Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
Send us all your questions or requests, and our expert team will assist you.
Accurate and timely diagnosis of pneumonia is the cornerstone of effective management. Because the symptoms of pneumonia can overlap with acute bronchitis, heart failure, pulmonary embolism, and other respiratory conditions, a rigorous diagnostic approach is essential. At Liv Hospital, we employ a multi-modal strategy that integrates clinical assessment, advanced imaging, and microbiological testing to not only confirm the diagnosis but also to stratify risk and identify the specific causative agent.
The diagnostic journey begins with a detailed medical history and physical examination.
The stethoscope remains a powerful tool. In pneumonia, auscultation of the lungs typically reveals abnormal breath sounds. Crackles (rales) are heard over the affected area, representing the popping open of fluid-filled alveoli. Bronchial breath sounds, which are louder and harsher than usual, may be heard over areas of dense consolidation.
Percussion of the chest wall over a consolidated lung segment produces a dull thud, contrasting with the resonant sound of air-filled lungs. Tactile fremitus, the vibration felt on the chest wall when the patient speaks, is typically increased over areas of pneumonia because solid tissue conducts sound better than air.
Imaging is crucial for confirming the presence of infiltrates and assessing the extent of the disease.
A chest X-ray is the primary diagnostic test. It visualizes the lungs and can identify infiltrates (white spots) that indicate infection. The pattern of infiltration can offer clues to the etiology: lobar consolidation suggests a bacterial cause, while diffuse interstitial infiltrates indicate a viral or atypical cause. It also helps detect complications such as pleural effusion (fluid around the lungs) or a lung abscess.
When the clinical picture is confusing or the X-ray is inconclusive, a chest CT scan provides a more detailed cross-sectional view of the lung parenchyma. A CT scan is highly sensitive and can detect small areas of infection, cavitations, or underlying lung diseases that may be obscured on a standard X-ray. It is beneficial for evaluating complex pneumonias or for differentiating infection from other pathologies, such as pulmonary embolism or malignancy.
Identifying the specific pathogen is vital for targeted antibiotic therapy and stewardship.
A sputum culture is standard for patients with a productive cough. It involves analyzing a sample of deep lung mucus to identify bacteria. A Gram stain can provide immediate preliminary information. However, obtaining a high-quality sample free of oral flora contamination can be challenging.
Blood cultures are drawn to detect bacteremia (bacteria in the blood). This is crucial for identifying the pathogen in severe cases and preventing sepsis. While blood cultures are positive in only a minority of CAP cases, a positive result definitively identifies the causative organism.
Rapid urinary antigen tests are available for Streptococcus pneumoniae and Legionella pneumophila. These tests are non-invasive, provide results quickly, and are unaffected by early antibiotic administration, making them valuable tools for guiding initial therapy.
Modern medicine increasingly relies on molecular techniques for rapid diagnosis.
Polymerase Chain Reaction (PCR) testing on nasopharyngeal swabs is used to detect respiratory viruses, including Influenza A and B, RSV, and SARS-CoV-2. Multiplex PCR panels can simultaneously test for a wide array of viral and atypical bacterial pathogens (like Mycoplasma and Chlamydia), providing results in hours rather than days.
Evaluating the functional impact of pneumonia is as crucial as identifying the cause.
Non-invasive pulse oximetry measures blood oxygen saturation. It is a vital sign that determines the need for supplemental oxygen and hospitalization.
In patients with severe respiratory distress, an ABG analysis provides precise measurements of partial pressure of oxygen (PaO2), carbon dioxide (PaCO2), and pH. This helps assess the severity of respiratory failure and guide decisions regarding ventilatory support.
To determine the appropriate site of care (home, general ward, or ICU), clinicians use validated severity scores.
The CURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age >65) and the Pneumonia Severity Index (PSI) are widely used tools. These scores integrate clinical and laboratory data to estimate the mortality risk and help doctors make objective decisions about hospital admission.
In immunocompromised patients or those who fail to respond to standard therapy, invasive procedures may be necessary.
Bronchoscopy involves passing a flexible tube with a camera into the lungs. This allows for direct visualization of the airways and the collection of bronchoalveolar lavage (BAL) fluid. BAL provides a sample from the lower respiratory tract that is less likely to be contaminated, which is essential for diagnosing fungal pneumonias (like Pneumocystis) or resistant bacterial infections.
If a significant pleural effusion is present, thoracentesis (needle drainage) is performed to analyze the fluid. This helps distinguish between a simple parapneumonic effusion and an empyema (infected fluid), which requires drainage.
Send us all your questions or requests, and our expert team will assist you.
A chest X-ray is the most reliable way to visualize the lungs and confirm the presence of fluid or inflammation (infiltrates) that characterizes pneumonia.
Sputum comes from deep in the lungs and contains the infection-causing bacteria. In contrast, saliva comes from the mouth and contains normal oral bacteria, which can confuse test results.
Pneumonia fills the air sacs with fluid, blocking oxygen from entering the blood; checking oxygen levels helps doctors gauge how severely lung function is compromised.
A PCR test is a molecular diagnostic tool that detects the genetic material of viruses or bacteria, allowing for rapid and accurate identification of the germ causing the infection.
A bronchoscopy is usually reserved for severe or complicated cases where standard tests haven’t identified the germ, or if the patient has a weak immune system and needs a specific diagnosis.
Your Comparison List (you must select at least 2 packages)
