Sunday, November 23, 2014

Pneumonia - Diagnosis

Bronchoscopy. Bronchoscopy is an invasive test to examine respiratory secretions. It is not usually needed in patients with community-acquired pneumonia, but it may be appropriate for patients with a severely compromised immune system who need immediate diagnosis, or in patients whose condition has worsened during treatment.

A bronchoscopy is done in the following way:

  • The patient is given a local anesthetic, oxygen, and sedatives.
  • The physician inserts a fiber optic tube into the lower respiratory tract through the nose or mouth.
  • The tube acts like a telescope into the body, allowing the physician to view the windpipe and major airways and look for pus, abnormal mucus, or other problems.
  • The doctor removes specimens for analysis and can also treat the patient by removing any foreign bodies or infected tissue encountered during the process.
Click the icon to see an image of bronchoscopy.

Bronchoalveolar lavage (BAL) may be done at the same time as bronchoscopy. This involves injecting high amounts of saline through the bronchoscope into the lung and then immediately sucking the fluid out. The fluid is then analyzed in the laboratory. Studies find BAL to be an effective method for detecting specific infection-causing organisms.

The procedure is usually very safe, but complications can occur. They include:

  • Allergic reactions to the sedatives or anesthetics
  • Asthma attacks in susceptible patients
  • Bleeding
  • Fever

Lung Biopsy. In very severe cases of pneumonia or when the diagnosis is unclear, particularly in patients with a damaged immune system, a lung biopsy may be required. A lung biopsy involves taking some tissue from the lungs and examining it under a microscope.

Lung Tap. This procedure typically uses a needle inserted between the ribs to draw fluid out of the lung for analysis. It is known by a number of names, including:

  • Lung aspiration
  • Lung puncture
  • Thoracic puncture
  • Transthoracic needle aspiration
  • Percutaneous needle aspiration
  • Needle aspiration

It is a very old procedure that is not done often anymore, because it is invasive and poses a slight risk for collapsed lung. Some experts argue, however, that a lung tap is more accurate than other methods for identifying bacteria, and the risk it poses is slight. Given the increase in resistant bacteria, they believe its use should be reconsidered in young people.

An infectious disease specialist may need to be consulted in severe or difficult cases.

Ruling Out Other Disorders that Cause Coughing or Affect the Lung

Common Causes of Persistent Coughing. Persistent coughing is nearly always temporary and harmless when other symptoms, such as fever, are not present. The four most common causes of persistent coughing are:


Review Date: 04/13/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)