Additional methods of examination

General blood analysis. The leukocyte count in the blood increases to 15-25 x 10⁹ per liter (15000-25000 per microlitre); neutrophils account for 80-90 per cent of the leucocytes; a shift to the left with the appearance of juvenile forms is sometimes observed. The number of eosinophils increases and they can disappear completely in grave cases. Relative lymphopenia and monocitosis are observed. The ESR increases, the red blood does not change.

Sputum is tenacious during the congestion period; it is slightly crimson and contains much protein, a small number of leucocytes, erythrocytes, alveolar cells, and macrophages. In the stage of red hepatization sputum is variant and rusty; it contains fibrin and a higher number of formed elements. In the stage of grey hepatization leucocyte count in the sputum increases significantly; the sputum becomes mucopurulent. In the resolution stage, leucocytes are converted into detritus, which is found in the sputum; many macrophages are also found. Pneumococci, staphylococci, Friedlaender diplobacilli can be detected in the sputum.

X-Ray changes in the lungs depend on the stage of the disease. The lung pattern is first intensified, then dense foci develop, which later fuse. The shadow usually corresponds to the lung lobe. The lungs become normally clear in two or three weeks. Dynamics of the X-ray changes spends on the tune when the therapy is begun.

Bronchopneumonia (focal pneumonia)

Separate lobules of the lungs are affected in bronchopneumonia, hence another name, lobular pneumonia. Inflammatory foci may be multiple, or they may fuse (confluent pneumonia); the foci may be located in various parts of both lungs simultaneously (mostly in the lower parts of the lungs).

Quite varied bacterial flora would be normally found in bronchopneumonia. The importance of pneumococcus has significantly decreased while the role of other microorganisms, especially of streptococci and staphylococci, has increased. Acute pneumonia is caused in many cases by viruses (in influenza, ornithosis, and psittacosis).

Development of bronchopneumonia is associated with the extension of the inflammatory process from the bronchi and bronchioles to the pulmonary tissue (hence another name of bronchopneumonia - catarrhal pneumonia, which reflects the transition of inflammation and infection with the mucous secretion from the inflamed bronchi into the alveoli). Infection gets inside the pulmonary tissue via the bronchi, and more frequently peribronchially, i.e. by lymph ducts and interalveolar septa. Local atelectasis that occurs in obstruction of the bronchus by a "mucopurulent plug" is important in the pathogenesis of bronchopneumonia. Obstruction of bronchial patency can be caused by a sudden bronchospasm and edema of the bronchial mucosa, inflammation (bronchitis), etc. Recently bronchopneumonia occurs mostly in children and the aged, usually during cold seasons (spring, autumn, winter).

Clinical features

The onset of the disease is usually overlooked because the often develops against the background of bronchitis or catarrh of the up air airways. But if a patient with clinical signs of acute bronchitis develops high temperature and has symptoms of a more severe disease, he should be considered to have bronchopneumonia. The most typical signs of bronchopneumonia are cough, fever and dyspnea. If the inflammatory focus at the periphery of the lung and the inflammation involves the pleura pain in the chest during coughing and deep breathing may occur. Fever may persist for various terms in bronchopneumonia. Usually fever is remittent and irregular. The temperature is often subfebrile or it may even be normal in the middle-aged or old patients.

Objective examination can sometimes reveal moderate hyperemia of face and cyanosis of the lips. Respiration accelerates to 25-30 per min; respiratory lagging of the affected side of the chest may be observed. Percussion and auscultation may prove ineffective if the inflammatory foci are small and deeply located. In the presence of a large focus, especially if it is located at the periphery of the lung tissue, and also in confluent pneumonia, the percussion sounds lose resonance (or become completely full), and auscultation reveals vesiculobronchial or bronchial breathing. Vocal fremitus and bronchophony are characteristic of such cases. Dry and moist rales are frequent, but consonating moist rales and crepitation that are heard over a limited part of the chest are especially informative.

Additional methods of examination

Clinical blood analysis: leukocytosis, neutrophilia, shift of leukocyte formula to the left, accelerated ESR.

Sputum analysis: in focal pneumonia the sputum is mucopurulant, tenacious or tenacious thick consistency, glass-like with yellow traces color, odorless. In microscopic study are revealed a lot of columns ciliated epithelium, leucocytes, alveolar macrophages.

X-ray examination: in focal pneumonia- the signs of focal pulmonary tissue consolidation (darkening limited by the lung's segment).