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[[Image:Acute pneumonia - i -- low mag.jpg|thumb|Acute pneumonia. [[H&E stain]]. (WC)]]
'''Pneumonia''' is inflammation of the lung, which includes infectious and non-infectious etiologies.   
'''Pneumonia''' is inflammation of the lung, which includes infectious and non-infectious etiologies.   


It is a subset of the [[medical lung diseases]].  This article primarily deals with the infectious pneumonias.  Idiopathic interstitial pneumonias are discussed very briefly; they are dealt with in detail in the ''[[diffuse lung diseases]]'' article.
It is a subset of the [[medical lung diseases]].  This article primarily deals with the infectious pneumonias.   
 
Idiopathic interstitial pneumonias are listed at the bottom; they are dealt with in detail in the ''[[diffuse lung diseases]]'' article.


=Infectious pnemonia=
=Infectious pnemonia=
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==Acute infectious pneumonia==
==Acute infectious pneumonia==
===General===
{{Main|Acute infectious pneumonia}}
*This is seen by pathologists, in [[autopsy]], from time-to-time.
The most common form of pneumonia. It is usually diagnosed clinically.
 
Most common cause:
*''Streptococcus pneumoniae''.<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
 
The top three community acquired (acute) pneumonia:<ref name=pmid12239229>{{Cite journal  | last1 = Nicolau | first1 = D. | title = Clinical and economic implications of antimicrobial resistance for the management of community-acquired respiratory tract infections. | journal = J Antimicrob Chemother | volume = 50 Suppl S1 | issue =  | pages = 61-70 | month = Sep | year = 2002 | doi =  | PMID = 12239229 }}</ref>
*''Streptococcuc pneumonia''.
*''Haemophilus influenzae''.
*''Moraxella catarrhalis''.
 
Other community acquired pneumonia:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
*S. aureus.
*Legionaella pneumophila.
*Klebsiella pneumoniae.
*Pseudomonas.
 
Hospital-acquired pneumonia:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
*Gram-negative rods.
*''Staphylococcus aureus''.
 
===Radiologic correlate===
*Air space disease.
 
===Gross pathology===
*Consolidation (the lung parenchyma is firm) - best appreciated by running a finger over the cut surface of the lung with a small-to-moderate amount of pressure.
 
Bronchopneumonia:
*Classically yellow-white centered on the bronchi.<ref>{{Ref AoGP|93}}</ref>
 
Lobar pneumnia is classically described in four stages:<ref>{{Ref AoGP|92}}</ref><ref>URL: [http://www.histopathology-india.net/Lobar_Pneumonia.htm http://www.histopathology-india.net/Lobar_Pneumonia.htm]. Accessed on: 27 February 2012.</ref>
#Congestion - day 1-2.
#Red hepatization - day 2-4.
#Gray hepatization - day 4-6.
#Resolution - day 6+.
 
Note:
*The stages of lobar pneumonia is considered more-or-less historical. In the age of antibiotics, lobar pneumonia is uncommon.
 
===Microscopic===
Features:
*Alveoli packed with [[PMN]]s.
*+/-Clusters of bacteria - small dots or rods.
*+/-Abscess formation.
**Lung abscess = destruction of parenchyma + [[PMN]]s.<ref name=Ref_AoGP95>{{Ref AoGP|95}}</ref>
 
DDx:
*[[Aspiration pneumonia]] - aspirated material, usually lack microorganisms.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Pneumonia_alveolus.jpg Normal alveoli & pneumonia (WC)].
 
===Stains===
*Gram stain -- to type the bacteria.


==Chronic infectious pneumonia==
==Chronic infectious pneumonia==
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*+/-[[Granuloma]]s.
*+/-[[Granuloma]]s.
==Aspiration pneumonia==
==Aspiration pneumonia==
===General===
{{Main|Aspiration pneumonia}}
*Not associated with microorganisms - though empiric antibiotics are relatively common to cover infectious pneumonias that cannot be excluded easily on clinical grounds.<ref name=pmid21263315>{{Cite journal  | last1 = Raghavendran | first1 = K. | last2 = Nemzek | first2 = J. | last3 = Napolitano | first3 = LM. | last4 = Knight | first4 = PR. | title = Aspiration-induced lung injury. | journal = Crit Care Med | volume = 39 | issue = 4 | pages = 818-26 | month = Apr | year = 2011 | doi = 10.1097/CCM.0b013e31820a856b | PMID = 21263315 }}</ref>
 
*Usually seen in the context of a toxin and/or pathology that affects the swallowing and cough reflexes.<ref name=pmid16082150>{{Cite journal  | last1 = Ohrui | first1 = T. | title = Preventive strategies for aspiration pneumonia in elderly disabled persons. | journal = Tohoku J Exp Med | volume = 207 | issue = 1 | pages = 3-12 | month = Sep | year = 2005 | doi =  | PMID = 16082150 }}</ref>
 
Common associations:<ref name=pmid16082150/>
*[[Stroke]].
*[[Multiple sclerosis]].
*[[Alcohol]] intoxication.
 
Other risk factors:<ref name=pmid21263315/>
*Traumatic brain injury.
*Seizure disorder.
*Bowel obstruction.
*Drugs.
*[[Obesity]].
*Labour.
 
Note:
*A special type of aspiration pneumonia is ''lipoid pneumonia''. It is dealt with in the ''[[lipoid pneumonia]]'' article.
 
===Gross===
*More common in the right lung.
**Right main stem bronchus is more vertical.
 
===Microscopic===
Features:
*Neutrophils.
*Foreign material, e.g. plant matter.
*+/-Foreign body giant cells.
*+/-Microorganisms.
 
DDx:
*[[Acute infectious pneumonia]].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Aspiration_pneumonia_%281%29.jpg Aspiration pneumonia - 1 - (WC)].
*[http://commons.wikimedia.org/wiki/File:Aspiration_pneumonia_%282%29.jpg Aspiration pneumonia - 2 - (WC)].
*[http://commons.wikimedia.org/wiki/File:Aspiration_pneumonia_%283%29.jpg Aspiration pneumonia - 3 - (WC)].


==Cytomegalovirus pneumonia==
==Cytomegalovirus pneumonia==
Michael
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