Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • positive past medical history
  • fever
  • productive cough
  • cavernous (amphoric) breath sounds
  • cardiac murmur

Other diagnostic factors

  • pleuritic chest pain
  • constitutional symptoms
  • cachexia
  • pallor
  • gingival disease
  • halitosis
  • absence of gag reflex
  • dyspnea
  • hemoptysis
  • rigors
  • weakness
  • arthralgia
  • hemorrhagic lesions
  • inspiratory crackles
  • bronchial breathing
  • decreased breath sounds
  • unilateral fixed rhonchus

Risk factors

  • predisposition to aspiration of gastric contents
  • poor dental hygiene and tooth extraction
  • bronchial obstruction
  • immunosuppression
  • chronic illness
  • extrapulmonary sepsis
  • pneumonia

Diagnostic investigations

1st investigations to order

  • complete blood count (CBC)
  • chest x-ray (CXR)
  • sputum Gram stain
  • sputum culture
  • blood culture
  • empyema fluid culture
Full details

Investigations to consider

  • CT chest
  • bronchoscopy
  • quantitative cultures of protected specimen brushings
  • quantitative cultures of protected bronchoalveolar lavage samples
  • percutaneous needle aspiration and culture
  • sputum cytology
  • lung ultrasound
  • echocardiogram
  • rapid ELISA for D-dimer
  • multidetector CT thorax
  • V/Q scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Ioannis P. Kioumis

Associate Professor of Pulmonary Medicine and Infectious Diseases

Aristotle University of Thessaloniki

Respiratory Medicine Clinic

General Hospital G. Papanikolaou

Thessaloniki

Greece

Disclosures

IPK declares that he has no competing interests.

Georgia G. Pitsiou

Assistant Professor in Pulmonary Medicine

Aristotle University of Thessaloniki

Respiratory Failure Unit

General Hospital G. Papanikolaou

Thessaloniki

Greece

Disclosures

GGP declares that she has no competing interests.

Peer reviewers VIEW ALL

Professor of Surgery

University of Louisville

Associate Chief of Staff for Research and Development

VAMC Louisville

Louisville

KY

Disclosures

WGC declares that he has no competing interests.

Senior Lecturer and Consultant Physician

North Bristol Lung Centre

Southmead Hospital

Bristol

UK

Disclosures

NM declares that he has no competing interests.

MRC Training Fellow and Specialist Registrar, Respiratory Medicine

Oxford Centre for Respiratory Medicine

Churchill Hospital

Oxford

UK

Disclosures

NR declares that he has no competing interests.

Consultant Physician

Honorary Senior Lecturer

Imperial College Healthcare Trust

Hammersmith Hospital

London

UK

Disclosures

PWI declares that he has no competing interests.

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