Question

The alveolar spaces of the lung are connected to one another through many small openings known as the Pores of Kohn. These openings allow equalization of air pressure during inspiration and expiration. Unfortunately in the case of pneumonia, the openings also allow the passage of bacteria, thus permitting an entire lobe of the lung to become rapidly involved with infection.

Mr. JD is a 32-year-old elementary school teacher who developed a cough and fever shortly after the school year started. He experienced right-sided chest pain when he coughed and his temperature increased to 103.2 degrees Farenheit. He developed chills and coughed up sputum that was yellow with traces of blood. In the middle of the night Mr. JD’s wife took him to a local hospital emergency room.


• The bacteria spread throughout the upper lobe of his right lung using the little alveolar pores that connect alveoli.

• These little openings are there for the purpose of equalizing air pressure within the lung, but the bacteria used them as a conduit to spread.

• This type of pneumonia is known as lobar pneumonia (because it involves an entire lobe) and it can be life-threatening.

• The fact that all the alveolar spaces in the affected lobe were filled with inflammatory material and bacteria meant that no gas exchange could take place in the affected region.

• The x-Ray findings indicated this as the area of increased density in the upper right lung field. The X-Ray density is more consistent with solid tissue rather than air filled spongy lung tissue.

Answer 1

Questions have not been provided with the case study. They are as follows:

1. Why did the nurse who listened to Mr. JD’s chest not hear breath sounds over the area of infection?

2. How did such a large area of Mr. JD’s lung become involved in the infection so quickly?

Answer:

1. Normally gas exchange process occurs continuously in the lungs so breathing sounds are audible from the chest. However, the infected area of Mr. JD's lungs was not able to exchange gas anymore. Alveoli or air sacs of the lungs were filled with bacteria and inflammatory cells due to which they were not able to take part in gas exchange. Hence, the nurse could not hear breathing sounds over the infected area.

2. Lungs are made of alveoli or air sacs which take part in gas exchange. All the alveoli are connected to each other via pores called as Pores of Kohn. These pores help to control the air pressure in lungs and prevent them from collapsing. However, in Mr. JD's case; the bacteria, inflammatory cells and their secretions used these pores to spread to every alveoli. Hence, a large area of his lung became infected in a short time.