Pneumonia - Diagnosis

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Invasive Diagnostic Procedures

Invasive diagnostic procedures may be required when:

• AIDS or other immune problems are present
• Patients have life-threatening complications
• Standard treatments have failed for no known reason

Invasive procedures include:

Thoracentesis. If a doctor detects pleural effusion during the physical exam or on an imaging study, and suspects that pus (empyema) is present, a thoracentesis is performed.

• Fluid in the pleura is withdrawn using a long thin needle inserted between the ribs.
• The fluid is then sent to the lab for multiple tests.

Complications of this procedure are rare, but can include collapsed lung, bleeding, and infection.

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Bronchoscopy. Bronchoscopy is an invasive test to examine respiratory secretions. It is not usually needed in patients with community-acquired pneumonia, but it may be appropriate for patients with a severely compromised immune system who need immediate diagnosis, or in patients whose condition has worsened during treatment.

A bronchoscopy is done in the following way:

• The patient is given a local anesthetic, oxygen, and sedatives.
• The physician inserts a fiber optic tube into the lower respiratory tract through the nose or mouth.
• The tube acts like a telescope into the body, allowing the physician to view the windpipe and major airways and look for pus, abnormal mucus, or other problems.
• The doctor removes specimens for analysis and can also treat the patient by removing any foreign bodies or infected tissue encountered during the process.

Click the icon to see an image of bronchoscopy.

Bronchoalveolar lavage (BAL) may be done at the same time as bronchoscopy. This involves injecting high amounts of saline through the bronchoscope into the lung and then immediately sucking the fluid out. The fluid is then analyzed in the laboratory. Studies find BAL to be an effective method for detecting specific infection-causing organisms.

The procedure is usually very safe, but complications can occur. They include:

• Allergic reactions to the sedatives or anesthetics
• Asthma attacks in susceptible patients
• Bleeding
• Fever