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Having Pulmonary Oedema But Hypostatic Pneumonia Is Suspected. Can An X-ray Give A Reliable Diagnosis?

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Posted on Mon, 25 Nov 2013
Question: (1) If a patient has pulmonary oedema but hypostatic pneumonia is suspected then can an X-ray give a reliable diagnosis? (2) If so, how? Is there an additional standard diagnostic test that can be used in these circumstances? (3) Finally, is there any way of telling whether a patient has hypostatic pneumonia or sepsis in these circumstance if two blood cultures are taken together and both are negative?
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Answered by Dr. Shashi Dangwal (7 hours later)
Brief Answer: Clinical corelation and other tests may help. Detailed Answer: Hello, Thanks for posting your query on XXXXXXX On x XXXXXXX chest, it may not be always possible to differentiate Pul oedema from hypostatic pneumonia. However there are some signs which may point towards one diagnosis or the other. These are as follows: In pul oedema, there may be associated cardiomegaly with evidence of various chamber enlargement, kerley B lines and pleural effusion. There may be perihilar cuffing. In hypostatic pneumonia, there are fluffy, irregular, patchy opacities scattered all over, more peripherally. CT chest shows opacities to be more in the dependent areas. Clinical co relation along with other tests like echo and ct chest help in establishing diagnosis. Hypostatic pneumonia may occur by itself in a debilitated patient mostly confined to the bed or may be a part of sepsis which is common in such patients. Blood culture and sputum culture may yield results but are generally negative as by the time these tests are ordered patient has already been on antibiotics.However as mentioned above other tests and clinical correlation may help in diagnosis.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Shashi Dangwal

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Practicing since :1979

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Having Pulmonary Oedema But Hypostatic Pneumonia Is Suspected. Can An X-ray Give A Reliable Diagnosis?

Brief Answer: Clinical corelation and other tests may help. Detailed Answer: Hello, Thanks for posting your query on XXXXXXX On x XXXXXXX chest, it may not be always possible to differentiate Pul oedema from hypostatic pneumonia. However there are some signs which may point towards one diagnosis or the other. These are as follows: In pul oedema, there may be associated cardiomegaly with evidence of various chamber enlargement, kerley B lines and pleural effusion. There may be perihilar cuffing. In hypostatic pneumonia, there are fluffy, irregular, patchy opacities scattered all over, more peripherally. CT chest shows opacities to be more in the dependent areas. Clinical co relation along with other tests like echo and ct chest help in establishing diagnosis. Hypostatic pneumonia may occur by itself in a debilitated patient mostly confined to the bed or may be a part of sepsis which is common in such patients. Blood culture and sputum culture may yield results but are generally negative as by the time these tests are ordered patient has already been on antibiotics.However as mentioned above other tests and clinical correlation may help in diagnosis.