Radiographic Imaging of Community-Acquired Pneumonia: A Case-Based Review

In conclusion, chest radiography for the investigation of possible CAP remains a common part of radiologic practice. Given this, even in a setting apart from the COVID-19 pandemic, the radiologist can contribute to the care of these patqqqqients beyond the simple identification of lobar pneumonia. Radiographs should always be interpreted in light of the clinical setting; subtle findings may correlate with acute interstitial or bronchopneumonia patterns in patients with infectious symptoms, and a masslike presentation that may suggest neoplasm to the untrained observer may also raise the possibility of acute infection. The radiologist should assess for pleural fluid and multilobar involvement, because these may affect clinical decisions about hospital and ICU admission and microbiologic assessment. In contrast, alternative diagnoses should always be considered in patients with a clinical presentation that is discordant from the radiographic finding of apparent pneumonia, at least with follow-up to assess for resolution. When upper lobe cavitation is present, further investigation for tuberculosis should ensue if the onset of symptoms is not acute. Lymphadenopathy evident on a radiograph or multiple pulmonary nodules, particularly when cavitary, should always suggest additional clinical evaluation rather than empirical treatment of CAP. Keeping these principles in mind will allow the radiologist to be a valuable contributor to patient care in the setting of suspected CAP.