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“Nature has given us all the pieces required to achieve exceptional wellness and health, but has left it to us to put these pieces together.”—Diane McLaren

First steps in Evidence-Based-Medicine half a century ago obliged us, clinical workers, at striving for a Lab Exam for every single diagnosis.

As a specialist in Radiology, I can only testify how wrong such a perspective in some situations could be.

As one example growing sputum brought forth frequently the wrong germ, most of the time Staphylococcus aureus from mouth flora.

Hence, the suggestion of etiology of excavated lung lesions.

Reality is different for this case, Anaerobes being frequent in apical lower lobe segment (Abscess), while other locations are siege of Pneumococcus (Pneumatocele).

Upper lobes are predilection of Mycobacteria (Tuberculosis).  

Apical lesions were once typical for Pneumocystis carinii in HIV, because of inhalation prevention.

Bechterew’s spondylitis produces ugly excavations of upper lobes, and diagnosis of bilateral arthritis of ileo-sacral articulations is probatory for this entity.

Acinar consolidation is the role for community pneumonia, while interstitial blurring points to atypical one.

 Covid-19 pneumonitis affected most lower and peripheral zones.

Mycoplasma pneumoniae is most common lung inflammation in autumn and winter months. Affected are lower pulmonary areas, but transparency remains intact on X-Rays.

Only the silhouette sign, with disappearance of diaphragm and heart contours, is positive.

The Alveolar Carcinoma, a type of Adenocarcinoma, spreads imitating community pneumonia.

Traditional smoking-related lung diseases include Langerhans cell histiocytosis (LCH), respiratory bronchiolitis-ILD (RB-ILD), and desquamative interstitial pneumonia (DIP).

Cessation of corresponding activity improves disease and its image.  

Most consolidations go hand-in-hand with increase of involved volume.

Reduction of structure is typical of Gram-negative germs, most commonly Klebsiella pneumophila.

In multiple cases it is crucial to start antibiotic therapy before definitive bacterial proof.