Basilar Pneumonia:  Occurs as a result of the introduction and immunological response of a pathogen into the lungs, the body releases white blood cells to fight off this infection.  This can cause fluid to fill up the alveoli and bronchi. It is the fluid build-up and subsequent illness that many of us consider pneumonia.  It is termed basilar or basal when the base or the lower segment of the inferior lobe is involved

Demographis: Pneumonia is a commonly occurring disease with ~4 million confirmed cases each year.  Bacteria, viruses, and mycoplasma are most common causes of pneumonia.  Basilar pneumonia is relatively rare in healthy individuals. Infants, young children, older adults, and otherwise immune-compromised patients are most susceptible (Sahn, 2007). 

Clinical Presentation:  Most cases of Basilar Pneumonia with present with chest pain that is sudden, sharp, aggravated by movement and accompanied by hacking, productive cough with green or rust colored sputum.(Brims, Davies et al. 2010)    A patient may present with upper back or shoulder pain, and the pain may refer to the lower quadrant of the affect lobe due the lower lobe infiltrate causing diaphragmatic irritation.  The patients may present with constitution symptoms (fever, diaphoresis, nausea, vomiting, diarrhea, pallor, dizziness/syncope, fatigue, and weight loss)(Boissonnault and Bass 1990).

Differential Diagnosis:  It is important to remember that a through subjective exam is imperative.  Pulmonary disease is rarely manifested as a pain syndrome without associated symptoms of disease being present. Common symptoms accompanying the pain complaints include sore throat, fever, hoarseness, cough, dyspnea, stridor, and wheezing. Smoking increases the risk for the most common conditions of the respiratory system including cancer and infection.
Acute appendicitis- Refer to gastrointestinal section on appendicitis as pain referral pattern is similar.

Physical Examination: Should include percussion and auscultation of the chest, which may reveal signs of dullness, inspiratory crackles, or bronchial sounds.  The presence of constitutional signs and symptoms indicate systemic illness.

Bottom Line: Refer out
 A patient that presents to physical therapy with the fore-mentioned presentation should be referred to their primary physician for further testing.  It is important to communicate with the physician, as the patient may have true musculoskeletal pain in the thoracic region as a result of faulty pain postures but should not be treated in physical therapy until the pneumonia or systemic illness is resolved.

Please refer to the "Basilar Pneumonia" section of the reference list.






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