A 47-year-old patient presents with fever, productive cough, and pleuritic chest pain. A chest radiograph is obtained to confirm the diagnosis of community-acquired pneumonia (CAP). Which radiographic pattern is MOST commonly associated with typical bacterial CAP?
Multiple thin-walled cavitary lesions in the upper lobes
Homogeneous consolidation confined to a single lobe of one lung with air bronchograms
Diffuse fine reticular infiltrates predominantly in the lung bases
Typical bacterial CAP-most often due to Streptococcus pneumoniae-classically produces a focal, homogeneous consolidation that involves a single lobe of one lung (lobar pneumonia). This unilateral lobar pattern is seen far more frequently than bilateral or diffuse patterns in uncomplicated cases. Bilateral perihilar ground-glass opacities are characteristic of viral processes, cavitary upper-lobe lesions suggest necrotizing infections such as tuberculosis or anaerobic abscesses, and diffuse reticular infiltrates are more typical of interstitial lung disease or Pneumocystis jirovecii infection, not routine CAP.
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