1. Lobar Pneumonia Xray and Generalities
Gram negative organisms
Legionella

2. Lobar Pneumonia What is it??
It is a form of pneumonia that affects a large and continuous area of the lobe of the lung
It is one of the two anatomic classifications of pneumonia (the other being bronchopneumonia).

3. Lobar Pneumonia
Symptoms: Usually has an acute progress which can be divided into 4 stages:
Congestion in the first 24 hours
Red hepatisation or consolidation
Grey Hepatisation
Resolution

4. Lobar Pneumonia Bacterial Causes:
Streptococcus pneumoniae (Most common cause)
Mycoplasma
Gram negative organisms
Legionella

5. Role of X-ray

6. Role of X-Ray
Pneumonia is suspected on the basis of a patient's symptoms and findings from physical examination
To help confirm the diagnosis usually a chest X-Ray is ordered.
Chest x-rays can reveal areas of opacity which represent consolidation.
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. (alveolar space that contains liquid instead of gas.)

7. Role of X-ray
Infiltrates can be divided in to alveoli and interstitial.
Alveloli infiltrate have Ill defined margins, a fluffy apearance, patchy densities, which coalesce
Bacterial pneumonia affects lobe & lobule producing alveolar infiltrate
Infiltrates outside the sac: can be at interstitium, septum or at the framework
In Viral pneumonia has interstitial pattern initially

8. Lung Infiltrates Acinar (usually from bacteria) Interstitial (Viral)
varying in size
indistinct edges
larger, hazy margins, cotton wool
same size
sharp edges
smaller densities

9. In pneumonia, depending upon the amount and distribution of the airspaces involved, may present as confluent parenchymal (lobar or segmental) opacity or merely patchy opacity. 
Air bronchograms would also confirm an alveolar process.

10. Lobar Pneumonia Xray
opacities inside the lung parynchema (with a free angle) is more propably lobar pneumonia.

11. Lobar Pneumonia Xray

12. Left Upper Lobe Pneumonia mainly on the lingula segment
Silhouette sign intra-thoracic radio-opacity, if in anatomic contact with a border of heart or aorta, will obscure that border. An intra-thoracic lesion not anatomically contiguous with a border or a normal structure will not obliterate that border
white, patchy opacity obliterates the left heart border (silhouette sign) indicating an anterior process. There are no other densities or deformities in the mediastinum.
upper margin of the opacity is patchy and ill-defined. As noted above, there is obliteration of the left heart border. These features suggest a lingular process as there is no fissure separating the lingula from the remainder of the left upper lobe
Silhouette Sign
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On the lateral view the oblique fissure is visible and in normal position. There is an indistinct area of patchy consolidation above the oblique fissure. The region above the fissure has an ill-defined upper margin.
Based on our CXR findings we can make the diagnosis of left upper lobe pneumonia, mainly of the lingular segment.