Advertisement

The Pneumonias pp 156-198 | Cite as

Presentation of Pneumonia

  • Monroe Karetzky

Abstract

The sensation of shortness of breath—dyspnea, or breathlessness—characterized by tachypnea and variable degrees of hypoxemia and hypocapnea is a characteristic clinical phenomenon of pneumonia and occurs even in the absence of pleuritic pain or fever. The alveolar hyperventilation reflected by the hypocapnia has been found to persist in patients with lobar pneumonia even after arterial hypoxemia is eliminated with oxygen therapy. A process of elimination can be observed in the long-standing efforts to attribute the sensation of breathlessness to objective criteria. Classic breath-holding studies have shown dyspnea to be alleviated by a rebreathing maneuver or with inspiration of oxygen and carbon dioxide gas mixtures that resulted in no improvement in either arterial hypoxemia or the associated respiratory acidosis. Thus linkage to chemoreceptor activity has been largely unsuccessful.

Keywords

Pleural Effusion Pleural Fluid Adult Respiratory Distress Syndrome Parietal Pleura Lung Abscess 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Trenchard D, Gardner D, Guz A: Role of pulmonary vagal afferent nerve fibers in the development of rapid shallow breathing in lung inflammation. Clin Sci 1972; 42: 251–263.PubMedGoogle Scholar
  2. 2.
    Buller AJ: The muscle spindle and the control of movement. In Howell JBL, Campbell EJM (eds): Breathlessness. Philadelphia: Davis, 1966, pp. 11–17.Google Scholar
  3. 3.
    Tobin MJ: Dyspnea: pathophysiologic basis, clinical presentation, and management. Arch Intern Med 1990; 150: 1604–1613.PubMedCrossRefGoogle Scholar
  4. 4.
    Killian KJ: Assessment of dyspnea. Eur Respir J 1988; 1: 195–197.PubMedGoogle Scholar
  5. 5.
    Burki NK: Dyspnea. Lung 1987; 165: 269–277.CrossRefGoogle Scholar
  6. 6.
    Braga PC, Allegra L: Cough. New York: Raven Press, 1989, pp. 244.Google Scholar
  7. 7.
    Leith DE: Cough. In Brain JD, Proctor DF, Reid LM (eds): Lung Biology in Health and Disease. Respiratory Defense Mechanisms, Vol. 5. New York: Marcel Dekker, 1977, pp. 545–592.Google Scholar
  8. 8.
    Karlsson J-A, Sant Ambrogio G, Widdicombe J: Afferent neural pathways in cough and reflex bronchoconstriction. J Appl Physiol 1988; 65: 1007–1023.PubMedGoogle Scholar
  9. 9.
    Lindgren BR: New aspects on inflammatory reactions and cough following inhibition of angiotensin converting enzyme. Acta Physiol Scand Suppl 573 1988; 133: 1–60.CrossRefGoogle Scholar
  10. 10.
    Murphy PA: Exogenous pyrogens. In Mackowiak PA (ed): Fever: Basic Mechanisms and Management. New York: Raven Press, 1991, pp. 49–58.Google Scholar
  11. 11.
    Kluger MJ, Ringler DH, Anver MR: Fever and survival. Science 1975; 188: 166–168.PubMedCrossRefGoogle Scholar
  12. 12.
    Robert NJ: The immunological consequences of fever. In Mackowiak PA (ed): Fever: Basic Mechanisms and Management. New York: Raven Press, 1991, pp. 125–142.Google Scholar
  13. 13.
    Greisman SE: Cardiovascular alterations during fever. In Mackowiak PA (ed): Fever: Basic Mechanisms and Management. New York: Raven Press, 1991, pp. 143–165.Google Scholar
  14. 14.
    Rowell LB: Human circulation: Regulation During Physical Stress. New York: Oxford University Press, 1986, pp. 416.Google Scholar
  15. 15.
    Wood SC: Interactions between hypoxia and hypothermia. Annu Rev Physiol 1991; 53: 71–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Edwards HT, Wood WB: A study of leukocytosis in exercise. Arbeitsphysiologie 1932; 6: 73–83.Google Scholar
  17. 17.
    Douglas RG Jr, Alford RH, Cate TR, Couch RC: The leukocyte response during viral respiratory illness in man. Ann Intern Med 1966; 64: 521–530.PubMedGoogle Scholar
  18. 18.
    Morens DM: WBC count and differential: value in predicting bacterial diseases in children. Am J Dis Child 1979; 133: 25–27.PubMedGoogle Scholar
  19. 19.
    Bull B, Korpman RA: Characterization of the WBC differential count. Blood Cells 1980; 6: 411–419.PubMedGoogle Scholar
  20. 20.
    Smyllie HC, Blendis LM, Armitage P: Observer disagreement in physical signs of the respiratory system. Lancet 1965; 2: 412–413.PubMedCrossRefGoogle Scholar
  21. 21.
    Baughman RP, Loudon RG: Sound spectral analysis of voice transmitted sound. Am Rev Respir Dis 1986; 134: 167–169.PubMedGoogle Scholar
  22. 22.
    Forgacs P: Lung Sounds. London: Ballière Tindall, 1978, p. 72.Google Scholar
  23. 23.
    Ploysongsang Y, Schonfeld SA: Mechanism of production of crackles after atelectasis during low-volume breathing. Am Rev Respir Dis 1982; 126: 413–415.PubMedGoogle Scholar
  24. 24.
    Forgacs P: Crackles and wheezes. Lancet 1967; 2: 203–205.PubMedCrossRefGoogle Scholar
  25. 25.
    Mikami R, Murao M, Cugell DW, et al: International symposium on lung sounds: synopsis of proceedings. Chest 1987; 92: 342–345.PubMedCrossRefGoogle Scholar
  26. 26.
    Spiteri MA, Cook DG, Clarke SW: Reliability of eliciting physical signs in examination of the chest. Lancet 1988; 1: 873–875.PubMedCrossRefGoogle Scholar
  27. 27.
    Loudon R, Murphy RLH Jr: Lung sounds. Am Rev Respir Dis 1984; 130: 663–673.Google Scholar
  28. 28.
    Bray HA: An appraisal of the theories of pleuritic pain. Am Rev Tuberc 1954; 69: 634–635.PubMedGoogle Scholar
  29. 29.
    Cherniack NS: Chest pain. In Murray JF, Nadel JA (eds): Textbook of Respiratory Medicine. Philadelphia: Saunders, 1988, pp. 409–413.Google Scholar
  30. 30.
    Heckerling PS, Tape TG, Wigton RS, et al: Clinical prediction rule for pulmonary infiltrates. Ann Intern Med 1990; 113: 664–670.PubMedGoogle Scholar
  31. 31.
    Fairbank JT, Patel MM, Dietrich PA: Legionnaires disease. J Thorac Imaging 1991; 6: 6–13.PubMedCrossRefGoogle Scholar
  32. 32.
    Hershey CO, Panaro V: Round pneumonia in adults. Arch Intern Med 1988; 148: 1155–1157.PubMedCrossRefGoogle Scholar
  33. 33.
    Caldwell A, Glauser FL, Smith WR, et al: The effects of dehydration on the radiologic and pathologic appearance of experimental canine segmental pneumonia. Am Rev Respir Dis 1975; 112: 651–656.PubMedGoogle Scholar
  34. 34.
    Donowitz GR, Harman C, Pope T, Stewart M: The role of the chest roentgenogram in febrile neutropenic patients. Arch Intern Med 1991; 151: 701–704.PubMedCrossRefGoogle Scholar
  35. 35.
    Kramer EL, Divgi CR: Pulmonary applications of nuclear medicine. Clin Chest Med 1991; 12: 55–75.PubMedGoogle Scholar
  36. 36.
    Kessler R, Fraisse P, Krause D, et al: Magnetic resonance imaging in the diagnosis of pulmonary infarction. Chest 1991; 99: 298–300.PubMedCrossRefGoogle Scholar
  37. 37.
    McFadden RG, Carr TJ, Mackie IDF: Thoracic magnetic resonance imaging in the evaluation of HIV-1/AIDS pneumonitis. Chest 1992; 101: 371–374.PubMedCrossRefGoogle Scholar
  38. 38.
    Pistolesi M, Miniati M, Giuntini C: Pleural liquid and solute exchange. Am Rev Respir Dis 1989; 140: 825–847.PubMedGoogle Scholar
  39. 39.
    Nakamura T, Tanaka Y, Fukabori T, et al: The role of lymphatics in removing pleural liquid in discrete hydrothorax. Eur Respir J 1988; 1: 826–831.PubMedGoogle Scholar
  40. 40.
    Stewart PB: The rate of formation and lymphatic removal of pleural fluid in pleural effusions. J Clin Invest 1963; 42: 258–262.PubMedCrossRefGoogle Scholar
  41. 41.
    Wiener-Kronish JP, Matthay MA: Pleural effusions associated with hydrostatic and increased permeability pulmonary edema. Chest 1988; 93: 852–858.PubMedCrossRefGoogle Scholar
  42. 42.
    Estenne M, Yernault J-C, DeTroyer A: Mechanism of relief of dyspnea after thoracentesis in patients with large pleural effusions. Am J Med 1983; 74: 813–819.PubMedCrossRefGoogle Scholar
  43. 43.
    Zaman I, Karetzky, M: Effect of the inspired oxygen concentration on the oxygen tension of pleural fluid. Am Rev Respir Dis 1991; 143 (Suppl): A660.Google Scholar
  44. 44.
    Brandstetter R, Karetzy M, Viejo C, Zaman I: Effect of ventilation on the carbon dioxide tension of pleural fluid. Chest 1991; 100: 76S.Google Scholar
  45. 45.
    Macklin MT, Macklin CC: Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine (Baltimore) 1944; 23: 281–358.Google Scholar
  46. 46.
    Krueger JJ, Sayre VA, Karetzky M: Infectious interstitial emphysema in AIDS. N J Med 1987; 84: 489–491.PubMedGoogle Scholar
  47. 47.
    Krueger JJ, Sayre VA, Karetzky M: Bronchoalveolar lavage-induced pneumothorax. Chest 1988; 94: 440–441.PubMedCrossRefGoogle Scholar
  48. 48.
    Menkes HA, Macklem PT: Collateral flow. In Geiger SR (ed): Handbook of Physiology. Sect. 3. The Respiratory System. Vol. III: Mechanics of Breathing, Part 2. Washington, DC: American Physiological Society, 1986, pp. 337–353.Google Scholar
  49. 49.
    Macklem PT: Airway obstruction and collateral ventilation. Physiol Rev 1971; 51: 368–436.PubMedGoogle Scholar
  50. 50.
    Menkes HA, Traystman R, Terry P: Collateral ventilation. Fed Proc 1979; 38: 22–26.PubMedGoogle Scholar
  51. 51.
    Karetzky M: Asthma mortality associated with pneumothorax and intermittent positive-pressure breathing. Lancet 1975; 1: 828–829.PubMedCrossRefGoogle Scholar
  52. 52.
    Latorre FJ, Tomasa A, Klamburg J, et al: Incidence of pneumothorax and pneumomediastinum in patients with aspiration pneumonia requiring ventilatory support. Chest 1977; 72: 141–144.PubMedCrossRefGoogle Scholar
  53. 53.
    Whittemore W: The treatment of acute empyema and pulmonary abscess. N Engl J Med 1931; 205: 797–800.CrossRefGoogle Scholar
  54. 54.
    Amberson JB: A clinical consideration of abscesses and cavities of the lung. Bull Johns Hopkins Hosp 1954; 94: 227–237.PubMedGoogle Scholar
  55. 55.
    Schweppe HI, Knowles JH, Kane L: Lung abscess: an analysis of the Massachusetts General Hospital cases from 1943 through 1956. N Engl J Med 1961; 265: 1039–1043.PubMedCrossRefGoogle Scholar
  56. 56.
    Bartlett JG, Gorbach SL, Tally FP, Finegold SM: Bacteriology and treatment of primary lung abscess. Am Rev Respir Dis 1974; 109: 510–518.PubMedGoogle Scholar
  57. 57.
    Barnett TB, Herring CL: Lung abscess: initial and late results of medical therapy. Arch Intern Med 1971; 127: 217–227.PubMedCrossRefGoogle Scholar
  58. 58.
    Weiss W: Cavity behavior in acute primary non-specific lung abscess. Am Rev Respir Dis 1973; 198: 1273–1275.Google Scholar
  59. 59.
    Schachter EN: Suppurative lung disease: old problems revisited. Clin Chest Med 1981; 2: 41–49.PubMedGoogle Scholar
  60. 60.
    Hagan JL, Hardy JD: Lung abscess revisited: a survey of 184 cases. Ann Surg 1983; 197: 755–762.PubMedCrossRefGoogle Scholar
  61. 61.
    Frieden TR, Biebuyck J, Hierholzer WJ Jr: Lung abscess with group A (3-hemolytic streptococcus: case report and review. Arch Intern Med 1991; 151: 1655–1657.PubMedCrossRefGoogle Scholar
  62. 62.
    Bartlett JG, Gorbach SL, Thadepalli H, Finegold SM: Bacteriology of empyema. Lancet 1974; 1: 338–340.PubMedCrossRefGoogle Scholar
  63. 63.
    Stark DD, Federle MP, Goodman PC, et al: Differentiating lung abscess and empyema: radiography and computed tomography. AJR 1983; 141: 163–167.PubMedGoogle Scholar
  64. 64.
    Davis SD, Henschke CI, Yankelevitz DF, et al: MR imaging of pleural effusions. J Comput Assist Tomogr 1990; 142: 192–198.CrossRefGoogle Scholar
  65. 65.
    Light RW, Luchsinger PC: Metabolic activity of pleural fluid. J Appl Physiol 1973; 34: 97–101.PubMedGoogle Scholar
  66. 66.
    Karetzky M, Kothari GA, Fourre JA, Khan AU: Effect of thoracentesis on arterial oxygen tension. Respiration 1978; 36: 96–103.PubMedCrossRefGoogle Scholar
  67. 67.
    Vladutiu AO: Pleural Effusion. Mount Kisco, NY: Futura, 1986, p. 422.Google Scholar
  68. 68.
    Ogirala RG, Williams MH Jr: Streptokinase in a loculated pleural effusion: effectiveness determined by site of instillation. Chest 1988; 94: 884–886.PubMedCrossRefGoogle Scholar
  69. 69.
    Van Metre TE Jr: Pneumococcal pneumonia treated with antibiotics: the prognostic significance of certain clinical findings. N Engl J Med 1954; 251: 1048–1052.CrossRefGoogle Scholar
  70. 70.
    Jay SJ, Johanson WJ Jr, Pierce AK: The radiographic resolution of Streptococcus pneumoniae pneumonia. N Engl J Med 1975; 293: 798–801.PubMedCrossRefGoogle Scholar
  71. 71.
    Graham WGB, Bradley DA: Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia. N Engl J Med 1978; 299: 624–627.PubMedCrossRefGoogle Scholar
  72. 72.
    Lattimer GL, Rhodes LV III, Salvent JS, et al: The Philadelphia epidemic of legionnaire’s disease: clinical, pulmonary and serologic findings two years later. Ann Intern Med 1979; 90; 522–526.PubMedGoogle Scholar
  73. 73.
    Kirtland SH, Winterbauer RH: Slowly resolving, chronic and recurrent pneumonia. Clin Chest Med 1991; 12: 303–318.PubMedGoogle Scholar
  74. 74.
    Fein AM, Feinsilver S, Niederman MS: Slowly resolving pneumonia in the elderly. In Niederman MS (ed): Respiratory Infections in the Elderly. New York: Raven Press, 1991, pp. 293–324.Google Scholar
  75. 75.
    Winterbauer RH, Bedon GA, Ball WC Jr: Recurrent pneumonia: predisposing illness and clinical patterns in 158 patients. Ann Intern Med 1969; 70: 689–700.PubMedGoogle Scholar
  76. 76.
    Nakazawa H, Tsuburaya T, Watanabe H, et al: Chronic bronchopneumonia with recurrent hemoptysis and resultant severe anemia. Respiration 1991; 58: 332–334.PubMedCrossRefGoogle Scholar
  77. 77.
    Zapol WM, Frikker MJ, Pontoppidan H, et al: The adult respiratory distress syndrome at Massachusetts General Hospital: etiology, progression and survival rates 1978–1988. In Zapol WM, Lemaire F (eds): Adult Respiratory Distress Syndrome. Lung Biology in Health and Disease, Vol. 50. New York: Marcel Dekker, 1991, pp. 367–380.Google Scholar
  78. 78.
    Gattinoni L, Pesenti A, Bombino M, et al: Relationships between lung computed tomographic density, gas exchange and PEEP in acute respiratory failure. Anesthesiology 1988; 69: 824–832.PubMedCrossRefGoogle Scholar
  79. 79.
    Suchyta MR, Elliot CG, Colby T, et al: Open lung biopsy does not correlate with pulmonary function after the adult respiratory distress syndrome. Chest 1991; 99: 1232–1237.PubMedCrossRefGoogle Scholar
  80. 80.
    Caroll GC, Tuman KJ, Braverman B, et al: Minimal positive end-expiratory pressure (PEEP) may be “best PEEP.” Chest 1988; 93: 1020–1025.Google Scholar
  81. 81.
    Dreyfuss D, Soler P, Basset G, Saumon G: High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988; 137: 1159–1164.PubMedGoogle Scholar
  82. 82.
    Johanson WG Jr: Bacterial infection in adult respiratory distress syndrome. In Zapol WM, Lemaire F (eds): Adult Respiratory Distress Syndrome. Lung Biology in Health and Disease, Vol. 50. New York: Marcel Dekker, 1991, pp. 77–89.Google Scholar
  83. 83.
    Martin TR, Pistorese BP, Hudson LD, Maunder RJ: The function of lung and blood neutrophils in patients with the adult respiratory distress syndrome: implications for the pathogenesis of lung infections. Am Rev Respir Dis 1991; 144: 254–262.PubMedCrossRefGoogle Scholar
  84. 84.
    Ronco JJ, Phang PT, Walley KR, et al: Oxygen consumption is independent of changes in oxygen delivery in severe adult respiratory distress syndrome. Am Rev Respir Dis 1991; 143: 1267–1273.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1993

Authors and Affiliations

  • Monroe Karetzky

There are no affiliations available

Personalised recommendations