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Q. What does the chest X-ray of a UTI patient show?

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 06, 2018

Hello doctor,

My mother was admitted to hospital nine months back with a catheter-related UTI. She was also hypothermic. Tests revealed that the UTI had become urinary sepsis. She was given IV antibiotics for this. Her legs were swollen with edema, as was her lower abdomen, but her chest was clear. She had three chest X-rays taken while she was in the hospital. I have attached these radiographs for your analysis. She developed sudden hypoxemia (SpO2 dropped to 70) and was given supplemental oxygen to saturate her blood. A stethoscope detected bilateral crepitations in her lungs. She had no cough, no tachycardia and no fever (she remained hypothermic throughout her stay in the hospital). Her leg edema remained during her time in hospital. The comments that accompanied her radiographs consisted of just a few ambiguous words. They included question marks and failed to make definitive diagnoses. This is why I am sending the radiographs to you. I need to know specifically what was happening in her lungs.

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hi,

Welcome to icliniq.com.

The chest X-ray done shows mildly increased bilateral lung markings and a mildly enlarged cardiac shadow (attachment removed to protect patient identity). There are no serious concerns about this X-ray. In the chest X-ray done a few days later, there is a generalised haziness in the left lung in addition to the prominent lung markings and the mildly enlarged cardiac shadow. Depending on the clinical signs, the possibilities can be a unilateral pneumonia or pulmonary edema. However, in literature, pulmonary edema is usually unilateral on the right side and without cardiac enlargement. In the chest X-ray done four days later, there are randomly distributed peri hilar opacities in the bilateral lungs and on seeing carefully there are air bronchograms and this is likely a picture of disseminated pneumonia. The other possibility being a diffuse pulmonary edema.


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Thank you doctor,

When you list diffuse pulmonary edema as the other possibility (after disseminated pneumonia), do you mean the cardiogenic variety of pulmonary edema? I am guessing so (due to the diffuse infiltrates, enlarged heart, and air bronchograms).

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hi,

Welcome back to icliniq.com.

A cardiogenic pulmonary edema is a possibility only if she had features of mitral regurgitation, congestive heart failure or left heart failure. I am not sure if she had any of the above. Otherwise, it would be a differential diagnosis between non-cardiogenic pulmonary edema and disseminated pneumonia.


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Thank you doctor,

She had some features of congestive heart failure (leg edema, hypoxemia, crackles breathing, hypothermia), and as you observed, enlarged heart shadow, as well as asthma, all of which made me wonder if the pulmonary edema you mentioned as a possibility might be cardiogenic. So the most likely diagnosis is disseminated pneumonia, with the other possibility diffuse pulmonary edema?

My mother had no history of aspiration, she could swallow well, and she had a functional gag reflex. There were no instances of her choking (or even coughing) while in the hospital. The radiographs details are not compatible with aspiration. Do you agree?

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hi,

Welcome back to icliniq.com.

I do not feel it can be from aspiration. To me, it looks like disseminated pneumonia which has evolved in about 10 to 12 days while in the hospital. This can, however, be linked to the urosepsis which is the most likely triggering factor in this situation. I am not aware of the bacteria isolated from urine and blood samples. Sometimes it can be the same bacteria in two organ systems and at times it can be a mixed infection. Pulmonary edema is a second possibility.


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