Blood gases, acid-base, and metabolic alterations in calves with bronchopneumonia diagnosed via clinical signs and thoracic ultrasonography: A cross-sectional study.

BACKGROUND: Bronchopneumonia (BP) in calves potentially causes systemic changes. OBJECTIVES: To describe metabolic, arterial blood gas, and acid-base disorders in calves with BP diagnosed by thoracic ultrasound (TUS), Wisconsin score (WISC), and combinations of WISC and TUS. ANIMALS: Two hundred thirty-one dairy preweaned dairy calves from 13 dairy farms. METHODS: Cross-sectional study. Each calf sequentially underwent arterial blood gas evaluation, WISC score, venous sampling, and TUS. Calves were grouped based on a single diagnostic method and combination of WISC and 2 TUS cutoffs (≥1 cm; ≥3 cm) as healthy, upper respiratory tract infection, subclinical BP, and clinical BP. RESULTS: Oxygenation and acid-base variables were unaffected. Glucose concentration in TUS-affected calves was significantly lower (P < .001) than in healthy calves (median ≥TUS1cm = 5.2 mmol/L 25%-75% interquartile range [IQR] 4.5-6.1,

Comparison of thoracic ultrasonography and thoracic radiography to detect active infectious bronchopneumonia in hospitalized dairy calves.

BACKGROUND: The best test between thoracic ultrasonography (TUS) and thoracic radiography (TR) or the best combination of tests (series or parallel) to detect active infectious bronchopneumonia (BP) in hospitalized dairy calves remains unknown. HYPOTHESIS/OBJECTIVES: To estimate performances of TUS and TR to detect active BP in hospitalized dairy calves and to determine the best strategy for using these tests based on a panel diagnosis method (PDM). Performances of TUS and TR were hypothesized to be equivalent. ANIMALS: Fifty hospitalized dairy calves (≥7 days old; ≤100 kg; standing; pCO2 ≥ 53 mm Hg; any reason of presentation). METHODS: Each calf prospectively and sequentially underwent physical examination, thoracic auscultation, blood analyses, and TUS and TR. Three blinded experts determined whether active BP was present/absent based on PDM. Krippendorff's alpha measured interexpert agreement. The sensitivities (Se) and specificities (Sp) of TUS and TR alone and in series or parallel were compared (McNemar's test; P < .05). RESULTS: Interexpert agreement was moderate at 0.58 (95%CI: 0.42; 0.73). The Se and Sp of TUS were 0.84 (95%CI: 0.60; 0.97) and 0.74 (95%CI: 0.57; 0.86), respectively. The Se and Sp of TR were 0.89 (95%CI: 0.67; 0.99) and 0.58 (95%CI: 0.39; 0.75), respectively. No significant difference was found in the Se and Sp of TUS and TR when analyzed alone, in series or in parallel. CONCLUSION: Thoracic ultrasonography or TR alone equally detected active BP in hospitalized dairy calves. Series or parallel analysis provided no additional benefit. Its ease of use and widespread accessibility support using TUS as a first-line test to detect active BP in hospitalized dairy calves.

Clinicopathologic and radiographic features in 33 cats with aspiration and 26 cats with bronchopneumonia (2007-2017).

BACKGROUND: Aspiration pneumonia (AP) and bronchopneumonia (BP) are poorly characterized diseases in cats that share clinical similarities to inflammatory airway disease (IAD). OBJECTIVES: Describe clinicopathologic, radiographic, and microbiologic features in cats with AP and BP and compare findings to those in cats with IAD. ANIMALS: Thirty-three cats with AP and 26 with BP; 44 cats with IAD. METHODS: Retrospective case-control study. Results extracted for all cats included signalment, physical examination findings, historical details, and potential risk factors for aspiration. Diagnostic test results were summarized including CBC, bronchoalveolar (BAL) fluid analysis and microbial culture. Radiographs were reviewed in masked fashion and scored for severity. Results of BAL fluid analysis were assessed for evidence of septic inflammation. RESULTS: Cats with AP were less likely to be presented for evaluation of cough (P < .001) and more likely to be hypothermic (P = .01) than were cats with IAD or BP. Median duration of signs was significantly shorter in cats with AP (12 days) compared to cats with BP or IAD (270 and 180 days; P = .01). Radiographically, cats with AP were more likely to have an alveolar pattern and higher total score than were cats with BP or IAD. Mycoplasma spp. were the organisms most commonly cultured from BAL fluid in cats with BP, but were not cultured from any cats with AP. CONCLUSION AND CLINICAL IMPORTANCE: Pneumonia must be distinguished from IAD in cats with cough and AP should be considered in cats with acute onset of tachypnea.

[Ultrasonography of the lung in calves]. / Überblick über die Ultraschallunter­suchung der Lunge beim Kalb.

INTRODUCTION: This paper reviews the technique used for thoracic -ultrasonography of the bovine lower respiratory tract and the ultrasonographic findings in calves with -bronchopneumonia. Studies that compare the results of auscultation with those of ultrasonography and postmortem examination are included as are studies that examine the relationship between ultrasonographic findings and bacterial lung infection and prognosis. Lesions associated with bronchopneumonia, pleuropneumonia, pneumothorax and lung abscesses are -easily imaged ultrasonographically and characterised in calves.

INTRODUCTION: Cet article passe en revue la technique utilisée pour l'échographie des voies respiratoires inférieures des bovins et les résultats de l'échographie chez les veaux atteints de bronchopneumonie. Les études qui comparent les résultats de l'auscultation à ceux de l'échographie et de l'examen post mortem sont incluses, tout comme les études qui étudient la relation entre les résultats de l'échographie et l'infection pulmonaire bactérienne ainsi que le pronostic. Les lésions associées à la bronchopneumonie, à la pleuropneumonie, au pneumothorax et aux abcès pulmonaires sont facilement imagées par échographie et caractérisées chez les veaux.

Lost in the Clinics and Found in the Morgue: A Case of Peripheral T-cell Lymphoma Masquerading as Pneumonia.

In modern medicine, there is an increasing dependence on noninvasive imaging modalities, for diagnosis and management of diseases. Though there are definite advantages to this, they are at times offset by diagnostic pitfalls especially in entities with elusive clinical presentation.Peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) is an aggressive subtype of T-cell lymphomas that does not meet criteria for a specific subtype. Peripheral T-cell lymphoma usually has varied clinical presentations depending on the site of involvement. Vast majority of PTCL patients present with systemic disease, generalized lymphadenopathy and constitutional symptoms. Pulmonary involvement is relatively rare and is seen in approximately 10% of patients.Here in we highlight a rare case of PTCL, masquerading as pneumonia due to extensive pulmonary involvement that went undiagnosed and was discovered at autopsy. This case of malignant lymphoma of T-cell origin involving the lung, which is very rare, highlights the continued importance of medical autopsies not only as a teaching tool but also as an important adjunct to investigative medicine in uncovering lapses that can subsequently be avoided to improve patient care and decrease mortality.

Bronconeumonía bilateral simulando descompensación cardíaca fácilmente detectada con ecografía multiventana / Bilateral bronchopneumonia simulating cardiac decompensation easily detected with multi-window ultrasound

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Association of lung lesions measured by thoracic ultrasonography at first diagnosis of bronchopneumonia with relapse rate and growth performance in feedlot cattle.

BACKGROUND: Severity of lung lesions quantified by thoracic ultrasonography (TUS) at time of bronchopneumonia (BP) diagnosis predicted death among steers not treated for this condition. Further research is needed to confirm that lung lesions detected by TUS can be associated with negative outcomes in cattle with BP that subsequently were treated. OBJECTIVE: To quantify the effects on relapse rate and average daily gain (ADG) of lung lesions detected by TUS at first BP diagnosis in feedlot cattle. ANIMALS: Prospective cohort of mixed beef-breed steers (n = 93; 243 ± 36 kg) and heifers (n = 51; 227 ± 42 kg) with BP at 4 feedlots. METHODS: Thoracic ultrasonography was performed by the same clinician and 16-second TUS videos were evaluated offline for maximal depth and area of lung consolidation, maximum number of comet tails, and maximal depth of pleural fluid. Individual ADG was calculated between 1 and 120 days after arrival. Effects of lesions on relapse rate and ADG were investigated using mixed regression models. RESULTS: Maximal depth of lung consolidation was associated with a higher risk of relapse (odds ratio [OR], 1.337/cm; 95% confidence interval [CI], 1.042-1.714) and lower ADG (- 34 g/cm; -64 to -4). Maximal area of lung consolidation also was associated with a higher relapse risk (OR, 1.052/cm2 ; 1.009-1.097) but not with ADG. Comet tails and pleural fluid were not associated with risk of relapse or ADG. CONCLUSIONS AND CLINICAL IMPORTANCE: Quantifying maximal depth and area of lung consolidation by TUS at first BP diagnosis can provide useful prognostic information in feedlot cattle.

[The frequency of abnormal ultrasonographic findings in the lungs of 129 calves with bronchopneumonia]. / Häufigkeit abnormer Ultraschallbefunde an der Lunge von 129 Kälbern mit Bronchopneumonie.

INTRODUCTION: The goal of this study was to analyse the frequency of ultrasonographic findings in 129 calves with bronchopneumonia and to determine how often multiple abnormalities occur in individual calves. The frequency of abnormal ultrasonographic findings ranged from 4 to 88%. Comet-tail artifacts were the most common finding (88%) followed in decreasing order by scattered echogenic foci (69%), air bronchograms (44%), superficial alveolograms (29%), pleural effusion (26%), hepatisation (23%), pleural lesions (18%), fluid bronchograms (14%), lung abscesses (6%) and fibrin deposits or fibrin strands (4%). Thoracic ultrasonography yielded a mean of 3.3 ± 1.55 abnormal findings (range, 1-6) per calf. Ultrasonography of the lungs in calves with bronchopneumonia is a useful adjunct to clinical examination and allows the determination of the type and severity of lesions.

INTRODUCTION: Dans la présente étude, la fréquence des constatations échographiques anormales recueillies sur 129 veaux souffrant de bronchopneumonie a été évaluée de manière rétrospective. Il a également été étudié combien de fois un veau présentait simultanément plusieurs découvertes. La fréquence des échographies anormales variait entre 4 et 88%. Des artefacts en queue de comète représentaient, avec 88%, les découvertes anormales les plus courantes. Ils étaient, par ordre décroissant, suivi par des réflexions de l'air (69%), des bronchogrammes aériens (44%), des alvéologrammes superficiels (29%), un épanchement pleural (26%), une hépatisation (23%), des altérations pleurales (18%), des bronchogrammes liquidiens (14%), des abcès pulmonaires (6%) et de la fibrine ou des ponts de fibrine (4%). En moyenne 3,3 ± 1,55 résultats d'échographie anormaux ont été déterminés par veau. L'examen échographique des poumons est, chez les veaux souffrant d'une bronchopneumonie, un complément précieux à l'examen clinique. Il permet de représenter la nature et la gravité des changements de bronchopneumonie et de les objectiver.

Inter-rater agreement and reliability of thoracic ultrasonographic findings in feedlot calves, with or without naturally occurring bronchopneumonia.

BACKGROUND: Thoracic ultrasonography (TUS) can be used to assess the extent and severity of lung lesions associated with bronchopneumonia (BP) in feedlot cattle. HYPOTHESIS/OBJECTIVES: To assess inter-rater agreement and reliability of TUS findings in feedlot cattle, with or without naturally occurring BP. ANIMALS: Feedlot steers with (n = 210) or without (n = 107) clinical signs of BP that were assessed by TUS in a previous case-control study. METHODS: A random sample of 50 TUS videos (16-s duration) were scored by 6 raters with various levels of TUS expertise. Lung consolidation, comet tail artifacts, pleural irregularity and effusion were scored. Inter-rater agreement was assessed using raw percentage of agreement (Pa), Cohen's and Fleiss' Kappa (κ), and Gwet agreement coefficient (AC1). Intra-class correlation (ICC) was determined for variables with continuous measurements (mixed factorial design). RESULTS: Median (interquartile range [IQR]) Pa were 0.84 (0.80-0.89), 0.82 (0.80-0.87), 0.62 (0.53-0.67), and 0.82 (0.75-0.86) for presence of lung consolidation, comet tails, pleural irregularity, and pleural effusion, respectively. For the same lesions, Fleiss κ (95% confidence intervals [CI]) were 0.67 (0.49-0.86), 0.56 (0.33-0.80), 0.20 (-0.05 to 0.44), and 0.36 (0.10-0.61), respectively. AC1 were 0.68 (0.51-0.86), 0.73 (0.58-0.89), 0.21 (-0.01 to 0.44), and 0.71 (0.51-0.92), respectively. Moderate reliability was found among raters for all quantitative variables (ICC ranged from 0.52 to 0.70). CONCLUSIONS AND CLINICAL IMPORTANCE: Inter-rater agreement was good for presence of lung consolidation, comet tails and pleural effusion (based on Pa and AC1) but was slight to poor for pleural irregularity.

A rare complication of chronic granulomatous disease in a child: constrictive aspergillus pericarditis.

A 3-year-old girl with the diagnosis of chronic granulomatous disease (CGD) was hospitalized for bronchopneumonia and congestive heart failure. Her medical history included methylprednisolone medication for autoimmune gastric outlet obstruction. Computed tomography revealed pneumonic infiltrations and pericardial thickening. A pulsed-wave Doppler recording revealed E/A >1. During a pericardiectomy, multiple islands of thick, firm-walled, fibrinous exudate-containing, small abscess formations were observed. Histopathological evaluation of pericardial tissue revealed granulomatous inflammation. Aspergillus fumigatus was cultured from the abscess. In conclusion, development of constrictive aspergillus pericarditis should be considered in patients with CGD because immediate initiation of antifungal management with aggressive surgical treatment is life-saving.

Single-energy computed tomography-based pulmonary perfusion imaging: Proof-of-principle in a canine model.

PURPOSE: Radiotherapy (RT) that selectively avoids irradiating highly functional lung regions may reduce pulmonary toxicity, which is substantial in lung cancer RT. Single-energy computed tomography (CT) pulmonary perfusion imaging has several advantages (e.g., higher resolution) over other modalities and has great potential for widespread clinical implementation, particularly in RT. The purpose of this study was to establish proof-of-principle for single-energy CT perfusion imaging. METHODS: Single-energy CT perfusion imaging is based on the following: (1) acquisition of end-inspiratory breath-hold CT scans before and after intravenous injection of iodinated contrast agents, (2) deformable image registration (DIR) for spatial mapping of those two CT image data sets, and (3) subtraction of the precontrast image data set from the postcontrast image data set, yielding a map of regional Hounsfield unit (HU) enhancement, a surrogate for regional perfusion. In a protocol approved by the institutional animal care and use committee, the authors acquired CT scans in the prone position for a total of 14 anesthetized canines (seven canines with normal lungs and seven canines with diseased lungs). The elastix algorithm was used for DIR. The accuracy of DIR was evaluated based on the target registration error (TRE) of 50 anatomic pulmonary landmarks per subject for 10 randomly selected subjects as well as on singularities (i.e., regions where the displacement vector field is not bijective). Prior to perfusion computation, HUs of the precontrast end-inspiratory image were corrected for variation in the lung inflation level between the precontrast and postcontrast end-inspiratory CT scans, using a model built from two additional precontrast CT scans at end-expiration and midinspiration. The authors also assessed spatial heterogeneity and gravitationally directed gradients of regional perfusion for normal lung subjects and diseased lung subjects using a two-sample two-tailed t-test. RESULTS: The mean TRE (and standard deviation) was 0.6 ± 0.7 mm (smaller than the voxel dimension) for DIR between pre contrast and postcontrast end-inspiratory CT image data sets. No singularities were observed in the displacement vector fields. The mean HU enhancement (and standard deviation) was 37.3 ± 10.5 HU for normal lung subjects and 30.7 ± 13.5 HU for diseased lung subjects. Spatial heterogeneity of regional perfusion was found to be higher for diseased lung subjects than for normal lung subjects, i.e., a mean coefficient of variation of 2.06 vs 1.59 (p = 0.07). The average gravitationally directed gradient was strong and significant (R(2) = 0.99, p < 0.01) for normal lung dogs, whereas it was moderate and nonsignificant (R(2) = 0.61, p = 0.12) for diseased lung dogs. CONCLUSIONS: This canine study demonstrated the accuracy of DIR with subvoxel TREs on average, higher spatial heterogeneity of regional perfusion for diseased lung subjects than for normal lung subjects, and a strong gravitationally directed gradient for normal lung subjects, providing proof-of-principle for single-energy CT pulmonary perfusion imaging. Further studies such as comparison with other perfusion imaging modalities will be necessary to validate the physiological significance.

Endobronchial actinomycosis associated with nonorganic foreign body aspiration after years of latency.

A 35-year-old diabetic man was referred for nonresolving chronic cough of 3 months duration. Computed tomography scan revealed linear opacities in right upper lobe. A flexible bronchoscopy demonstrated a mass in the right upper lobe bronchus. An endobronchial biopsy of the lesion revealed granulation tissue and an actinomycotic infection. The patient did not respond to treatment for actinomycosis. He was subjected to thoracoscopic surgery and a small nonorganic foreign body covered in thick coat of actinomycosis was removed. The patient then responded to penicillin treatment. We report a case of nonorganic foreign body-induced endobronchial actinomycosis secondary to pen end cap aspirated during childhood.

Chest computed tomography for the diagnosis of Mycoplasma pneumoniae infection.

We analysed 53 cases of laboratory-confirmed Mycoplasma pneumoniae infection with cough lasting ≥ 7 days and chest radiography showing no abnormal findings. Twenty-two (41%) of those patients showed abnormal findings on chest high-resolution computed tomography. In the daily clinical setting, for assessment of acute cough, physicians should be aware that it is difficult to confirm bronchiolitis or bronchopneumonia due to M. pneumoniae by chest radiography.

Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011.

BACKGROUND: Coxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9. METHODS: We analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree. RESULTS: Of the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of fever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome (n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar. CONCLUSIONS: The most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.

Chest X-ray findings in HIV- infected Highly Active Antiretroviral Treatment (HAART)-naïve patients.

INTRODUCTION: Patients with human immunodeficiency virus (HIV) infection frequently present with a wide spectrum of pulmonary and cardiac complications from the virus, opportunistic infections and neoplasms that may be associated with a high mortality rate. Diseases of the respiratory tract account for about half of deaths from AIDS, while cardiac diseases account for more than a quarter of deaths from AIDS. This study aimed at determining the prevalence of pulmonary and cardiac diseases using a chest radiograph in HAART-naïve HIV-infected patients. METHODS: This study was conducted at Lagos State University Teaching Hospital (LASUTH) HIV clinic between September 2010 and August 2011 amongst all registered HAART-naïve HIV/AIDS patients. Patients had posterior-anterior chest radiographs done in full inspiration. Participants were asked and aided to fill the structured questionnaires to obtain demographic data. RESULTS: Out of a total of one hundred and two recruited for the study, 54 ( 52.94%) had a normal chest radiograph, while 48 (47.06%) had abnormal chest radiograph .The abnormal findings included, 27.45% who had bronchopneumonia, 6.86% cardiomegaly, 5.88% pulmonary tuberculosis, 5.88% radiological features of congestive cardiac failure, and 0.98% bronchitis. CONCLUSION: It appears that more than half of HAART-naïve HIV-infected patients have normal chest radiographs. Bronchopneumonia (27.5%) is the commonest pulmonary abnormality associated with HIV infection, while the prevalence of pulmonary tuberculosis is 5.88%.

Age-related thoracic radiographic changes in golden and labrador retriever muscular dystrophy.

Golden retriever and Labrador retriever muscular dystrophy are inherited progressive degenerative myopathies that are used as models of Duchenne muscular dystrophy in man. Thoracic lesions were reported to be the most consistent radiographic finding in golden retriever dogs in a study where radiographs were performed at a single-time point. Muscular dystrophy worsens clinically over time and longitudinal studies in dogs are lacking. Thus our goal was to describe the thoracic abnormalities of golden retriever and Labrador retriever dogs, to determine the timing of first expression and their evolution with time. To this purpose, we retrospectively reviewed 390 monthly radiographic studies of 38 golden retrievers and six Labrador retrievers with muscular dystrophy. The same thoracic lesions were found in both golden and Labrador retrievers. They included, in decreasing frequency, flattened and/or scalloped diaphragmatic shape (43/44), pulmonary hyperinflation (34/44), hiatal hernia (34/44), cranial pectus excavatum (23/44), bronchopneumonia (22/44), and megaesophagus (14/44). The last three lesions were not reported in a previous radiographic study in golden retriever dogs. In all but two dogs the thoracic changes were detected between 4 and 10 months and were persistent or worsened over time. Clinically, muscular dystrophy should be included in the differential diagnosis of dogs with a combination of these thoracic radiographic findings.

Computed tomography findings of influenza A (H1N1) pneumonia in adults: pattern analysis and prognostic comparisons.

AIM: The aim of this study was to evaluate retrospectively the chest computed tomography findings of influenza A (H1N1) pneumonia and their relationship with clinical outcome. METHODS: Chest computed tomography findings and clinical outcomes of 76 patients with influenza A (H1N1) pneumonia were assessed. Computed tomography findings were evaluated for the presence and distribution of parenchymal abnormalities, which were then classified into 3 patterns: bronchopneumonia, cryptogenic organizing pneumonia (COP), and acute interstitial pneumonia (AIP) patterns. Clinical courses were divided into 2 groups on the basis of necessitating admission to intensive care unit or mechanical ventilation therapy (group 1) or not (group 2). RESULTS: Lung abnormalities consisted of ground-glass opacity (93%, 71 patients), consolidation (66%, 50 patients), small nodules (61%, 46 patients), and tree-in-bud sign (22%, 17 patients). Lesions were classified into bronchopneumonia (49%, 37 patients), COP (30%, 23 patients), AIP (18%, 14 patients), and unclassifiable (3%, 2 patients) patterns. Patients with AIP pattern had a tendency to belonging to group 1, accounting for 40% (8 of 20 patients) of group 1 course and only 11% (6 of 56 patients) of group 2 course (P = 0.004). CONCLUSIONS: Computed tomography findings of influenza A (H1N1) pneumonia in adults can be classified into COP, AIP, and bronchopneumonia patterns. Patients presenting with AIP pattern have a tendency to show poor prognosis.

Imaging pneumonia in immunocompetent and immunocompromised individuals.

PURPOSE OF REVIEW: The article aims to indicate the current role of radiological imaging in immune competent and immunocompromised patients with pneumonia. The radiological findings in the most common conditions will be reviewed. RECENT FINDINGS: Three basic patterns of radiographic abnormality are recognized: lobar (nonsegmental) pneumonia; bronchopneumonia (lobular pneumonia); and interstitial pneumonia. The chest radiograph remains the initial radiological investigation. Computed tomography (CT) is more sensitive than the chest radiograph. The appearances on CT with certain infections such as mycoplasma, invasive aspergillosis, and pneumocystis, in the appropriate clinical setting, may allow a treatment decision to be made when obtaining fluid or tissue for culture is problematical. MRI technology is advancing and this technique may provide an option for follow-up of chronic disease in younger patients in whom radiation exposure is a concern, but MRI does not yet match CT as a diagnostic test in this field. SUMMARY: Radiology retains a key role in diagnosing pneumonia, excluding pneumonia, following up patients to check for resolution and to evaluate potential complications. The chest radiograph remains the initial examination. CT is more sensitive and with certain infections more specific. MRI provides an option for monitoring progress, although cannot yet match CT as an initial diagnostic test.