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.
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.
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).
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.
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?
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.
Query: Hi doctor, I have attached an x-ray report of my 1 year old baby girl. The report was ill-defined haziness seen in the right perhilar and para-cardiac regions - pneumonitis. What does it mean? She has cough since last five days. My mom is suffering from active tuberculosis. So, x-ray was suggested a... Read Full >>
Answer: Hello, Welcome to icliniq.com. I understand your concern. See as you said, your mother is suffering from active TB (tuberculosis), TB in the child should also be ruled out first. It may be just pneumonia, but TB should be ruled out with some more investigations mentioned below. Is the child gaining ... Read Full
Query: Hello doctor, I have a question. Well, I had an STD. It was chlamydia, but it was cured. It was months ago. I recently had sexual relationships like two months ago, after that, I started getting a yellow discharge and I went to the doctor. They told me I had UTI. They gave me pills that I am taking... Read Full >>
Answer: Hello, Welcome to icliniq.com. The pill is not the cause of bleeding. You said your cycles are not regular. So, what happens is because the cycle duration is long, there are chances of heavy bleeding. Unless you have confirmed that pregnancy was not there (abortion can cause too much bleeding), ... Read Full
Ask your health query to a doctor online?Ask a Radiologist Now