Diagnosis of Bronchopneumonia

Clinical Presentation

The American Thoracic Society recommends that bronchopneumonia diagnosis should be suspected when patients present with new respiratory symptoms, such as cough, sputum production, dyspnea, especially when accompanied by fever 1
The American College of Chest Physicians suggests that abnormal auscultatory findings, including crackles and abnormal breath sounds on chest examination, are indicative of bronchopneumonia 1
Atypical presentations in elderly patients, such as confusion, failure to thrive, worsening chronic illness, or falls, often without fever but with tachypnea present, should raise suspicion for bronchopneumonia 1

The American College of Radiology recommends that standard posteroanterior and lateral chest radiographs are essential and should be obtained in all patients with suspected pneumonia 1
Chest radiography can differentiate pneumonia from mimicking conditions and identify coexisting problems, such as bronchial obstruction, pleural effusion, or multilobar involvement 1

The Infectious Diseases Society of America suggests that sputum Gram stain and culture should be obtained before antibiotics when a good quality specimen is available 2
Blood cultures, with two sets, should be obtained in hospitalized patients, as they have high specificity when positive, though sensitivity is less than 25% 3, 4
Pleural fluid analysis should be performed if an effusion is present, with testing for Gram stain, culture, cell count, protein, LDH, glucose, and pH 3

The American Thoracic Society recommends that Legionella urinary antigen testing should be performed if severe pneumonia or treatment failure is suspected 2, 5
Cultures for tuberculosis and endemic fungi should be obtained in at-risk patients with an appropriate epidemiologic history 2

The American College of Chest Physicians suggests that bronchoscopy is usually not needed and patience is necessary to observe full radiographic clearing 6, 7, 8
Bronchoscopy should be considered when a patient is less than 55 years old, a nonsmoker, with multilobar disease and persistent infiltrates, or when there is no clinical response within 72 hours of appropriate therapy 7, 5

The American Thoracic Society notes that even with extensive testing, a specific etiology cannot be identified in up to half or more of all community-acquired pneumonia cases 1