Ventilator-associated Pseudomonas aeruginosa pneumonia: Radiographic findings

PURPOSE: To characterize the radiographic features of ventilator- associated Pseudomonas aeruginosa pneumonia (PAP). MATERIALS AND METHODS: In 56 patients (40 men and 16 women), PAP was documented with fiberoptic bronchoscopy. All patients underwent mechanical ventilation for at least 48 hours before diagnosis. The findings on chest radiographs were recorded. In eight patients in whom computed tomography (CT) was performed, results were compared with radiographic findings. RESULTS: Twenty-six patients with adult respiratory distress syndrome (ARDS) had diffuse bilateral confluent opacities; 30 patients without ARDS had multifocal opacities. In 13 patients, cavities were detected at chest radiography, CT, or both. Seven of 29 patients with pleural abnormalities had empyema. CT provided important additional information (presence of cavities or effusions) in four cases. CONCLUSION: Findings on chest radiographs are nonspecific for PAP. The frequencies of cavities and empyema are surprisingly low, perhaps owing to prompt diagnosis and therapy.