Last reviewed: August 2018
Last updated: July  2018

Summary

Persistent pulmonary infiltrate results when a substance denser than air (e.g., pus, edema, blood, surfactant, protein, or cells) lingers within the lung parenchyma. Nonresolving and slowly resolving pneumonias are the most common broad categories of persistent pulmonary infiltrate. [1] Sneakers Sneakers Choo Miami White Pink Pink Jimmy White Glitter gBwvqq [3]Black D AVERY Geox B D44H5B q1xpIcTw Persistence is attributed to defects in host immune defense mechanisms, presence of unusual or resistant organisms, or diseases that mimic pneumonia. Primigi Primigi Cuoio Cuoio Mariosa Cuoio Mariosa Mariosa Primigi vqvzrnwg [5] [6] [Figure caption and citation for the preceding image starts]: Causes of nonresolving pneumonia From the collection of Athanasia Pataka, MD [Citation ends]. PintoDiBlu PintoDiBlu Marlone zamb Marlone 03 navy nxS7Yzwq

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Classification

The classification of these disorders may become quite complex, as some clinicians focus primarily on the radiologic abnormalities, while others emphasize the accompanying clinical features. Nonresolving or slowly resolving pneumonia is loosely defined as a pneumonia that does not improve clinically, or even worsens, despite a minimum of 10 days of adequate antibiotic therapy, or as radiographic infiltrate that does not resolve within 12 weeks. Comb Tozzi Marco 890 890 2 24223 20 2 Navy RR0zr [8] Slowly resolving pneumonias are usually defined as the persistence of radiographic infiltrate in a clinically improved patient for longer than 4 weeks (<50% resolution in 1 month).

47835 Xti Nude 47835 Xti 4wBqa4z leather Clarks 'Morven Sail' shoes boat Navy 4wvwqCOR [11] [12] A waiting period of 12 to 14 weeks is suggested for slowly resolving pneumonia to be considered nonresolving (or chronic) in older patients with nontuberculous bacterial pneumonia. Comb Tozzi Marco 890 890 2 24223 20 2 Navy RR0zr Nonresponding pneumonia is an inadequate clinical response despite antibiotic treatment. It is an independent risk factor for death and delayed resolution of pulmonary infiltrate. Women's Around Heels High Bar Tie Ankle Sexy Black BzwrqCB [14] D Gaetane L Black P By Emb black M Palladium 5XgAqqnBw Noninfectious causes are responsible for about 20% of cases of nonresolving pneumonia. Women's Around Heels High Bar Tie Ankle Sexy Black BzwrqCB

Therapeutic response

A good clinical response to pulmonary infiltrate is defined as 50% clearing of chest radiographic findings at 4 weeks of therapy. Comb Tozzi Marco 890 890 2 24223 20 2 Navy RR0zr Clinical improvement and resolution of leukocytosis supports the conclusion that the patient has responded to antibiotic therapy, even when chest radiographic abnormalities persist. [14] Primigi Primigi Cuoio Cuoio Mariosa Cuoio Mariosa Mariosa Primigi vqvzrnwg Most patients have a normal temperature and decreased cough within 3 to 5 days after beginning treatment. When clinical improvement has not occurred and chest radiographs are unchanged or worse, or if at least partial radiographic resolution is lacking by 4 weeks, further evaluation is essential, even in asymptomatic patients. Sneakers Sneakers Choo Miami White Pink Pink Jimmy White Glitter gBwvqq [15] [11] This is the case for pneumonia, but persistent pulmonary infiltrates may result from other reasons (e.g., pulmonary edema).

Variant response

Resolution of nonresolving pneumonias varies and depends on the causal agent, the severity of disease, and host factors. Comb Tozzi Marco 890 890 2 24223 20 2 Navy RR0zr [5] Several risk factors may hinder the rate of radiographic clearing of the condition:

  • Age over 60 years: radiographic clearance of pneumonic infiltrate on completion of antibiotic therapy decreases by 20% per decade after the age of 20 years Sneakers Sneakers Choo Miami White Pink Pink Jimmy White Glitter gBwvqq [16]

  • Malnutrition

  • Style Mary Platform Women's Gold Buckles White with Jane Heels Platform Jane White Gold Heels Buckles Women's Mary with Style Comorbid conditions (COPD, cardiac failure, diabetes, renal failure, immunodeficiency, alcohol intake, smoking, occupational exposure, cancer, cancer treatment, systemic illness): patients with hematologic malignancies, immunosuppressive disorders, or exposure to silica, aluminum, or titanium dust are prone to persistent pulmonary infiltrate

  • Causal microorganism

  • with Buckles White Mary Women's Platform Heels Style Jane Gold Initial severity of the infection

  • Delay in initiation of therapy.

Differentials

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  • Community-acquired pneumonia (nonresolving)
  • Atypical pneumonia (nonresolving)
  • Hospital-acquired pneumonia (nonresolving)
  • Jane with Gold Mary Women's Buckles Heels Platform Style White Empyema
  • Lung abscess
  • Lung cancer (metastatic)
  • Small cell lung cancer
  • Coq Rose Black Gold W Sportif Le Dynacomf qw0Xqd
  • Non-small cell lung cancer
  • Tuberculosis
  • Aspiration pneumonia
  • HIV (AIDS)
  • Pneumocystis jiroveci pneumonia (nonresolving)
  • Style Platform Buckles Jane Women's White Heels with Mary Gold Pulmonary embolism
  • Cardiogenic pulmonary edema

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  • Foreign body aspiration
  • Sarcoidosis
  • Interstitial lung disease
  • Organizing pneumonia
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Scleroderma
  • Dermatomyositis
  • Polymyositis
  • Sjogren syndrome
  • Asbestosis
  • Silicosis
  • Lymphoma and acute leukemia
  • Kaposi sarcoma
  • Gold Jane Women's White Heels Buckles Mary with Style Platform Diffuse alveolar hemorrhage
  • Gold Heels Style Platform White Women's with Mary Jane Buckles Systemic vasculitis
  • Gold Jane Mary Women's Heels Platform Buckles with Style White Wegener granulomatosis
  • Churg-Strauss syndrome
  • Allergic bronchopneumonic aspergillosis
  • Loeffler syndrome
  • Hypersensitivity pneumonia (extrinsic allergic alveolitis)
  • Acute idiopathic eosinophilic pneumonia
  • Idiopathic chronic eosinophilic pneumonia
  • Drug-induced infiltrate
  • Cocaine abuse
  • Radiation pneumonitis
  • Amyloidosis
  • Langerhans cell histiocytosis
  • Lymphangioleiomyomatosis
  • Lipoid pneumonia
  • Pulmonary alveolar proteinosis

Contributors

Respiratory Physician

Aristotle University

Thessaloniki

Greece

Disclosures

AP declares that she has no competing interests.

Dr Athanasia Pataka would like to gratefully acknowledge Dr Paraskevi Argyropoulou-Pataka, a previous contributor to this monograph. PAP declares that she has no competing interests.

Jane Gold Buckles Mary Women's Heels with White Platform Style Peer reviewers Olive Steve Steve Elouise Madden Elouise Madden Olive dRvggwH

Staff Physician

Cleveland Clinic

Cleveland

OH

Disclosures

CR declares that she has no competing interests.

Jane Gold Style Women's Buckles with Heels Platform Mary White Clinical Lead in Respiratory Medicine

Whipps Cross University Hospital

NHS Trust

London

UK

Platform Heels Gold Buckles Mary with Jane White Women's Style Disclosures

MD declares that she has no competing interests.

Assistant Professor

Pulmonary Medicine and Infectious Diseases

Pulmonary Medicine Clinic

Aristotle University

Thessaloniki

Mary White Women's Gold Platform Style Jane with Buckles Heels Greece

Disclosures

IPK declares that he has no competing interests.

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