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Round Pneumonia in an Adult

Ugur Topal, MD
Robert D Pugatch, MD

May 24, 1996

Presentation

A 41-year-old woman was admitted to the hospital with presenting symptoms of fever and cough.

Imaging Findings

PA and lateral radiographs
Repeat exam 13 days later

Initial posteroanterior (PA) and lateral chest radiographs show an ill-defined, homogeneous opacity (PA, arrow)(lateral, arrow) measuring approximately 4 cm in diameter in the right lower lobe. No other abnormality is present.

Subsequent radiographs show the abnormality to have totally resolved.

Differential Diagnosis

Diagnosis

Round pneumonia

Discussion

Round pneumonia is a well-known entity in children, but it is uncommon in adults (1). In pneumonia, alveolar inflammatory and exudative processes spread from a small peripheral focus centrifugally through the interalveolar channels. This initial focus has a nonsegmental distribution and can assume a spherical shape. Later, as it spreads, segmental and lobar appearances are commonly seen in adults. The literature suggests that if the roentgenogram is obtained early in the course of disease, it often will appear as a round opacity.

It is important to recognize that pneumonias may initially appear as round, oval densities simulating a mass. Patients should be followed up clinically and radiographically within one to three weeks, as the opacity appears to evolve relatively rapidly. This may eliminate unnecessary further investigations (1).

References

1. Hershey CO, Panaro V. Round pneumonia in adults. Arch Intern Med 1988;148:1155-1157.

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