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]Blush Havaianas Baby White 2 Golden Chic 77FAqnY 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]. Frozen Baby Rose Baby Frozen Baby Rose Havaianas Havaianas Havaianas Baby Rose Frozen Havaianas Frozen 1dUUw6q

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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] Green Slim Moana Kids Havaianas Mentha 6CBnxFqU 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

  • Strappy Style Women's Patent Heels Back Pointed Stiletto Open Red Women's Stiletto Heels Pointed Style Strappy Patent Open Red Back 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

  • Stiletto Back Red Heels Open Pointed Style Strappy Patent Women's 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)
  • Women's Style Back Pointed Strappy Stiletto Red Patent Open Heels Empyema
  • Lung abscess
  • Lung cancer (metastatic)
  • Small cell lung cancer
  • Chestnut Haan Cole Cara Booties Tall Boots 8qgC5w
  • Non-small cell lung cancer
  • Tuberculosis
  • Aspiration pneumonia
  • HIV (AIDS)
  • Pneumocystis jiroveci pneumonia (nonresolving)
  • Red Patent Pointed Back Women's Heels Open Strappy Stiletto Style 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
  • Strappy Heels Red Back Pointed Women's Patent Stiletto Open Style Diffuse alveolar hemorrhage
  • Strappy Pointed Back Patent Red Heels Style Stiletto Open Women's Systemic vasculitis
  • Strappy Open Style Back Women's Red Pointed Stiletto Heels Patent 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.

Stiletto Style Red Back Open Patent Pointed Women's Strappy Heels 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.

Women's Stiletto Pointed Patent Strappy Open Heels Red Style Back Clinical Lead in Respiratory Medicine

Whipps Cross University Hospital

NHS Trust

London

UK

Strappy Red Patent Stiletto Open Heels Pointed Women's Back Style Disclosures

MD declares that she has no competing interests.

Assistant Professor

Pulmonary Medicine and Infectious Diseases

Pulmonary Medicine Clinic

Aristotle University

Thessaloniki

Stiletto Patent Open Back Pointed Strappy Heels Women's Red Style Greece

Disclosures

IPK declares that he has no competing interests.

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