria in urine, sputum, or blood. Legionella bacteria can cause a severe form of pneumonia known as Legionnaires' disease. While the disease can be fatal, most cases can be treated successfully with antibiotics.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
A negative result means that it is most likely that you do not have the bacteria. However false negatives exist, and, therefore, further testing must be done to rule out the disease.
Related conditions
Legionella is a type of bacteria that can cause a severe form of pneumonia known as Legionnaires' disease. Legionella tests look for these bacteria in urine, sputum, or blood. Legionnaires' disease got its name in 1976 after a group of people attending an American Legion convention became ill with pneumonia.
Legionella bacteria can also cause a milder, flu-like illness called Pontiac fever. Together, Legionnaires' disease and Pontiac fever are known as legionellosis.
Legionella bacteria are found naturally in freshwater environments. But the bacteria can make people sick when it grows and spreads in man-made water systems. These include plumbing systems of large buildings, including hotels, hospitals, nursing homes, and cruise ships. The bacteria may then contaminate water sources, such as hot tubs, fountains, and air-conditioning systems.
Legionellosis infections happen when people breathe in mist or small drops of water that contain the bacteria. The bacteria do not spread from person to person. But a disease outbreak can occur when many people are exposed to the same contaminated water source.
Not everyone who is exposed to Legionella bacteria will get sick. You are more likely to develop an infection you are:
Over the age of 50
A current or former smoker
Have a chronic disease such as diabetes or kidney failure
Have a weakened immune system due to a disease such as HIV/AIDS or cancer, or are taking medicines that suppress the immune system
While Pontiac fever usually clears up on its own, Legionnaires' disease can be fatal if not treated. Most people will recover if promptly treated with antibiotics.
Legionella tests are used to find out whether you have Legionnaires' disease. Other lung diseases have symptoms similar to Legionnaires' disease. Getting the right diagnosis and treatment may help prevent life-threatening complications.
You may need this test if you have symptoms of Legionnaires' disease. Symptoms usually show up two to 10 days after exposure to Legionella bacteria and may include:
Cough
High fever
Chills
Headache
Chest pain
Shortness of breath
Fatigue
Nausea and vomiting
Diarrhea
Legionella tests may be done in urine, sputum, or blood.
During a urine test:
You will need to use the "clean catch" method to ensure your sample is sterile. The clean catch method includes the following steps:
Wash your hands.
Clean your genital area with a cleansing pad.
Start to urinate into the toilet.
Move the collection container under your urine stream.
Collect at least an ounce or two of urine into the container, which should have markings to indicate the amount.
Finish urinating into the toilet.
Return the sample container as instructed by your health care provider.
Sputum is a thick type of mucus made in your lungs when you have an infection.
During a sputum test:
A health care provider will ask you to breathe deeply and then cough deeply into a special cup.
Your provider may tap you on the chest to help loosen sputum from your lungs.
If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist that can help you cough more deeply.
During a blood test:
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for a Legionella test.
There is no risk to providing a urine or sputum sample. There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If your results were positive, it probably means you have Legionnaires' disease. If your results were negative, it may mean you have a different type of infection. It may also mean not enough Legionella bacteria were found in your sample.
If you have questions about your results, talk to your health care provider.
Whether your results were positive or negative, your provider may do others tests to confirm or rule out a diagnosis of Legionnaires' disease. These include:
Chest X-Rays
Gram Stain
Acid Fast Bacillus (AFB) Tests
Bacteria Culture
Sputum Culture
Respiratory Pathogens Panel
182246: Legionella pneumophila Urinary Antigen | LabCorp [accessed on Dec 10, 2018]
LAGU - Clinical: Legionella Antigen, Urine [accessed on Dec 10, 2018]
https://www.cdc.gov/legionella/downloads/fs-legionnaires.pdf [accessed on Dec 10, 2018]
Legionellosis [accessed on Dec 10, 2018]
Legionella Testing [accessed on Dec 10, 2018]
Additional Materials (7)
Legionella pneumophila
Magnified 5000X, this digitally colorized scanning electron microscopic (SEM) image depicted a large grouping of Legionella pneumophila bacteria. Note the presence of an elongated-rod morphology in some organisms, seen in other images from this series as well. L. pneumophila frequently elongate when grown in broth, when plate-grown cells age, or when refrigerated, as in this case. Usually, L. pneumophila are stout, fat bacilli, which was the morphology displayed by the majority of these organisms. These bacteria originated on a 1 week-old culture plate (+/- 1 day), forming a single colony, at 37oC, on a buffered charcoal yeast extract (BCYE) medium with no antibiotics. The original sample was acid-treated for 15 min, to minimize fungal impurities, which would have inhibited the visualization of these organisms.
Image by CDC/ Margaret Williams, PhD; Claressa Lucas, PhD; Tatiana Travis, BS; Photo credit: Janice Haney Carr
Legionella pneumophila
Under a magnification of 43,700X, this transmission electron microscopic (TEM) image was created from a whole preparation of Legionella pneumophila bacteria, which had been negatively stained using uranyl acetate, and grown on bacteriologic medium. It reveals L. pneumophila organisms reproducing, undergoing the process of cell division, as well as delineating the bacterium’s outer envelope.
Image by CDC/ Dr. Francis Chandler
Legionnaires' Disease
Figure. . . Imaging studies of 42-year-old man with severe pneumonia caused by Legionella pneumophila serogroup 11, showing lobar consolidation of the left lower lung lobe, with an air-bronchogram within the homogeneous airspace consolidation. Consensual mild pleural effusion was documented by a chest radiograph (A) and high-resolution computed tomography (B). A week after hospital admission, repeat high-resolution computerized tomography of the chest showed extensive and homogeneous consolidation of left upper and lower lobes, accompanied by bilateral ground-glass opacities (C and D).
Image by Antonella GrottolaComments to Author , Fabio Forghieri, Marisa Meacci, Anna Fabio, Lorena Pozzi, Patrizia Marchegiano, Mauro Codeluppi, Monica Morselli, Leonardo Potenza, Ambra Paolini, Valeria Coluccio, Mario Luppi, Fabio Rumpianesi, and Monica Pec
Legionella pneumophila
This transmission electron microscopic (TEM) image reveals the presence of numerous Legionella pneumophila bacteria, which were multiplying inside a cultured human lung fibroblast. You’ll note that there were multiple intracellular bacilli, including dividing bacilli, that were visible in both longitudinal and transaxial sections.
Image by CDC/ Dr. Edwin P. Ewing, Jr.
The Legionella bacteria, which causes Legionnaires' disease
This illustration depicted a three-dimensional (3D), computer-generated image, of a group of Gram-negative, Legionella pneumophila, bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery.
Image by CDC/ Sarah Bailey Cutchin; Photo credit: Illustrator: Dan Higgins
Antonella GrottolaComments to Author , Fabio Forghieri, Marisa Meacci, Anna Fabio, Lorena Pozzi, Patrizia Marchegiano, Mauro Codeluppi, Monica Morselli, Leonardo Potenza, Ambra Paolini, Valeria Coluccio, Mario Luppi, Fabio Rumpianesi, and Monica Pec
Legionella pneumophila
CDC/ Dr. Edwin P. Ewing, Jr.
The Legionella bacteria, which causes Legionnaires' disease
CDC/ Sarah Bailey Cutchin; Photo credit: Illustrator: Dan Higgins
3:01
Legionnaires' Disease: What You Need to Know
Paul Cochrane/YouTube
1:56
Legionella
ArkitekStudios/YouTube
Parainfluenza Type 3 Test
Parainfluenza Type 3 Test
Also called: Human Parainfluenza Virus Type 3, HPIV-3
Parainfluenza virus type 3 is one of a group of common viruses known as human parainfluenza viruses (HPIV) that cause a variety of respiratory illnesses. Symptoms may include fever, runny nose, and cough. HPIV-3 can also cause bronchiolitis, bronchitis, and pneumonia.
Parainfluenza Type 3 Test
Also called: Human Parainfluenza Virus Type 3, HPIV-3
Parainfluenza virus type 3 is one of a group of common viruses known as human parainfluenza viruses (HPIV) that cause a variety of respiratory illnesses. Symptoms may include fever, runny nose, and cough. HPIV-3 can also cause bronchiolitis, bronchitis, and pneumonia.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
A negative result means you likely don't have a parainfluenza infection, and that some other virus is probably causing your symptoms. Your health care provider may order more tests before making a diagnosis.
Related conditions
Human parainfluenza viruses (HPIVs) belong to the Paramyxoviridae family. They are negative-sense, single-stranded, enveloped RNA viruses. There are four types (1 through 4) and two subtypes (4a and 4b) of HPIVs. The clinical and epidemiological features for each HPIV type can sometimes vary. In the United States, infections associated with HPIV-1 are seen more commonly in odd-numbered years and HPIV-2 and HPIV-3 are seen annually. HPIVs commonly infect infants and young children. However, anyone can get HPIV infection.
The incubation period, the time from exposure to HPIV to onset of symptoms, is generally 2 to 7 days.
HPIV-1 and HPIV-2 are most often associated with croup. HPIV-1 often causes croup in children, whereas HPIV-2 is less frequently detected. Both types can cause upper and lower respiratory tract illnesses. People with upper respiratory tract illness may have cold-like symptoms.
HPIV-3 is more often associated with bronchiolitis, bronchitis, and pneumonia.
HPIV-4 is not recognized as often but may cause mild to severe respiratory tract illnesses.
HPIVs Are Not the Same as Influenza (Flu) Viruses
There are many different types of viruses that cause respiratory infections. Two of those viruses are HPIVs and influenza (flu).
People get HPIV infections more often in the spring, summer, and fall. Flu is more common in the winter.
Flu vaccine will not protect you against HPIV infections.
Infection with human parainfluenza viruses (HPIVs) can be confirmed by—
direct detection of viral genome by polymerase chain reaction (PCR) assay,
direct detection of viral antigens in respiratory secretions (collected within 1 week of symptom onset) using immunofluorescence or enzyme immunoassay,
isolation and identification of the virus in cell culture, or
demonstration of a significant rise in HPIV-specific IgG antibodies between appropriately collected paired serum specimens or specific IgM antibodies in a single serum specimen.
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.
A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.
A chest CT scan is a more detailed type of chest X-ray. This painless imaging test takes many detailed pictures, called slices, of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models to help show the size, shape, and position of your lungs and structures in your chest.
This imaging test is often done to follow up on abnormal findings from earlier chest x rays. A chest CT scan also can help determine the cause of lung symptoms such as shortness of breath or chest pain, or check to see if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, pulmonary embolism, emphysema, tuberculosis, and pneumonia.
A chest CT scan provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest. Doctors use this test to:
Follow up on abnormal results from standard chest x rays.
Find the cause of lung symptoms, such as shortness of breath or chest pain.
Find out whether you have a lung problem, such as a tumor, excess fluid around the lungs, or a pulmonary embolism (a blood clot in the lungs). The test also is used to check for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if you have symptoms of lung problems, such as chest pain or trouble breathing. The scan can help find the cause of the symptoms.
A chest CT scan looks for problems such as tumors, excess fluid around the lungs, and pulmonary embolism (a blood clot in the lungs). The scan also checks for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if a standard chest x ray doesn't help diagnose the problem. The chest CT scan can:
Provide more detailed pictures of your lungs and other chest structures than a standard chest x ray
Find the exact location of a tumor or other problem
Show something that isn't visible on a chest x ray
Your chest CT scan may be done in a medical imaging facility or hospital. The CT scanner is a large, tunnel-like machine that has a table. You will lie still on the table and the table will slide into the scanner. Talk to your doctor if you are uncomfortable in tight or closed spaces to see if you need medicine to relax you during the test. You will hear soft buzzing or clicking sounds when you are inside the scanner and the scanner is taking pictures. You will be able to hear from and talk to the technician performing the test while you are inside the scanner. For some diagnoses, a contrast dye, often iodine-based, may be injected into a vein in your arm before the imaging test. This contrast dye highlights areas inside your chest and creates clearer pictures. You may feel some discomfort from the needle or, after the contrast dye is injected, you may feel warm briefly or have a temporary metallic taste in your mouth.
Wear loose-fitting, comfortable clothing for the test. Sometimes the CT scan technician (a person specially trained to do CT scans) may ask you to wear a hospital gown. You also may want to avoid wearing jewelry and other metal objects. You'll be asked to take off any jewelry, eyeglasses, and metal objects that might interfere with the test. You may be asked to remove hearing aids and dentures as well. Let the technician know if you have any body piercing on your chest.
Tell your doctor whether you're pregnant or may be pregnant. If possible, you should avoid unnecessary radiation exposure during pregnancy. This is because of the concern that radiation may harm the fetus.
Chest CT scans have some risks. In rare instances, some people have an allergic reaction to the contrast dye. There is a slight risk of cancer, particularly in growing children, because the test uses radiation. Although the amount of radiation from one test is usually less than the amount of radiation you are naturally exposed to over three years, patients should not receive more CT scans than the number that clinical guidelines recommend. Another risk is that chest CT scans may detect an incidental finding, which is something that doesn’t cause symptoms but now may require more tests after being found.
Talk to your doctor and the technicians performing the test about whether you are or could be pregnant. If the test is not urgent, they may have you wait to do the test until after your pregnancy. If it is urgent, the technicians will take extra steps to protect your baby during this test. Let your doctor know if you are breastfeeding because contrast dye can pass into your breast milk. If you must have contrast dye injected, you may want to pump and save enough breast milk for one to two days after your test or you may bottle-feed your baby for that time.
https://www.nhlbi.nih.gov/health-topics/chest-ct-scan [accessed on Aug 25, 2021]
https://medlineplus.gov/ency/article/003788.htm [accessed on Aug 25, 2021]
Additional Materials (50)
Pleural empyema
CT chest showing large right sided hydro-pneumothorax from pleural empyema. Arrows A: air, B: fluid
Image by Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga
How Are Pleurisy and Other Pleural Disorders Diagnosed?
CT with the identification of underlying lung lesion: an apical bulla.
Image by Robertolyra
How Are Pleurisy and Other Pleural Disorders Treated?
Right-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.
Image by en:User:Clinical Cases
Chest Radiograph
Chest X-Ray : Specialized test, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan, may be needed to confirm the presence of an aneurysm.
Image by TheVisualMD
What To Expect During a Coronary Calcium Scan
3D reconstruction of the thin multislice CT, covering human heart and lungs
Image by Semnic
Incision for Open-Chest Bypass Surgery
Open-chest bypass surgery requires the surgeon to make an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart.
Image by TheVisualMD
A child's guide to hospital: CT Chest
Video by The Royal Children's Hospital Melbourne/YouTube
What is it like to have a CT scan? | Cancer Research UK
Video by Cancer Research UK/YouTube
Coronary CT angiography of coronary arteries
Researchers have found that anti-inflammatory biologic therapies used to treat moderate to severe psoriasis can significantly reduce coronary inflammation in patients with the chronic skin condition. Scientists said the findings are particularly notable because of the use of a novel imaging biomarker, the perivascular fat attenuation index (FAI), that was able to measure the effect of the therapy in reducing the inflammation.
The study published online in JAMA Cardiology, has implications not just for people with psoriasis, but for those with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis. These conditions are known to increase the risk for heart attacks and strokes. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
In this image: Coronary CT angiography image of the coronary arteries depicting the perivascular fat attenuation index before and after biologic therapy at one-year follow-up for patients with excellent response to biologic therapy.
Image by Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI
Coronary CT
Coronary CT
Image by Bác sĩ Nguyễn Minh Đức
CT of the blood vessels and heart
CT of the blood vessels and heart
Image by Bác sĩ Nguyễn Minh Đức
Chest CT showing pulmonary sequestration
chest CT: diagnosis is pulmonary sequestration
Image by RadsWiki
Scimitar syndrome chest CT
Scimitar syndrome chest CT
Image by Matthew Cham, MD
/Wikimedia
Having a Cardiac CT Scan in Hospital
Video by Oxford AHSN/YouTube
What to Expect from a CT Exam with Contrast
Video by RAYUS Radiology™/YouTube
Protocoling chest CTs
Video by Thoracic Radiology/YouTube
Low Dose CT Scans to Look for Lung Cancer
Video by Lee Health/YouTube
Lung Cancer Screening (LCS)
Video by Cleveland Clinic/YouTube
CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)
Video by MedCram - Medical Lectures Explained CLEARLY/YouTube
What to Expect: CT Scan | Cedars-Sinai
Video by Cedars-Sinai/YouTube
How I Read a Chest CT
Video by Thoracic Radiology/YouTube
Introduction to Computed Tomographic imaging of the Chest
Video by Yale Radiology and Biomedical Imaging/YouTube
Lung Cancer Screening: The Life-saving CT Scan
Video by RAYUS Radiology™/YouTube
How to prepare for a CT scan
Video by Sunnybrook Hospital/YouTube
Using CT Scans to Screen for Lung Cancer
Video by UConn Health/YouTube
Cardiac CT scan
Video by UHP_NHS/YouTube
Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.
Video by Dumb Old Dad/YouTube
What is it like to get a CT Scan with Contrast?
Video by STRIDE Project/YouTube
Thorax with Healthy Heart
3D visualization based on scanned human data of a healthy heart in the thorax.
Image by TheVisualMD
Heart and Lungs
The heart and lungs are the primary contents of the thorax. They are interconnected with very large blood vessels. The heart sends oxygen-poor blood through the pulmonary arteries to the lungs, which oxygenate it and return it to the heart through the pulmonary veins. The pulmonary arteries arise from one large pulmonary trunk, and then begin branching exponentially once they enter the lungs in order to reach the functional respiratory units and pick up oxygen. The smallest pulmonary veins then take the oxygenated blood backwards through the lungs and empty into the back of the heart through four larger pulmonary veins. The oxygen-rich blood is then pumped by the heart out into the body through the aorta. Deoxygenated blood from body tissues returns to the heart through the superior and inferior vena cava and the cardiac cycle repeats continuously. The pulmonary veins and arteries are the only case where arteries carry deoxygenated blood and veins carry blood that has been oxygenated.
Image by TheVisualMD
Thorax with Muscle Involved in Respiration
3D visualization of an anterior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhale occurs, pressure is equalized and the cycle restarts.
Image by TheVisualMD
Thorax with Muscle Involved in Respiration
3D visualization of an inferior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhalation occurs, pressure is equalized and the cycle restarts.
Image by TheVisualMD
Thorax with visible Lung and Heart
3D visualization of a posterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Female Thorax Showing Breast
Visualization based on scanned human data of an anterior view of female breast.
Image by TheVisualMD
Male Thorax with Visible Heart
Visualization of male heart. The nerve supply of the heart is emphasized specifically the cardiac plexus. The plexus which rest around the base of the heart, mainly in the epicardium, is formed by cardiac branches from the vagus nerves and the sympathetic trunks and ganglia.
Image by TheVisualMD
Thorax with Heart and Lung
3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. The cone-shaped lungs occupy most of the thoracic cavity. Each lung is suspended in its own pleural cavity and connected to the mediastinum (which houses the heart) by its root which is made up of vascular and bronchial attachments. The anterior, lateral and posterior surfaces of the lung are in close contact with the ribs and form a continuously curving surface called the costal surface. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Cross Section of Human Thorax. Liver in bottom Left
Cross Section of Human Thorax. Liver in bottom Left
Image by TheVisualMD
Male Thorax Showing Trachea and Lung
3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.
Image by TheVisualMD
Thoracic Aneurysm in the Aorta
Aneurysms that occur in the part of the aorta that is higher in the chest are called thoracic aortic aneurysms. Aortic aneurysms often grow slowly and usually without any symptoms therefore making them difficult to detect
Image by TheVisualMD
Ventilation/perfusion scan
subFusion processing applied to a SPECT lung ventilation-perfusion scan.
Image by KieranMaher at English Wikibooks
Bronchi and Bronchiole of Lung
3D visualization of an inferior view of a transverse section of the thorax, highlighting the lungs, reconstructed from scanned human data. The trachea, cardiac impression, and transverse sections of the thoracic aorta and esophagus are clearly illustrated. The bronchial tree is also visible. When air is inhaled into the lungs, it flows through large tubes called bronchi, branches into smaller tubes known as bronchioles, and ends up in the thousands of small pouches that are the alveoli. This is where the oxygen is transferred from the air into the bloodstream. Each alveolar sac, or air sac, is surrounded by a bed of capillaries, and the walls between the lung and the capillary are extremely thin. The walls are so delicate, in fact, that the inhaled oxygen can seep from the air sacs to bind to the hemoglobin in the blood, while the carbon dioxide and other waste gasses leave the blood and diffuse into the lungs where they can be exhaled.
Image by TheVisualMD
Chest Pain
Angina
Image by TheVisualMD
Chest Pain
Chest Pain
Image by TheVisualMD
Chest Pain or Tightness
Image by TheVisualMD
CT scanner
A view of the CT scanner in the new Fort Belvoir Community Hospital. The hospital, still under construction, is a 2005 Base Realignment and Closure project, and is scheduled to open later this year.
Image by Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps
Illustration of 3 X-ray images and a patient entering a CT scanner
Radiation can be dangerous, but it can also save lives. When you’re faced with a medical test that uses radiation, don’t let fear get in your way. Learn about the risks and benefits, and know what questions to ask.
Image by NIH News in Health
Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner
CT scan.
Image by NIDDK Image Library
Advanced CT Scanning
An NIH Clinical Center study participant receives a scan in the Photon-Counting CT scanner.
Image by NIH Clinical Center
Sensitive content
This media may include sensitive content
CAT Scan
A computer-assisted tomographic (CAT) scanner, with a Caucasian female technician working at a screen and behind a glass wall. A patient is on a table and being tested by the CAT scanner. The lighting is very subdued. This new technology revolutionized detection of brain tumors.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Virtual Colonoscopy Slice of CT Data
Virtual colonoscopy is a new imaging technology that uses computed tomography (CT) images to look for polyps and cancer in the colon. A computed tomography scanner takes cross-sectional images of the patient's colon, after the colon has been inflated with gas. A three-dimensional model is created from the CT slices and evaluated by a radiologist for abnormalities.
Image by TheVisualMD
Pleural empyema
Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga
How Are Pleurisy and Other Pleural Disorders Diagnosed?
Robertolyra
How Are Pleurisy and Other Pleural Disorders Treated?
en:User:Clinical Cases
Chest Radiograph
TheVisualMD
What To Expect During a Coronary Calcium Scan
Semnic
Incision for Open-Chest Bypass Surgery
TheVisualMD
4:22
A child's guide to hospital: CT Chest
The Royal Children's Hospital Melbourne/YouTube
1:50
What is it like to have a CT scan? | Cancer Research UK
Cancer Research UK/YouTube
Coronary CT angiography of coronary arteries
Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI
Coronary CT
Bác sĩ Nguyễn Minh Đức
CT of the blood vessels and heart
Bác sĩ Nguyễn Minh Đức
Chest CT showing pulmonary sequestration
RadsWiki
Scimitar syndrome chest CT
Matthew Cham, MD
/Wikimedia
4:59
Having a Cardiac CT Scan in Hospital
Oxford AHSN/YouTube
2:33
What to Expect from a CT Exam with Contrast
RAYUS Radiology™/YouTube
7:48
Protocoling chest CTs
Thoracic Radiology/YouTube
1:44
Low Dose CT Scans to Look for Lung Cancer
Lee Health/YouTube
8:27
Lung Cancer Screening (LCS)
Cleveland Clinic/YouTube
5:10
CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)
MedCram - Medical Lectures Explained CLEARLY/YouTube
3:29
What to Expect: CT Scan | Cedars-Sinai
Cedars-Sinai/YouTube
17:21
How I Read a Chest CT
Thoracic Radiology/YouTube
8:46
Introduction to Computed Tomographic imaging of the Chest
Yale Radiology and Biomedical Imaging/YouTube
3:09
Lung Cancer Screening: The Life-saving CT Scan
RAYUS Radiology™/YouTube
2:19
How to prepare for a CT scan
Sunnybrook Hospital/YouTube
2:07
Using CT Scans to Screen for Lung Cancer
UConn Health/YouTube
5:04
Cardiac CT scan
UHP_NHS/YouTube
6:28
Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.
Dumb Old Dad/YouTube
2:52
What is it like to get a CT Scan with Contrast?
STRIDE Project/YouTube
Thorax with Healthy Heart
TheVisualMD
Heart and Lungs
TheVisualMD
Thorax with Muscle Involved in Respiration
TheVisualMD
Thorax with Muscle Involved in Respiration
TheVisualMD
Thorax with visible Lung and Heart
TheVisualMD
Female Thorax Showing Breast
TheVisualMD
Male Thorax with Visible Heart
TheVisualMD
Thorax with Heart and Lung
TheVisualMD
Cross Section of Human Thorax. Liver in bottom Left
TheVisualMD
Male Thorax Showing Trachea and Lung
TheVisualMD
Thoracic Aneurysm in the Aorta
TheVisualMD
Ventilation/perfusion scan
KieranMaher at English Wikibooks
Bronchi and Bronchiole of Lung
TheVisualMD
Chest Pain
TheVisualMD
Chest Pain
TheVisualMD
Chest Pain or Tightness
TheVisualMD
CT scanner
Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps
Illustration of 3 X-ray images and a patient entering a CT scanner
NIH News in Health
Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner
NIDDK Image Library
Advanced CT Scanning
NIH Clinical Center
Sensitive content
This media may include sensitive content
CAT Scan
National Cancer Institute / Linda Bartlett (Photographer)
Virtual Colonoscopy Slice of CT Data
TheVisualMD
Chest X-Ray
Chest X-Ray Test
Also called: CXR, Chest X Ray, Chest Radiograph, Chest Radiography, Chest Film
A chest X-ray is an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest. The test can help diagnose and monitor conditions of the heart, lungs, bones, and chest cavity.
Chest X-Ray Test
Also called: CXR, Chest X Ray, Chest Radiograph, Chest Radiography, Chest Film
A chest X-ray is an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest. The test can help diagnose and monitor conditions of the heart, lungs, bones, and chest cavity.
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X rays are electromagnetic waves. They use ionizing radiation to create pictures of the inside of your body. A chest x ray takes pictures of the inside of your chest. The different tissues in your chest absorb different amounts of radiation. Your ribs and spine are bony and absorb radiation well. They normally appear light on a chest x ray. Your lungs, which are filled with air, normally appear dark.
Related conditions
A chest x ray is a painless, noninvasive test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. "Noninvasive" means that no surgery is done and no instruments are inserted into your body. This test is done to find the cause of symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), and fever.
Chest x rays help doctors diagnose conditions such as pneumonia (nu-MO-ne-ah), heart failure, lung cancer, lung tissue scarring, and sarcoidosis (sar-koy-DO-sis). Doctors also may use chest x rays to see how well treatments for certain conditions are working. Also, doctors often use chest x rays before surgery to look at the structures in the chest.
Chest x rays are the most common x-ray test used to diagnose health problems.
Doctors may recommend chest x rays for people who have symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), or fever. The test can help find the cause of these symptoms.
Chest x rays look for conditions such as pneumonia, heart failure, lung cancer, lung tissue scarring, or sarcoidosis. The test also is used to check how well treatments for certain conditions are working.
Chest x rays also are used to evaluate people who test positive for tuberculosis (tu-ber-kyu-LO-sis) exposure on skin tests.
Sometimes, doctors recommend more chest x rays within hours, days, or months of an earlier chest x ray. This allows them to follow up on a condition.
People who are having certain types of surgery also may need chest x rays. Doctors often use the test before surgery to look at the structures inside the chest.
Depending on your doctor's request, you'll stand, sit, or lie for the chest x ray. The technician will help position you correctly. He or she may cover you with a heavy lead apron to protect certain parts of your body from the radiation.
The x-ray equipment usually consists of two parts. One part, a box-like machine, holds the x-ray film or a special plate that records the picture digitally. You'll sit or stand next to this machine. The second part is the x-ray tube, which is located about 6 feet away.
Before the pictures are taken, the technician will walk behind a wall or into the next room to turn on the x-ray machine. This helps reduce his or her exposure to the radiation.
Usually, two views of the chest are taken. The first is a view from the back. The second is a view from the side.
For a view from the back, you'll sit or stand so that your chest rests against the image plate. The x-ray tube will be behind you. For the side view, you'll turn to your side and raise your arms above your head.
If you need to lie down for the test, you'll lie on a table that contains the x-ray film or plate. The x-ray tube will be over the table.
You'll need to hold very still while the pictures are taken. The technician may ask you to hold your breath for a few seconds. These steps help prevent a blurry picture.
Although the test is painless, you may feel some discomfort from the coolness of the exam room and the x-ray plate. If you have arthritis or injuries to the chest wall, shoulders, or arms, you may feel discomfort holding a position during the test. The technician may be able to help you find a more comfortable position.
When the test is done, you'll need to wait while the technician checks the quality of the x-ray pictures. He or she needs to make sure that the pictures are good enough for the doctor to use.
You don't have to do anything special to prepare for a chest x ray. However, you may want to wear a shirt that's easy to take off. Before the test, you'll be asked to undress from the waist up and wear a gown.
You also may want to avoid wearing jewelry and other metal objects. You'll be asked to take off any jewelry, eyeglasses, and metal objects that might interfere with the x-ray picture. Let the x-ray technician (a person specially trained to do x-ray tests) know if you have any body piercings on your chest.
Let your doctor know if you're pregnant or may be pregnant. In general, women should avoid all x-ray tests during pregnancy. Sometimes, though, having an x ray is important to the health of the mother and fetus. If an x ray is needed, the technician will take extra steps to protect the fetus from radiation.
Chest x rays have few risks. The amount of radiation used in a chest x ray is very small. A lead apron may be used to protect certain parts of your body from the radiation.
The test gives out a radiation dose similar to the amount of radiation you're naturally exposed to over 10 days.
Chest x rays show the structures in and around the chest. The test is used to look for and track conditions of the heart, lungs, bones, and chest cavity. For example, chest x-ray pictures may show signs of pneumonia, heart failure, lung cancer, lung tissue scarring, or sarcoidosis.
Chest x rays do have limits. They only show conditions that change the size of tissues in the chest or how the tissues absorb radiation. Also, chest x rays create two-dimensional pictures. This means that denser structures, like bone or the heart, may hide some signs of disease. Very small areas of cancer and blood clots in the lungs usually don't show up on chest x rays.
For these reasons, your doctor may recommend other tests to confirm a diagnosis.
https://www.nhlbi.nih.gov/health-topics/chest-x-ray [accessed on Aug 25, 2021]
https://medlineplus.gov/ency/article/003804.htm [accessed on Aug 25, 2021]
https://www.radiologyinfo.org/en/info/chestrad [accessed on Aug 25, 2021]
https://www.emedicinehealth.com/chest_x-ray/article_em.htm [accessed on Aug 25, 2021]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Chest X-Ray Basics in 5 min
Video by Nick Smith/YouTube
How X-rays see through your skin - Ge Wang
Video by TED-Ed/YouTube
What causes Acute respiratory distress syndrome (ARDS) and who is at Risk?
Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.
Image by Altaf Gauhar Haji, Shekhar Sharma, DK Vijaykumar and Jerry Paul
Tuberculosis X-ray
An anteroposterior X-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis. This AP X-ray of the chest reveals the presence of bilateral pulmonary infiltrate (white triangles), and caving forma.
Image by CDC / Der Lange
Respiratory Syncytial Virus
This highly-magnified, 1981 transmission electron microscopic (TEM) image, reveals some of the morphologic traits exhibited by a human respiratory syncytial virus (RSV). The virion is variable in shape, and size, with an average diameter between 120-300nm. RSV is the most common cause of bronchiolitis and pneumonia among infants and children, under 1-year of age.
Image by CDC/ E. L. Palmer
Q Fever Pneumonia X-ray
Combination of two x-rays (A) normal chest x-ray (B) x-ray documenting Q fever pneumonia.
Image by US Gov
Chest X Ray
A Lateral Chest X-Ray with the heart shadow outlined.
Image by US Army
Projectional radiography
Image relating focal spot size to geometric unsharpness in projectional radiography.
Image by Source images by Blausen Medical and LadyofHats (Mariana Ruiz Villarreal) Derivative by Mikael Haggstrom
Chest Radiograph
Chest X-Ray : Specialized test, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan, may be needed to confirm the presence of an aneurysm.
Image by TheVisualMD
X-ray of Healthy Lung
This image shows an x-ray of healthy lungs.
Image by TheVisualMD
Cancer screening
Cancer Imaging: X-Rays : Chest X-rays can be used to show the presence of tumors, as for lung cancer, but they may also indicate problems associated with cancer. An X-ray may produce images suggestive of fluid accumulation, masses, or enlarged lymph nodes.
Image by TheVisualMD
Lung Cancer
Chest X-ray (Cancer): This is an x-ray image of a chest. Both sides of the lungs are visible with a growth on the left side of the lung, which could possibly be lung cancer.
Image by National Cancer Institute
Chest X Ray
Mediastinal structures on a chest radiograph.
Image by Mikael Haggstrom, from source images by ZooFari, Stillwaterising and Gray's Anatomy creators
CT Chest Scan of Pleura effusion
CT scan of chest showing loculated pleural effusion in left side. Some thickening of pleura is also noted. From my personal collection. Permission obtained from patient.
Image by Drriad
Chest X-ray (Cancer)
This is an x-ray image of a chest. Both sides of the lungs are visible with a growth on the left side of the lung, which could possibly be lung cancer.
Image by National Cancer Institute / Unknown Photographer
This browser does not support the video element.
CT Scans (VIDEO)
This video shows how modern science of scanning can expose the health condition of the patient. The video starts with a patient undergoing CT scanning, an x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Visible are the heart, lungs, and arteries of a patient.
Video by TheVisualMD
Chest X-Ray
Air-filled trachea and lungs Diaphragmatic domes Mediastinal structures Vascular markings
Arrows indicate costophrenic angles
Image by US Army
Gallstones
Gallstones as seen on plain x-ray.
Image by James Heilman, MD
Hemoptysis x-ray
Hemoptysis can be discovered with the help of radiology.
Image by Aidan Jones from Oxford, U.K.
X-ray of Lung with Pulmonary Edema
Within the lungs, the main airways (bronchi) branch off into smaller passageways, the smallest of which are called bronchioles. At the end of the bronchioles are tiny air sacs (alveoli). Pulmonary edema is a condition caused when excess fluid collects in these air sacs, making it difficult to breathe. Fluid in the lungs can be caused by pneumonia, acute respiratory distress and other conditions, but in most cases, the cause of pulmonary edema is heart problems (when a damaged heart can't pump enough blood and fluid leaks into the lungs).
Image by TheVisualMD
What To Expect During and After Implantable Cardioverter Defibrillator Surgery
A normal chest X-ray after placement of an ICD, showing the ICD generator in the upper left chest and the ICD lead in the right ventricle of the heart. Note the 2 opaque coils along the ICD lead.
Image by Gregory Marcus, MD, MAS, FACC
This browser does not support the video element.
Chest X-ray: NCI B-roll [video]
NCI B-roll of a patient receiving a Chest X-ray. This video is silent.
Video by National Cancer Institute (NCI)
X-Ray of Aneurysm within Chest frontal view
Most aneurysms are detected in the course of an exam, such as a physical exam or a chest X-ray, being performed for a different reason.
Image by TheVisualMD
Pleural Effusion: Tests
Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity. A pleural effusion: as seen on chest X-ray. The A arrow indicates fluid layering in the right chest. The B arrow indicates the width of the right lung. The volume of the lung is reduced because of the collection of fluid around the lung.Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity. A pleural effusion: as seen on chest X-ray. The A arrow indicates fluid layering in the right chest. The B arrow indicates the width of the right lung. The volume of the lung is reduced because of the collection of fluid around the lung.
Image by CDC InvictaHOG
Coccidioidomycosis
This anteroposterior (AP) chest x-ray revealed pulmonary changes indicative of pulmonary fibrosis in a case of coccidioidomycosis, caused by fungal organisms of the genus, Coccidioides. Because these changes also resemble those seen in other lung infections including tuberculosis, the findings uncovered with a chest x-ray needs to be coupled with serologic testing, as well as possible tissue biopsy. The degree of fibrotic changes, indicative of scarring found on x-ray, can be directly correlated to the severity of the fungal infection.
Image by CDC/ Dr. Lucille K. Georg
How Is Acute respiratory distress syndrome (ARDS) Diagnosed?
Chest X-Ray: Acute respiratory distress syndrome on plain Xray
Image by James Heilman, MD
How Are Asbestos-Related Lung Diseases Diagnosed?
Early Asbestosis in a Retired Pipe Fitter : Chest X-ray in asbestosis shows plaques above diaphragm
Image by Clinical Cases
Aspergillosis
This was a photomicrograph of a lung tissue specimen, harvested from a caged, sulfur-crested cockatoo, that depicted some of the histopathologic changes that had been caused by the fungal organism, Aspergillus fumigatus, in a case of avian pulmonary aspergillosis. Here, you are able see how the periodic acid-Schiff (PAS) stain, revealed A. fumigatus ultrastructural morphology including conidial heads and mycelium.
Image by CDC/ Dr. William Kaplan
Pleural Effusion - Defined
A large left sided pleural effusion as seen on an upright chest X-ray
Image by Drriad
Pleural Effusion: Tests
A large left sided pleural effusion as seen on an upright chest X-ray
Image by James Heilman MD
Breast implants
Chest X-ray showing breast implants
Image by James Heilman
Living With Idiopathic Pulmonary Fibrosis
No cure is available for idiopathic pulmonary fibrosis (IPF) yet. Your symptoms may get worse over time. As your symptoms worsen, you may not be able to do many of the things that you did before you had IPF.
However, lifestyle changes and ongoing care can help you manage the disease.
If you're still smoking, the most important thing you can do is quit. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. Ask family members and friends not to smoke in front of you or in your home, car, or workplace.
Image by Drriad
Symptoms and Spread of SARS (Severe acute respiratory syndrome)
A chest x-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS.
Image by CDC
Chilaiditi syndrome
Chest X-ray showing obvious Chilaiditi's sign, or presence of gas in the right colic angle between the liver and right hemidiaphragm (left side of the image).
Piper's Sign: In days gone by the lateral chest x-ray (demonstrating greater opacity in the aortic arch and descending aorta than the thoracic spine) gave an indication to the degree of calcified plaque burden a patient had. This has been known as Piper's sign and can often be seen in elderly persons particularly those with concomitant osteoporosis.
Image by U4077905
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Image by Stockholm
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Image by Lange123 at German Wikipedia
Chest X-ray in influenza and Haemophilus influenza
Chest X-ray of a 76 year old woman, who developed cough and labored breathing. First testing showed influenza B virus, and later a nasopharyngeal swab detected Haemophilus influenzae. The H influenzae presumably developed as an opportunistic infection secondary to the flu. This X-ray was taken 2 weeks after cultures and start of antibiotics, showing delayed pneumonic infiltrates that were only vaguely visible on initial (not shown) X-rays.
Image by Mikael Häggström
Chest X-ray in influenza and Haemophilus influenzae, lateral
Chest X-ray of a 76 year old woman, who developed cough and labored breathing. First testing showed influenza B virus, and later a nasopharyngeal swab detected Haemophilus influenzae. The H influenzae presumably developed as an opportunistic infection secondary to the flu. This X-ray was taken 2 weeks after cultures and start of antibiotics, showing delayed pneumonic infiltrates that were only vaguely visible on initial (not shown) X-rays.
Image by Mikael Häggström
Fungal Parasites and Pathogens
(a) Ringworm presents as a red ring on skin; (b) Trichophyton violaceum, shown in this bright field light micrograph, causes superficial mycoses on the scalp; (c) Histoplasma capsulatum is an ascomycete that infects airways and causes symptoms similar to influenza. (credit a: modification of work by Dr. Lucille K. Georg, CDC; credit b: modification of work by Dr. Lucille K. Georg, CDC; credit c: modification of work by M. Renz, CDC; scale-bar data from Matt Russell)
Image by CNX Openstax
This anteroposterior (AP) chest x-ray revealed radiologic evidence of pulmonary pneumocystosis in the form of bilateral pulmonary interstitial infiltrates. This infection was due to the presence of an opportunistic fungal infection by the fungal organism Pneumocystis jirovecii, formerly known as Pneumocystis carinii. (This image was provided by Jonathan W.M. Gold. M.D., Assoc. Dir. Special Microbiology Lab, Assist. Attending Physician, Memorial Sloan-Kettering Cancer Center and Assist. Prof. of Medicine, Cornell Univ. Med. College, New York.)
Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PCP), one of the most frequent and severe opportunistic infections in immunocompromised patients. Pneumocystis organisms represent a large group of species of atypical fungi with universal distribution and pulmonary tropism, and each species has a strong specificity for a given mammalian host species.
Image by CDC/ Jonathan W.M. Gold, MD
Chest X-ray PA inverted and enhanced
Chest X-ray PA inverted and enhanced
Image by Stillwaterising
Chest X-Ray of Canadian dollar coin in esophagus of child
PA view Chest X-Ray of Canadian dollar coin in esophagus of child. Released per permission of mother.
Image by Samir (talk)
Chest X Ray
Structures shown: Air-filled trachea and lungs Diaphragmatic domes Mediastinal structures Vascular markings. Arrows indicate costophrenic angles
Image by US Army
Thoracic diaphragm
X-ray of chest, showing top of diaphragm.
Image by OpenStax College
Chest X Ray
Roentgenogram or Medical X-ray image. May not be to scale.
Aspect of a bulky thymoma (red circle) on the chest x-ray.
Stockholm
Lambert–Eaton myasthenic syndrome-Chest X-ray showing a tumor in the left lung (right side of the image)
Lange123 at German Wikipedia
Chest X-ray in influenza and Haemophilus influenza
Mikael Häggström
Chest X-ray in influenza and Haemophilus influenzae, lateral
Mikael Häggström
Fungal Parasites and Pathogens
CNX Openstax
This anteroposterior (AP) chest x-ray revealed radiologic evidence of pulmonary pneumocystosis in the form of bilateral pulmonary interstitial infiltrates. This infection was due to the presence of an opportunistic fungal infection by the fungal organism Pneumocystis jirovecii, formerly known as Pneumocystis carinii. (This image was provided by Jonathan W.M. Gold. M.D., Assoc. Dir. Special Microbiology Lab, Assist. Attending Physician, Memorial Sloan-Kettering Cancer Center and Assist. Prof. of Medicine, Cornell Univ. Med. College, New York.)
CDC/ Jonathan W.M. Gold, MD
Chest X-ray PA inverted and enhanced
Stillwaterising
Chest X-Ray of Canadian dollar coin in esophagus of child
Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist.
7:02
Reading a chest X-ray
Osmosis/YouTube
Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.
Altaf Gauhar Haji, Shekhar Sharma, DK Vijaykumar and Jerry Paul
Blood Gases Test
Arterial Blood Gas (ABG) Test
Also called: ABG, Arterial Blood Gas Analysis, Blood Gases, Blood Gas Analysis, Blood Oxygen Level
An arterial blood gas (ABG) test measures oxygen, carbon dioxide, and acidity in a blood sample to see how well your lungs, heart and kidneys are working. Abnormal results can mean there's a problem with your lungs or kidneys.
Arterial Blood Gas (ABG) Test
Also called: ABG, Arterial Blood Gas Analysis, Blood Gases, Blood Gas Analysis, Blood Oxygen Level
An arterial blood gas (ABG) test measures oxygen, carbon dioxide, and acidity in a blood sample to see how well your lungs, heart and kidneys are working. Abnormal results can mean there's a problem with your lungs or kidneys.
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80
90
95
Your result is Very low.
Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed. Oxygen therapy may be used to assist in raising blood oxygen levels.
Related conditions
{"scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":60,"max":80},"text":"A lower than normal result indicates decreased levels of oxygen in the inhaled air. Changes in environmental pressure may also cause a change in the available oxygen for diffusion into the body. "},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":80,"max":100},"text":"Normal results vary based on the laboratory and the method used."},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":100,"max":120},"text":"A higher than normal result indicates increased levels of oxygen in the inhaled air."}],"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
80
100
Your result is Low.
A lower than normal result indicates decreased levels of oxygen in the inhaled air. Changes in environmental pressure may also cause a change in the available oxygen for diffusion into the body.
Related conditions
{"scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Decreased","long":"Decreased","orientation":"horizontal"},"values":{"min":10,"max":35},"text":"Abnormal results may indicate that you have an electrolyte imbalance, kidney problems, or lung problems."},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":35,"max":45},"text":"Normal results vary based on the laboratory and the method used."},{"flag":"abnormal","label":{"short":"Elevated","long":"Elevated","orientation":"horizontal"},"values":{"min":45,"max":60},"text":"Abnormal results may indicate that your body has an electrolyte imbalance, or that there is a problem removing carbon dioxide through your lungs."}],"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
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35
45
Your result is Decreased.
Abnormal results may indicate that you have an electrolyte imbalance, kidney problems, or lung problems.
Related conditions
{"scale":"log","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"vertical"},"values":{"min":0,"max":7.35},"text":"A blood pH below 7.35 is acidic. Blood acidosis can be a warning sign that a health condition isn\u2019t properly controlled."},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"vertical"},"values":{"min":7.35,"max":7.45},"text":"Your blood has a normal pH range of 7.35 to 7.45. This means that blood is naturally slightly alkaline or basic."},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"vertical"},"values":{"min":7.45,"max":14},"text":"A blood pH higher than 7.45 is alkaline or basic. An illness can temporarily raise your blood pH. More serious health conditions can also lead to blood alkalosis."}],"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
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7.35
7.45
Your result is Low.
A blood pH below 7.35 is acidic. Blood acidosis can be a warning sign that a health condition isn’t properly controlled.
Related conditions
An arterial blood gas (ABG) test measures the amount of oxygen and carbon dioxide in your blood. It also checks the acidity of your blood. This is called your acid-base balance or your pH level. The blood sample is taken from an artery, which is a blood vessel that carries oxygen-rich blood from your lungs to your body.
In an ABG test, the blood oxygen measurement shows how well your lungs move oxygen from the air into your blood when you breath in. The carbon dioxide measurement shows and how well your lungs remove carbon dioxide from your blood when you breath out.
Carbon dioxide is an acidic waste product that your body makes. If your blood and tissues become even slightly too acidic or too basic (alkaline), it can seriously affect many of your organs and even become life-threatening.
Your lungs and your kidneys do much of the work to keep your acid-base balance normal. So, the acid-base measurement from an ABG test can help diagnose and monitor conditions that affect your lungs and kidneys as well as many other conditions that may upset your acid-base balance.
An ABG test is used to help:
Check your acid-base balance
Diagnose serious problems with your lungs and breathing
Diagnose kidney disorders
Find out whether treatment is working for breathing disorders, kidney disease, or other conditions that may affect your acid-base balance
There are many reasons why you may need this test. For example, you may need an ABG test if you:
Have symptoms of a problem with your acid-base balance, such as:
Uncontrolled rapid or deep breathing, which may be a sign that your lungs are trying to adjust acids or bases by changing the amount of oxygen or carbon dioxide in your blood
Nausea and vomiting
Arrhythmia (a problem with the rate or rhythm of your heartbeat)
Confusion
Fatigue
Muscle twitching and/or cramps
Are being treated for a lung disease or a condition that affects your breathing, such as:
Asthma
Chronic obstructive pulmonary disease (COPD)
Cystic fibrosis
Myasthenia gravis
Have symptoms after you have had:
Carbon monoxide poisoning
An inhalation injury (breathing in smoke, hot air, and/or harmful chemicals)
A recent head or neck injury that could affect your breathing
Are receiving oxygen therapy in the hospital
Most blood tests take a sample from a vein. For this test, a health care provider will take a sample of blood from an artery. That's because blood from an artery has higher oxygen levels than blood from a vein.
The sample is usually taken from an artery on the inside of your wrist, but it may be taken from an artery in your arm or groin. For a newborn, the sample may be taken from the baby's heel or the umbilical cord shortly after birth.
If your blood sample is taken from your wrist, the provider will first test your blood circulation. The provider will hold your wrist and apply pressure to the arteries to cut off blood flow to your hand for several seconds. Then the provider will let go of your wrist to check how quickly blood flow returns to your hand. If your blood flow is normal, the provider will collect a blood sample.
A blood sample taken from an artery tends to be more uncomfortable than most blood tests, which use a vein. So, the provider may apply some numbing medicine to your skin first. The provider will insert a needle with a syringe into the artery to remove some blood.
When the syringe is full, the provider will bandage the puncture site. Pressure will be applied to the site for at least 5 minutes to stop the bleeding.
If you take blood thinners, including aspirin, ask your health care provider whether you should stop taking them before your test. And tell your provider about all other medicines and supplements you take. But don't stop taking any medicines unless your provider tells you to.
If you are on oxygen therapy, your oxygen may be turned off for about 20 minutes before the test. This will be done only if you can breathe without oxygen therapy.
There is very little risk to having a blood oxygen level test. You may have some bleeding, bruising, or soreness at the spot where the needle was put in. Very rarely, the needle may damage a nerve or the artery. You may be told to avoid lifting heavy objects for 24 hours after the test.
ABG test results involve many body systems that affect each other. And there are many health conditions that can cause abnormal results. For these reasons, it's best to have your provider explain what your results mean for your health.
Your ABG test results will list many measurements, including:
Oxygen saturation (O2Sat). This measures how much oxygen your red blood cells are carrying.
Partial pressure of oxygen (PaO2). This measures the pressure of oxygen that's dissolved in your blood. It helps show how well oxygen moves from your lungs to your bloodstream.
Partial pressure of carbon dioxide (PaCO2). This measures the amount of carbon dioxide in your blood. It also shows how easily carbon dioxide can move out of your body.
Acid-base balance (pH level). This measures the acidity of your blood. Too much acid is called acidosis. Too much base (alkaline) is called alkalosis. These conditions are symptoms of other problems that upset the acid-base balance in your body.
An ABG test alone usually can't provide a final diagnosis. So, if your results are not normal, your provider will likely order more tests to make a diagnosis. In general, abnormal results may mean you have a problem with your lungs or kidneys or a metabolic disorder. Metabolic disorders affect how your body uses food for energy. Certain medicines may also upset your acid-base balance and lead to abnormal ABG test results.
Another type of test, called pulse oximetry, can check your blood oxygen saturation levels. A small clip-like device, called a pulse oximeter, is usually attached to your finger. The device tells you the percentage of red blood cells that are full of oxygen. Pulse oximetry may be useful if blood oxygen levels are the only concern. Ask your provider if this test is right for you.
Arterial Blood Gas (ABG) Test: MedlinePlus Medical Test [accessed on Dec 26, 2023]
Blood gases: MedlinePlus Medical Encyclopedia [accessed on Sep 02, 2018]
ABG (Arterial Blood Gas) | Lab Tests | GLOWM [accessed on Dec 26, 2023]
Blood Gases - Testing.com. Dec 13, 2021 [accessed on Dec 26, 2023]
Additional Materials (8)
How to take an arterial blood gas (ABG) - OSCE guide
The cardiovascular system is vast network of arteries, veins and vessels that would extend 60,000 miles if stretched end-to-end. All but a tiny fraction of this vessel network is invisible to the naked eye. The smallest capillaries (from latin "hairlike") are so narrow that red blood cells must pass through in single file. Higher than normal blood iron levels have been linked to heart disease and the reason is believed to be the oxidative stress the excess iron places on the walls of the blood vessels. It is the biological counterpart of rust. There are 20-30 trillion red blood cells (RBCs) in an adult's body. The life span of RBCs, which are produced in bone marrow, is about 100 days, which means that 2 million die (and are replaced) each second, but in that short lifetime they can make 75,000 round trips between lungs, heart and tissues in the body.
Image by TheVisualMD
Bronchi and Bronchiole of Lung
3D visualization of an inferior view of a transverse section of the thorax, highlighting the lungs, reconstructed from scanned human data. The trachea, cardiac impression, and transverse sections of the thoracic aorta and esophagus are clearly illustrated. The bronchial tree is also visible. When air is inhaled into the lungs, it flows through large tubes called bronchi, branches into smaller tubes known as bronchioles, and ends up in the thousands of small pouches that are the alveoli. This is where the oxygen is transferred from the air into the bloodstream. Each alveolar sac, or air sac, is surrounded by a bed of capillaries, and the walls between the lung and the capillary are extremely thin. The walls are so delicate, in fact, that the inhaled oxygen can seep from the air sacs to bind to the hemoglobin in the blood, while the carbon dioxide and other waste gasses leave the blood and diffuse into the lungs where they can be exhaled.
Image by TheVisualMD
Male Thorax with Visible Trachea and Lung
3D visualization of an anterior oblique view of the trachea and the lungs, reconstructed from scanned human data. The bifurcation of the trachea and the extensive branching of the right and left bronchi are revealed. The respiratory system consists of branching tubes that work to bring oxygen from the air to the organs and tissues of the body, and to expel carbon dioxide wastes from the body to the air. The bronchial tree is a system of airways in which the \"trunk\" is the windpipe and the \"branches\" are the subdividing passages that permeate the lungs. While the rest of the system works as a kind of accordion pump, the structures of the bronchial network split and split again until they are so numerous and so thin at their membranous tips that gas molecules can cross over to the blood through a network of capillaries that, laid end to end, would measure more than 1,000 miles.
Image by TheVisualMD
Capillary in Alveolus
This is a magnified section of capillaries in an aveolus. Capillaries are the smallest blood vessels in the body. The walls of the capillaries are the primary sites for gas and nutrition exchange.
Image by TheVisualMD
Alveolar Type II Cells Secreting Surfactant
The walls of the alveoli, the tiny air sacs within the lungs where the exchange of oxygen and carbon dioxide takes place, are lined with three major alveolar cells. These are: Type I (squamous alveolar) cells, Type II (great alveolar) cells, and the third type, magrophages. Type II cells secrete pulmonary surfactant, which lowers the surface tension of water and allows the membrane to separate, thereby increasing the capability to exchange gases and reducing fluid accumulation in the alveolus. Premature infants sometimes have a developmental insufficiency of surfactant production and structural immaturity in the lungs.This results in infant respiratory distress syndrome (IRDS).
Image by TheVisualMD
3:20
How to take an arterial blood gas (ABG) - OSCE guide
Geeky Medics/YouTube
9:55
Arterial Puncture for Blood Gas Analysis
SECEI ESCS/YouTube
Measurement Chamber
J3D3/Wikimedia
Red Blood Cell in Capillary
TheVisualMD
Bronchi and Bronchiole of Lung
TheVisualMD
Male Thorax with Visible Trachea and Lung
TheVisualMD
Capillary in Alveolus
TheVisualMD
Alveolar Type II Cells Secreting Surfactant
TheVisualMD
Bronchoscopy
Bronchoscopy
Also called: Endoscopy of the bronchi
A bronchoscopy is a medical procedure that allows visualization of the inside of a person's airways. It is used to diagnose lung disease or to treat some lung conditions.
Bronchoscopy
Also called: Endoscopy of the bronchi
A bronchoscopy is a medical procedure that allows visualization of the inside of a person's airways. It is used to diagnose lung disease or to treat some lung conditions.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal result means that normal cells and fluids are found. No foreign substances or blockages are seen.
Related conditions
Bronchoscopy is a procedure that allows a health care provider to look at your lungs. It uses a thin, lighted tube called a bronchoscope. The tube is put through the mouth or nose and moved down the throat and into the airways. It helps diagnose and treat certain lung diseases.
Bronchoalveolar lavage (BAL) is a procedure that is sometimes done during a bronchoscopy. It is also called bronchoalveolar washing. BAL is used to collect a sample from the lungs for testing. During the procedure, a saline solution is put through the bronchoscope to wash the airways and capture a fluid sample.
Bronchoscopy may be used to:
Find and treat growths or other blockages in the airways
Remove lung tumors
Control bleeding in the airway
Help find the cause of persistent cough
If you've already been diagnosed with lung cancer, the test can help show how severe it is.
Bronchoscopy with BAL is used to collect tissue for testing. These tests help diagnose different disorders of the lungs including:
Bacterial infections such as tuberculosis and bacterial pneumonia
Fungal infections
Lung cancer
One or both tests may be used if an imaging test showed a potential problem with the lungs.
You may need one or both tests if you have symptoms of a lung disease, such as:
Persistent cough
Trouble breathing
Coughing up blood
You may also need a BAL if you have an immune system disorder. Some immune system disorders, such as HIV/AIDS, can put you at higher risk for certain lung infections.
Bronchoscopy and BAL are often done by a pulmonologist. A pulmonologist is a doctor who specializes in diagnosing and treating lung diseases.
A bronchoscopy usually includes the following steps:
You may need to remove some or all of your clothing. If so, you will be given a hospital gown.
You will recline in a chair that is like a dentist's chair or sit on a procedure table with your head raised.
You may get medicine (sedative) to help you relax. The medicine will be injected into a vein or given through an IV (intravenous) line that will be placed in your arm or hand.
Your provider will spray a numbing medicine in your mouth and throat, so you won't feel any pain during the procedure.
Your provider will insert the bronchoscope down your throat and into your airways.
As the bronchoscope is moved down, your provider will examine your lungs.
Your provider may perform other treatments at this time, such as removing a tumor or clearing a blockage.
At this point, you may also get a BAL.
During a BAL:
Your provider will put a small amount of saline through the bronchoscope.
After washing the airways, the saline is sucked up into the bronchoscope.
The saline solution will contain cells and other substances, such as bacteria, which will be taken to a lab for testing.
You may need to fast (not eat or drink) for several hours before your procedure. Your provider will let you know how long you need to avoid food and drink.
You should also arrange to have someone drive you home. If you've been given a sedative, you may be drowsy for a few hours after your procedure.
There is very little risk to having a bronchoscopy or a BAL. The procedures may give you a sore throat for a few days. Serious complications are rare, but they may include bleeding in the airways, infection, or a collapsed part of a lung.
If your bronchoscopy results were not normal, it may mean you have a lung disorder such as:
A blockage, growth, or tumor in the airways
Narrowing of part of the airways
Lung damage due to an immune disorder such as rheumatoid arthritis
If you had BAL and your lung sample results were not normal, it may mean you have lung cancer or a type of infection such as:
Tuberculosis
Bacterial pneumonia
Fungal infection
If you have questions about your results, talk to your health care provider.
In addition to BAL, there are other procedures that can be done during a bronchoscopy. These include:
Sputum culture. Sputum is a thick type of mucus made in your lungs. It is different than spit or saliva. A sputum culture checks for certain types of infections.
Laser therapy or radiation to treat tumors or cancer
Treatment to control bleeding in the lungs
https://medlineplus.gov/lab-tests/bronchoscopy-and-bronchoalveolar-lavage-bal/ [accessed on Oct 17, 2021]
https://medlineplus.gov/ency/article/003857.htm [accessed on Oct 17, 2021]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (20)
Rigid bronchoscopy
Rigid bronchoscopy
Image by JBARRETO
Diagram showing a bronchoscopy
Diagram showing a bronchoscopy
Image by Cancer Research UK / Wikimedia Commons
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This media may include sensitive content
Bronchoscopy
Seen is a Caucasian male physician using a bronchoscope which is a flexible tube with a light inside and is inserted into the patient's trachea. Doctors can view inside the body through the tube allowing easier access to removal of tumors.
Image by National Cancer Institute / Unknown Photographer
Sensitive content
This media may include sensitive content
What Does Bronchoscopy Show?
Lung cancer in the left. bronchus as seen with a bronchoscope.
Image by JHeuser
Bronchoscopy
Video by Covenant Health/YouTube
Bronchoscopy & Lung Nodule Biopsy | Fox Chase Cancer Center
Video by Fox Chase Cancer Center/YouTube
EBUS guide for patients: bronchoscopy technique for chest abnormalities
Video by astrazeneca/YouTube
Electromagnetic Navigation Bronchoscopy
Video by Gundersen Health System/YouTube
Bronchoscopy - examination of your airways (English version)
Video by Longkanker Nederland/YouTube
Sedation for Bronchoscopy (English version)
Video by Longkanker Nederland/YouTube
Robotic bronchoscopy - Mayo Clinic
Video by Mayo Clinic/YouTube
Bronchoscopy Patient Journey at the Royal Berkshire Hospital
Video by Royal Berkshire NHS Foundation Trust/YouTube
Bronchoscopy
Video by Tan Tock Seng Hospital/YouTube
What happens during a bronchoscopy?
Video by Top Doctors UK/YouTube
Intro to Bronchoscopy: Lower Airway Anatomy -- BAVLS
Video by American Thoracic Society/YouTube
Using a Bronchial Scope for a Bronchoscopy at Christian Hospital in St. Louis, Missouri
Video by Christian Hospital/YouTube
Diagnostic Bronchoscopy
Video by Cleveland Clinic Abu Dhabi/YouTube
All About Bronchoscopy
Video by Singapore General Hospital/YouTube
Bronchoscopy Procedure, South West Acute Hospital
Video by WesternTrust/YouTube
Intro to Bronchoscopy: Risks, indications, contraindications and obtaining consent -- BAVLS
Video by American Thoracic Society/YouTube
Rigid bronchoscopy
JBARRETO
Diagram showing a bronchoscopy
Cancer Research UK / Wikimedia Commons
Sensitive content
This media may include sensitive content
Bronchoscopy
National Cancer Institute / Unknown Photographer
Sensitive content
This media may include sensitive content
What Does Bronchoscopy Show?
JHeuser
2:12
Bronchoscopy
Covenant Health/YouTube
4:25
Bronchoscopy & Lung Nodule Biopsy | Fox Chase Cancer Center
Fox Chase Cancer Center/YouTube
7:32
EBUS guide for patients: bronchoscopy technique for chest abnormalities
astrazeneca/YouTube
2:09
Electromagnetic Navigation Bronchoscopy
Gundersen Health System/YouTube
1:58
Bronchoscopy - examination of your airways (English version)
Longkanker Nederland/YouTube
2:51
Sedation for Bronchoscopy (English version)
Longkanker Nederland/YouTube
4:43
Robotic bronchoscopy - Mayo Clinic
Mayo Clinic/YouTube
7:13
Bronchoscopy Patient Journey at the Royal Berkshire Hospital
Royal Berkshire NHS Foundation Trust/YouTube
3:12
Bronchoscopy
Tan Tock Seng Hospital/YouTube
2:18
What happens during a bronchoscopy?
Top Doctors UK/YouTube
7:26
Intro to Bronchoscopy: Lower Airway Anatomy -- BAVLS
American Thoracic Society/YouTube
5:31
Using a Bronchial Scope for a Bronchoscopy at Christian Hospital in St. Louis, Missouri
Christian Hospital/YouTube
3:37
Diagnostic Bronchoscopy
Cleveland Clinic Abu Dhabi/YouTube
3:36
All About Bronchoscopy
Singapore General Hospital/YouTube
9:06
Bronchoscopy Procedure, South West Acute Hospital
WesternTrust/YouTube
7:31
Intro to Bronchoscopy: Risks, indications, contraindications and obtaining consent -- BAVLS
American Thoracic Society/YouTube
Treatment
Medication
Image by StoryMD
Medication
Medication
Image by StoryMD
Pneumonia - Treatment
Treatment for pneumonia depends on your risk factors and how serious your pneumonia is. Many people who have pneumonia are prescribed medicine and recover at home. You may need to be treated in the hospital or an intensive care unit (ICU) if your pneumonia is serious.
Medicines
Your doctor may prescribe some of the following medicines to treat your pneumonia at home or at the hospital, depending on how sick you are.
Management at home
If your pneumonia is mild, your doctor may prescribe medicines or suggest over-the-counter medicines to treat it at home.
Antibiotics for bacterial pneumonia. Most people begin to feel better after one to three days of antibiotic treatment. However, you should take antibiotics as your doctor prescribes. If you stop too soon, your pneumonia may come back.
Antiviral medicine for viral pneumonia. These medicines may not be effective against some viruses that cause pneumonia.
Antifungal medicines for fungal pneumonia.
Over-the-counter medicines. Your doctor may suggest over-the-counter medicines to treat your fever and muscle pain or help you breathe easier. Talk to your doctor before taking cough or cold medicine.
Management at the hospital
If your pneumonia is serious, you may be treated in a hospital to get antibiotics and fluids through an intravenous (IV) line inserted into your vein and to get oxygen therapy to increase the amount of oxygen in your blood. If your pneumonia is very serious, you may need to be put on a ventilator.
Procedures
Your healthcare team may need to perform a procedure or surgery to remove seriously infected or damaged parts of your lung. This may help you recover and may prevent your pneumonia from coming back.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (5)
Pneumonia diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Doctor Explains Typical Pneumonia Treatment Plan
Video by AP Archive/YouTube
Pneumonia: types, causes, and treatment
Video by Top Doctors UK/YouTube
Pneumonia | Treatment and Prevention
Video by Ninja Nerd/YouTube
Treating Covid Pneumonia: Real Story told by a Frontline Doctor
Video by Tiny Medicine/YouTube
10:15
Pneumonia diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
2:19
Doctor Explains Typical Pneumonia Treatment Plan
AP Archive/YouTube
7:34
Pneumonia: types, causes, and treatment
Top Doctors UK/YouTube
35:34
Pneumonia | Treatment and Prevention
Ninja Nerd/YouTube
4:47
Treating Covid Pneumonia: Real Story told by a Frontline Doctor
Tiny Medicine/YouTube
Prevention
Fight flu early with vaccine
Image by Cpl. Jackeline Perez Rivera / Marine Corps Installations East
Fight flu early with vaccine
A healthcare professional injects a patient with a flu vaccine during a Community influenza vaccination event held by Naval Hospital Camp Lejeune aboard Marine Corps Base Camp Lejeune, Oct. 20. Everyone 6 months of age and older should get a flu vaccine each year, said Lt. Cmdr. Bryan Alvarez, Naval Hospital Camp Lejeune’s director of Public Health.
Image by Cpl. Jackeline Perez Rivera / Marine Corps Installations East
Pneumonia - Screening and Prevention
Pneumonia can be very serious and even life-threatening. Vaccines can help prevent some types of pneumonia. Good hygiene (washing your hands often), quitting smoking, and keeping your immune system strong by getting regular physical activity and eating healthy are other ways to lower your risk of getting pneumonia.
Vaccines
Vaccines can help prevent pneumonia caused by pneumococcus bacteria or the flu virus. Vaccines cannot prevent all cases of pneumonia. However, compared to people who don't get vaccinated, those who are vaccinated and still get pneumonia tend to have:
Fewer serious complications
Milder infections
Pneumonia that doesn’t last as long
Pneumococcus vaccines
Two vaccines are available to prevent infections from the pneumococcus bacteria, the most common type of bacteria that causes pneumonia. Pneumococcus vaccines are especially important for people at high risk of pneumonia, including:
Adults age 65 or older
Children age 2 or younger
People who have chronic (ongoing) diseases, serious long-term health problems, or weak immune systems. This may include people who have cancer, HIV, asthma, sickle cell disease, or damaged or removed spleens.
People who smoke
Flu (influenza) vaccine
Your yearly flu vaccine can help prevent pneumonia caused by the flu. The flu vaccine is usually given in September through October, before flu season starts.
Hib vaccine
Haemophilus influenzae type b (Hib) is a type of bacteria that can cause pneumonia and meningitis. The Hib vaccine is recommended for all children under 5 years old in the United States. The vaccine often is given to infants starting when they are 2 months old.
Other ways to prevent pneumonia
You can take the following steps to help prevent pneumonia:
Wash your hands with soap and water or alcohol-based hand sanitizers to kill germs.
Don’t smoke. Smoking prevents your lungs from properly filtering out and defending your body against germs. For free help and support, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Keep your immune system strong. Get plenty of physical activity and follow a healthy eating plan.
If you have problems swallowing, eat smaller meals of thickened foodand sleep with the head of your bed raised up. These steps can help you avoid getting food, drink, or saliva into your lungs.
If you have a planned surgery, your doctor may recommend that you don’t eat for 8 hours or drink liquids for 2 hours before your surgery. This can help prevent food or drink from getting into your airway while you are sedated.
If your immune system is impaired or weakened, your doctor may recommend you take antibiotics to prevent bacteria from growing in your lungs.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (5)
What can I do to prevent getting pneumonia?
Video by MassGeneralHospital/YouTube
Pneumonia and how to prevent it
Video by CHI St. Vincent/YouTube
Health advice for the Prevention of Pneumonia and Respiratory Tract Infection
Video by 衞生署衞生防護中心, CHP, Department of Health, HKSARG/YouTube
Pneumococcal Vaccine - Vaccines and Your Baby - The Children's Hospital of Philadelphia (10 of 14)
Video by The Children's Hospital of Philadelphia/YouTube
Ventilator Association Pneumonia Prevention
Video by Kaiser Permanente Thrive/YouTube
0:31
What can I do to prevent getting pneumonia?
MassGeneralHospital/YouTube
5:15
Pneumonia and how to prevent it
CHI St. Vincent/YouTube
0:31
Health advice for the Prevention of Pneumonia and Respiratory Tract Infection
衞生署衞生防護中心, CHP, Department of Health, HKSARG/YouTube
2:54
Pneumococcal Vaccine - Vaccines and Your Baby - The Children's Hospital of Philadelphia (10 of 14)
The Children's Hospital of Philadelphia/YouTube
1:54
Ventilator Association Pneumonia Prevention
Kaiser Permanente Thrive/YouTube
Recovery
Recovering in Bed when Sick
Image by Myriams-Fotos/Pixabay
Recovering in Bed when Sick
Image by Myriams-Fotos/Pixabay
Recovering From Pneumonia
If you are diagnosed with pneumonia, it is important to follow your treatment plan, take steps to help your body recover, monitor your condition, and take steps to prevent your infection from spreading to others.
It may take time to recover from pneumonia. Some people feel better and are able to return to their normal routines in one to two weeks. For others, it can take a month or longer. Most people continue to feel tired for about a month. Talk with your doctor about when you can return to your normal activities. Watch the video below to learn about managing your recovery at home.
Follow your treatment plan
It is important that you take all your medicines as your doctor prescribes. If you are using antibiotics, continue to take the medicine until it is all gone. You may start to feel better before you finish the medicine, but you should continue to take it. If you stop too soon, the bacterial infection and your pneumonia may come back. It may also become resistant to the antibiotic, making treatment more difficult.
Take steps to help your body recover
The following steps can help your body recover from pneumonia.
Choose heart-healthy foods, because good nutrition helps your body recover.
Drink plenty of fluids to help you stay hydrated.
Don’t drink alcohol or use illegal drugs. Alcohol and illegal drugs weaken your immune system and can raise the risk of complications from pneumonia.
Don’t smoke and avoid secondhand smoke. Breathing in smoke can worsen your pneumonia. For free help quitting smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Get plenty of sleep. Good quality sleep can help your body rest and improve the response of your immune system.
Get light physical activity. Moving around can help you regain your strength and improve your recovery. However, you may still feel short of breath, and activity that is too strenuous may make you dizzy. Talk to your doctor about how much activity is right for you.
Sit upright to help you feel more comfortable and breathe more easily.
Take a couple of deep breaths several times a day.
Monitor your condition
Ask your doctor when you should schedule follow-up care. If your symptoms have not improved, your doctor may use a chest X-ray to help diagnose other conditions that may be causing your symptoms.
Your doctor may suggest pulmonary rehabilitation to help you breathe better as your lungs recover. You may also need physical therapy to help you regain your strength. Physical activity can help improve your recovery.
Pneumonia can have long-term effects such as depression, and worsening heart and blood vessel diseases. Call your doctor if you develop these conditions, if your symptoms suddenly get worse, or if you have trouble breathing or talking.
Take steps to protect yourself and others
The following steps can help you prevent spreading the infection to others around you.
Cover your nose and mouth while coughing or sneezing.
Get rid of used tissues right away.
Limit contact with family and friends.
Wash your hands often, especially after coughing and sneezing.
Some people get pneumonia again and again. Tell your doctor if this happens.
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (2)
Pneumonia Discharge
Video by Covenant Health/YouTube
Jeanne's Story: Her Inspiring Recovery from Pneumonia
Video by Kindred Hospitals/YouTube
6:12
Pneumonia Discharge
Covenant Health/YouTube
2:50
Jeanne's Story: Her Inspiring Recovery from Pneumonia
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Pneumonia
Pneumonia is an infection in one or both of the lungs that causes the air sacs of the lungs to fill up with fluid or pus. It can be very serious and even life threatening. Learn about the symptoms of pneumonia, how it's treated, and how to prevent it.