Chest X-Ray: Pneumonia Vs Normal

Chest X-rays are often ordered to evaluate a suspected pneumonia. Pneumonia is an infection of the lung.   Pneumonia can be caused by multiple types of organisms like bacteria, fungus, and viruses.  Normal chest X-ray shows clear lungs while the X-ray with pneumonia often shows areas of abnormal white or hazy lung.

Can an X-ray tell if you have pneumonia?

X-rays can often tell if you have a pneumonia.  Pneumonia can have multiple appearances.  Pneumonia can be confined to a small part of the lung or involve both lungs diffusely.   Some pneumonias can not be seen on X-ray or are very subtle.

How does pneumonia appear on a chest X-ray?

Pneumonia can have different appearances on chest X-ray.  Some pneumonias will have lung consolidation which means the lung is densely white in the area of pneumonia.  Other pneumonias such as that from viruses or some other organisms can have hazy lungs or branching and nodular opacities.    There are pneumonias which are poorly seen on X-rays.

What does pneumonia look like in the lungs?

Pneumonia in the lungs will most commonly be seen as white areas superimposed on the normally black lung on chest X-ray.  Other appearances can be nodules or rounded spots, branching areas or subtle tiny white spots in the lung.

What color is pneumonia on X-ray?

Pneumonia will be white on X-ray.  Some pneumonias are hazy or less white.  Other pneumonias may simply be very subtle tiny white spots interspersed with normal lung (interstitial pattern). The normal lung is black on X-ray.

How big is pneumonia on X-ray?

The size of the pneumonia varies from one small area that may be  barely visible on chest X-ray to involvement throughout both lungs.

Greater involvement of the lungs may indicate a more serious infection.  The infection can spread into the blood.  There can be complications like abscesses or pockets of pus.  There can be respiratory failure requiring a ventilator.

Where is pneumonia found in the lung?

Pneumonias can occur in any part of the lung.  Pneumonias can involve the bronchial air tubes and spread into the lung or involve an entire lobe of the lung.  Pneumonias can also involve the lung around the air sacs.

Pneumonia from aspiration occurs when a foreign substance is inhaled into the lung.  This causes a direct insult to the lung.  This type of pneumonia has characteristic location depending on if the patient is recumbent or standing.

Symptoms of pneumonia

Productive cough, fevers, shortness of breath, and fatigue are common.

What causes pneumonia?

Pneumonia is an infection of the lung that can be caused by bacteria, viruses, and fungi.  Aspiration pneumonia is caused by direct entry of a foreign substance into the lung.  Some organisms infect patients in the community or hospital setting while others infect those who have weakened immune systems.

Do chest xrays always show pneumonia?

No, not always.  Some pneumonias are hard or impossible to see on X-ray.  Other pneumonias are hidden by overlying structures in the chest.   For example, a big blood vessel in front of a pneumonia on chest X-ray can hide it or make it hard to see.

Some pneumonias do not appear on chest X-rays until after the symptoms have begun.   It is therefore important for your doctor to consider a chest X-ray as one tool for the diagnosis of pneumonia.

Tests to diagnose pneumonia

In addition to chest X-rays, CT scans are great at diagnosing pneumonia.  CTs use more radiation and are more expensive however.  Sputum cultures are good at identifying organisms that are causing the pneumonia. Other more invasive tests like bronchoscopy or biopsy is seldom used.

Pneumonia vs normal chest X-ray: summary

Pneumonia on chest X-ray will most commonly be a white or hazy area in the lung.  Some pneumonias are difficult or impossible to see on X-ray.  Many different kinds of organisms can cause a pneumonia.  The imaging will not tell us what kind of organism is causing the pneumonia.   Imaging is just one tool used for the diagnosis of pneumonia.

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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