Pneumonia is an inflammatory process of predominantly infectious etiology that affects all structural elements of the lung tissue. In pulmonary practice, this disease occurs in people of any age: from infants to adults and the elderly, and is extremely dangerous. Pulmonologists classify pneumonia according to various characteristics into several forms and types, each of which requires the appointment of a specific therapy.
Diagnosis of pneumonia begins with examination and questioning of the patient, collection of anamnesis, and includes a number of laboratory and instrumental examination methods. Diagnostic measures are necessary to determine the etiology and severity of the pathological process, to assess the likelihood of complications, as well as to differentiate pneumonia from other types of lung damage.
Who is the examination assigned to?
Everyone can independently suspect a serious pulmonary disease. Pneumonia is characterized by the rapid development of febrile phenomena, cough, signs of intoxication, an increase in temperature to 38 degrees and above. It is necessary to contact a therapist or pulmonologist and undergo an examination in order to diagnose pneumonia if the following symptoms are present:
- shortness of breath, shortness of breath;
- chest pain;
- heavy sweating;
- decreased general tone, severe weakness;
- lack of appetite;
- cyanosis of the skin;
- unproductive cough with the separation of a small amount of mucous, purulent sputum, sometimes interspersed with blood.
The clinic of pneumonia is characterized by severe intoxication, which can manifest itself as tachycardia, arrhythmia, nausea and vomiting, and abdominal pain.
Ways to diagnose pneumonia
At the first stage, the doctor interviews the patient, analyzes his complaints. He also finds out whether there have been recent hypothermia, viral respiratory diseases, whether there is in the patient’s life the influence of occupational and other hazards that can provoke pneumonia.
After this, a clinical examination of the patient is carried out. Suspicion of pneumonia gives cyanosis of the skin, especially in the area of the nasolabial triangle, retraction of the intercostal spaces.
Examination also includes percussion and auscultation (listening to the lungs). Percussion is the method of tapping a part of the body and analyzing the sounds that arise during this. The doctor taps his fingers on the chest in the projection of the lungs and listens to sounds, determining the size and shape of the paired organ, identifying pathological areas.
Auscultation involves listening to breathing with a stethoscope. With pneumonia, there are signs such as a weakening of alveolar breathing, bronchial breathing is heard in areas where it is normally inaudible, and fine bubbling moist rales are heard.
If the initial diagnosis suggests an inflammatory process in the lungs, then the patient is prescribed:
- general clinical blood test to detect signs of inflammation and assess the patient’s condition;
- sputum bacterioscopy (examination of sputum under a microscope);
- bacteriological culture of sputum (to assess the quantitative indicator of the pathogen, determine its type and sensitivity to antibiotics);
- X-ray of the lungs in the anterior and lateral projection.
These survey methods are required. In some cases, in order to make a correct diagnosis, the doctor may need data from other diagnostic studies. According to the indications, the following can be assigned:
- a study of the function of external respiration (if the patient has impaired ventilation of the lungs);
- analysis of the gas composition and acid-base state of the blood (in cases of severe respiratory failure);
- serological tests (for atypical forms of pneumonia);
- tomography of the lungs (if the doctor suspects the development of destruction or tumor process in the lungs);
- bronchoscopy – examination of the bronchopulmonary system using a fiber optic apparatus (prescribed if the patient has blood in the sputum, there is reason to suspect the development of a tumor process, as well as with a protracted or complicated course of the disease);
- examination of the pleural fluid obtained by the puncture method (when detecting the spread of the pathological process to the pleural cavity);
- biochemical blood test (assigned to elderly patients with a severe, long-term complicated course of the inflammatory process);
- lung scintigraphy is one of the methods of radiation diagnostics to assess the functionality of lung tissue (prescribed for suspected pulmonary embolism).
Indicators indicative of pneumonia
A general blood test reveals an increase in the erythrocyte sedimentation rate up to 20-25 mm / hour with focal pneumonia, with severe croupous lesions – up to 50-60 mm / hour. The criterion for pneumonia in a blood test is an increase in the number of leukocytes (mainly due to an increase in immature rod-nuclear neutrophils), an increase in the content of lymphocytes, eosinophils and basophils in the blood formula.
Microscopic examination of the sputum assesses its color and nature (yellowish-green purulent sputum, sometimes with blood impurities), consistency (with a lobar form – viscous, if pulmonary edema develops – liquid). If sputum has an unpleasant odor, this indicates the development of destruction, a purulent process in the lungs. Sputum is sown on special nutrient media to determine the causative agent of the inflammatory process.
X-ray examination is the most informative method for making a diagnosis. It allows you to install:
- the presence and localization of the focus of the pathological process (on the roentgenogram it looks like a lighter spot);
- structural changes in the lung tissue;
- the prevalence of inflammation;
- the presence of a lesion of the pleural cavity;
- changes in the roots of the lungs;
- the presence or absence of destructive changes.
With focal pneumonia, the picture shows groups of small foci of inflammation, sometimes merging, an increase in the pattern of the lungs, expansion of the root of the affected lung. With croupous pneumonia, the picture shows a darkening of the affected lobe of the lung.
Also, X-ray allows for differential diagnosis of pneumonia. It is very important to determine which process triggered the symptomatology of the pulmonary lesion. Pneumonia is differentiated from cavitary cancers, tuberculosis.
Computed tomography is the most informative diagnostic method to date, allowing to identify the localization of even very small foci of the inflammatory process, to find out the details of the pathology. The use of CT is limited only by the high cost of such studies, the lack of tomographs in most conventional medical institutions.
The diagnosis of pneumonia is formulated by specifying the following criteria:
- etiology of the disease;
- localization and spread of the inflammatory process (which segment or lobe is affected, left-sided, right-sided or bilateral course);
- the severity of the disease;
- the presence or absence of complications;
- the stage of development of the pathological process (initial, detailed, convalescence);
- the presence or absence of additional pathologies.
Pneumonia is a serious and dangerous disease that requires a comprehensive and complete diagnosis in order to prescribe an adequate effective treatment. If an inflammatory process in the lungs is detected, the patient needs hospitalization; at home it will not be possible to carry out the necessary effective therapy.