Diagnosing pneumonia

introduction

Early diagnosis is important for pneumonia so that appropriate treatment can be initiated quickly. Before treatment, the doctor wants to find out which pathogen is likely to have caused the infection so that he can prescribe the right antibiotic.
When making the diagnosis, the doctor also wants to assess the severity of the disease in order to further decide whether the treatment can be carried out on an outpatient basis or whether the patient must be referred to a hospital.

This is how pneumonia is diagnosed

In order to diagnose pneumonia, the doctor asks the patient specific questions about his symptoms and the medical history. This enables him to determine which symptoms have existed where and for how long and whether the patient has other pre-existing illnesses or allergies.
This is followed by the physical examination, during which the lungs are listened to with the stethoscope (med. Ausculation) and the chest is tapped with the fingers (med. percussion). This allows the doctor to detect rattling noises and reduced breathing noises, among other things, which are groundbreaking for the diagnosis of pneumonia. The blood pressure, heart rate, body temperature and the general condition of the patient are also recorded during the examination.

A blood sample is then taken, whereby inflammation parameters and changes in blood values ​​are examined. If the findings of the previous examinations suggest pneumonia, a chest x-ray (chest x-ray) must always be taken to confirm the diagnosis. In special cases, further imaging, for example by computed tomography (CT) or magnetic resonance tomography (MRT), may be necessary.

In the case of atypical pneumonia that are not caused by conventional pathogens, the pathogen can be detected using sputum diagnostics. A bronchoscopy is performed in which the doctor inserts a flexible tube into the airways through the mouth. In this way, mucus can be extracted directly from the lungs and examined microbiologically.

Find out more about the topic here: Levels of inflammation in the blood.

You can see that on an X-ray

Pneumonia can be diagnosed with great certainty using an X-ray. An overview of the chest is taken, once from the front and once from the side. Doctors refer to these images as "chest X-ray in two planes".

The radiologist can use the X-ray to identify shadows and signs of fluid accumulation that can be traced back to the inflammatory processes within the lung tissue. Furthermore, the location and extent of the pneumonia can be recognized. In addition, other diseases can be excluded as the cause of the symptoms. However, an X-ray image cannot reliably detect the pathogen.

When pneumonia is spread, scarring is also noticeable. In such a case, action should be taken at the latest and therapy with antibiotics.

Read more about the topic here: Chest x-ray.

You can see that in the blood

Taking blood is part of the basic diagnosis of pneumonia. This is a simple and quick examination that can be carried out cheaply and is extremely helpful due to its high informative value.

The doctor is primarily interested in whether there are changes in the blood that indicate pneumonia. These signs of inflammation include a strong increase in white blood cells (med. Leukocytosis) also a prolonged erythrocyte sedimentation rate (ESR) and an increased CRP value. CRP is a protein that is only found in very small amounts in healthy people. In the case of bacterial infections, it increases very sharply and is therefore a good indication that there is inflammation in the body due to pathogens. An increased concentration of procalcitonin (PCT) in the blood also occurs in the event of infections and provides conclusions about the possible presence of pneumonia.

The blood test can also determine the pathogen in patients who are hospitalized as an inpatient. In the case of pneumonia that is treated on an outpatient basis, however, this is not necessary.

Blood values ​​in pneumonia? Read more about this here.

When do you need a CT?

If the findings are unclear or if the diagnosis of pneumonia cannot be reliably made on the basis of the X-ray images, computed tomography of the chest (CT chest) can also be performed.

The resolution of a CT image is better than that of an X-ray image, which means that conspicuous changes can be assessed more reliably. Studies have shown that the CT is clearly superior to the classic chest X-ray in diagnosing pneumonia, which is why CT images will probably also be an integral part of pneumonia diagnostics in the future.

Find out more about the topic here: CT of the lungs.

When do you need an MRI?

Magnetic resonance therapy (MRT) enables a reliable assessment of pneumonia and is even somewhat superior to CT. For findings that are very difficult to assess and if the doctor cannot make a diagnosis of pneumonia, an MRI can be performed.

In contrast to an X-ray or a CT examination, an MRI is associated with greater effort and longer waiting times and is therefore carried out less often in critical patients who need rapid treatment.

More information on the topic MRI of the lungs you'll find here.

How do you diagnose cold pneumonia?

The diagnosis of cold or atypical pneumonia is in most cases difficult because typical symptoms such as high body temperature or fever are absent. Here, too, the doctor first asks the patient about his medical history and performs a physical examination. Patients often experience fatigue, a dry cough, and chest pain. The doctor often finds no abnormalities during the physical examination. The blood values ​​are usually only slightly changed in the case of cold pneumonia.

A chest x-ray should always be performed if atypical pneumonia is suspected. The images often show an inflammatory infiltrate in the lungs. An infiltrate describes foreign, disease-causing cells, tissues or fluids in the imaging. The detection of atypical pathogens in the blood or sputum diagnosis secures the diagnosis of cold pneumonia.

Find out all about the topic here: Pneumonia without a fever.