Pneumonia on X-ray: what the image looks like and what the doctor sees

Pneumonia is inflammation of lung tissue, usually infectious, with involvement of the alveoli. A chest X-ray is one of the main methods for diagnosing it. We explain what the doctor sees on the image and why one image alone is not enough.

Why an X-ray is done for pneumonia

Pneumonia is an infection of one or both lungs.

The main diagnostic methods are X-ray examination of the lungs and sputum testing. X-ray is part of the set of examinations when pneumonia is suspected: it is done to confirm changes in lung tissue and rule out other diseases. A delay in diagnosis worsens the prognosis.

More than 17 million people are diagnosed with pneumonia each year. Children under 5 years of age and people over 65 years of age are at increased risk.

What can be seen on an X-ray in pneumonia

In pneumonia, the alveoli fill with fluid or pus. Inflammatory exudation in the alveoli creates an area of consolidation, which is described on the image as an opacity.

Bronchopneumonia and viral pneumonia on an X-ray

“Bronchopneumonia” is another name for pneumonia that appears in medical texts and diagnoses.

Inflammation begins in the respiratory bronchioles: acute bronchitis or bronchiolitis develops. The process then spreads to lung tissue. Due to impaired bronchial patency, foci of atelectasis occur.

Viral pneumonia is caused by influenza, respiratory syncytial virus, and SARS-CoV-2. It often runs a mild course and resolves on its own within a few weeks, but sometimes it is serious and requires treatment in a hospital. With viral pneumonia, there remains a risk of secondary bacterial infection.

Lung CT: when additional methods are needed

If a person is in the hospital, has severe symptoms, is elderly, or has comorbidities, additional tests may be prescribed, including computed tomography.

CT shows how extensive the lung involvement is. It can reveal complications: lung abscess, pleural effusion — accumulation of fluid in the pleural cavity.

Additional methods are not needed for everyone. The doctor determines the scope of examination based on the severity of the condition.

What else is included in the diagnosis of pneumonia

Pneumonia resembles a cold and influenza, so the diagnosis is sometimes not made immediately. The doctor takes a history of symptoms, examines the patient, and listens to the lungs with a stethoscope. Then examinations are prescribed.

• chest X-ray;
• complete blood count — shows whether the immune system is actively fighting the infection;
• blood culture — looks for bacteria that have entered the bloodstream;
• sputum testing — checks for bacteria in the sputum;
• pulse oximetry — measures the oxygen level in the blood.

In severe cases and in the hospital, bronchoscopy and pleural fluid testing may be possible. Medical attention is sought if a cough persists for up to 3 weeks, yellow or green sputum is produced, chest pain occurs when breathing or coughing, or shortness of breath appears.

A diagnosis of pneumonia alone is not a reason to call an ambulance. 103 or 112 — if the person is gasping for air and cannot speak, the skin, lips, or tongue are pale, blue, or mottled, blood is coughed up, sudden confusion appears, or a child cannot be woken or is lethargic.

This material is for reference. It does not replace consultation with a doctor: the image is read and the diagnosis is made by a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer