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Pulmonary Consolidation

Consolidation of Lung

Pulmonary consolidation is a term denoting the filling of alveoli and the respiratory bronchioles with dense material, such as fluid, pus, blood or cellular content. As a result, infections, particularly pneumonia, as well as malignancies, immune-mediated reactions, and various other etiologies can cause pulmonary consolidation that is visible on X-rays and other imaging studies. Computed tomography and magnetic resonance imaging are often employed to confirm the underlying cause.


Presentation

Pulmonary consolidation is a pathological process during which infiltration of alveoli by a range of dense materials (pus, blood, fluid or cells) causes an improper function of the affected area. One of the most important etiologies is pneumonia (of any type), when inflammatory cells, pus and sometimes even blood obstruct the air flow through the respiratory system and the alveoli, resulting in the inability for gas-exchange processes to occur. On the other hand, pulmonary edema, often seen in congestive heart failure, is the principal event that leads to fluid-filled air spaces. Other notable causes include malignant diseases (both primary and metastatic tumors of the lungs), hypersensitivity or aspirational pneumonitis, occupational lung disorders (such as silicosis), cystic fibrosis, and pulmonary embolism with subsequent infarction [1] [2] [3]. Regardless of the underlying etiology, symptoms include dyspnea, increased respiratory effort and a cough (often productive), whereas fever (in the setting of an infection) or hemoptysis (primarily seen in tumors) are infrequently present [2] [3]. Symptoms may gradually appear when chronic conditions are responsible for pulmonary consolidation, but they can also develop abruptly and cause a significant risk for the patient's life, as severe respiratory insufficiency is a known complication if a large portion of the lung is affected by this pathological process.

Bronchial Breath Sounds
  • Bronchial Breath Sounds Bronchial breath sounds often result from consolidation within lung parenchyma with a patent airway leading to the involved area.[emedicine.medscape.com]
  • Auscultation over the same region should help to distinguish between these possibilities, as consolidation generates bronchial breath sounds while an effusion is associated with a relative absence of sound.[meded.ucsd.edu]
  • Consolidation: bronchial breath sounds, bronchophony, pectoriloquy, possible splinting on the (pneumonia) affected side.[nurseslearning.com]
  • Bronchial Breath Sounds : Loud, high-pitched with air swishing past. Bronchovesicular Sounds: Heard near branching of main bronchi, combination of bronchial and vesicular sounds.[kumc.edu]
Infectious Mononucleosis
  • Infectious mononucleosis occurs most commonly among adolescents and young adults. Moreover, intrathoracic involvement by infectious mononucleosis, especially pulmonary consolidation, is uncommon.[ncbi.nlm.nih.gov]
Splenectomy
  • Conventional treatment is antibiotic therapy and total or partial splenectomy, although percutaneous drainage may be considered in patients with contraindications for surgery. 5 References [1] R. Chaudhry,R.K. Mahajan,A. Diwan,S. Khan,R.[archbronconeumol.org]
Shoulder Pain
  • Edelson A 6-year-old boy with shoulder pain [3] N. Nelken,J. Ignatius,M. Skinner,N. Christensen Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature Am J Surg, 154 (1987), pp. 27-34 [4] S.[archbronconeumol.org]

Workup

Pulmonary consolidation is a radiological sign that is identified using different imaging studies, but initial signs of an ongoing process in the lungs can also be observed during a physical examination. The intensity of vibration of the chest wall while a patient is speaking (known as tactile fremitus) will be increased in areas of consolidation, while percussion of the intercostal spaces can reveal dullness, similarly to percussing of a solid organ [2] [3]. In addition, abnormal transmission of voice during auscultation (bronchophony) may be noted [3]. Clinical suspicion toward a respiratory pathology should be raised if any of the mentioned clinical signs (in addition to abnormal lung sounds) are present, in which case imaging studies should be performed as soon as possible, especially if patient rapidly deteriorates. Plain radiography is a useful initial method [4]. Lung ultrasonography has recently shown to be a reliable method for detection of consolidations [5] [6], while computed tomography (CT) is the gold standard in visualizing many respiratory disorders and is performed whenever possible [4]. Magnetic resonance imaging (MRI) has also been mentioned as a good method for visualization of pulmonary consolidation [6].

Air Bronchogram
  • The shape and lumen of the bronchi with air bronchogram sign, the length of the involved bronchus with air bronchogram sign, the length of lesion on the same plane and direction, and the ratio between the length of the involved bronchus and that of the[ncbi.nlm.nih.gov]
  • CT revealed air bronchogram, CT angiogram sign, bulging fissure, and fluid bronchogram in all six cases with partial bronchial obstruction (except for absence of air bronchogram in one case).[ncbi.nlm.nih.gov]
  • The US air bronchogram was seen in 32 of the 39 patients (82%), the fluid bronchogram in 37 patients (94%) and the scattered echogenic foci in 30 (77%).[ncbi.nlm.nih.gov]
  • Strong linear echoes with characteristic air artifacts (air bronchogram) and anechoic tubular structures (fluid bronchogram) were visualized in 36 of 39 patients (92.30%).[ncbi.nlm.nih.gov]
  • Air bronchograms were detected in 141 patients, fluid bronchograms in 27 patients, and parapneumonic effusion in 74 patients.[ncbi.nlm.nih.gov]
X-Ray Abnormal
  • Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points Compare the left and right upper, middle and lower lung zones Decide which side is abnormal Compare an area of abnormality[radiologymasterclass.co.uk]
Chest X-Ray Abnormal
  • Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points Compare the left and right upper, middle and lower lung zones Decide which side is abnormal Compare an area of abnormality[radiologymasterclass.co.uk]
Salmonella Typhi
  • Chandel Unusual presentation of enteric fever: three cases of splenic and liver abscesses due to Salmonella typhi and Salmonella paratyphi A Trop Gastroenterol, 24 (2003), pp. 198-199 [2] K. Edelson A 6-year-old boy with shoulder pain [3] N.[archbronconeumol.org]

Treatment

  • The consolidation disappeared 17 months later without treatment, and the patient has remained asymptomatic.[ncbi.nlm.nih.gov]
  • The patients were divided into three groups: those with infectious diseases (group A, n 28), those with non-infectious diseases in which the use of corticosteroids was the treatment of choice (group B, n 33), and others (group C, n 19).[ncbi.nlm.nih.gov]
  • This helps localize the area that has been affected and needs treatment . Normally, in pulmonary consolidation , the affected part is confined to one lobe and hence is also known as lobar pneumonia.[b4tea.com]
  • Treatment for pneumonia involves the use of antibiotics given either orally or intravenously, oxygen therapy and other breathing treatments.[home-remedies-for-you.com]
  • However, close observation is essential during and after IPV treatments, especially in patients who have difficulty mobilizing or expectorating sputum.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis is poor because of delayed diagnosis and poor response to chemotherapy.[jstage.jst.go.jp]
  • The prognosis is usually good, especially in the milder cases. In severe cases, complications such as pneumonia may occur.[home-remedies-for-you.com]
  • Jaundice does not worsen the prognosis of the pneumonia. In Zimbabwe there does not seem to be this link. Sarcoidosis is uncommon in black and colored people, although very common in Afro-Americans in the United States.[isradiology.org]
  • What is the prognosis for patients managed in the recommended ways? The prognosis for patients with pleural effusions depends on the underlying cause.[clinicaladvisor.com]

Etiology

  • As a result, infections, particularly pneumonia, as well as malignancies, immune-mediated reactions, and various other etiologies can cause pulmonary consolidation that is visible on X-rays and other imaging studies.[symptoma.com]
  • In many cases of pulmonary diseases extending up to the pleura, ultrasound (US) helps to identify the etiology of the lesion. There are several sonomorphological criteria to differentiate peripheral pulmonary consolidations.[ncbi.nlm.nih.gov]
  • The different degrees of reactive vasoconstriction may be helpful in exploring the possible etiology of pulmonary consolidation.[ncbi.nlm.nih.gov]
  • It can also be used for needle aspiration guidance for etiologic diagnosis of patients with complicated pneumonia.[ncbi.nlm.nih.gov]
  • Incidence has also increased due to the greater prevalence of immunosuppressive states, producing more reports in recent series of fungal etiologies. 3,4 In this respect, our case is uncommon, due to the lack of predisposing factors, such as immunosuppression[archbronconeumol.org]

Pathophysiology

  • Color Doppler US can demonstrate the vascular patterns and may help in the understanding of underlying pathophysiology. Sonographic examinations of the upper and central mediastinum provide good results in 90-95% of cases.[ncbi.nlm.nih.gov]
  • […] parenchyma Lung is #1 site for infections that cause lost workdays Infection of lung is more frequent than any other visceral organ Generally microorganisms are inhaled, but pneumonia may also occur through hematogenous spread or direct inoculation Pathophysiology[pathologyoutlines.com]
  • Major pulmonary embolism: Review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121:877-905 He H, Stein MW, Zalta B, Haramati LB.[blog.5minsono.com]

Prevention

  • Oxygen toxicity Inhalation of toxic fumes Infiltration of lymphoma or alveolar cell carcinoma Treatment for Pulmonary Consolidation: Vaccination and maintaining general hygiene are some ways to prevent the occurrence of this lobar pneumonia.[b4tea.com]
  • The early switch to cefotaxime, initiated due to radiological findings initially interpreted as pneumonia, may have prevented a poor outcome, but on the other hand, this erroneous interpretation complicated the diagnosis.[archbronconeumol.org]
  • Prevent cancer cells to develop. It will restrain cancer cells to grow. 2. Prevent liver, kidney, pancreas decease and it can cure ulcer as well. 3. Strengthen the lung, prevent heart attack and high blood pressure. 4.[florian-hotinfoblog.blogspot.com]
  • Treatment for Lung Consolidation Some of the ways that lung consolidation can be treated include: Maintaining your general hygiene and vaccinations to help prevent lobar pneumonia from occurring.[healthool.com]
  • Vaccines are usually administered to prevent infection by viruses and bacteria.[physio-pedia.com]

References

Article

  1. Khan AN, Al-Jahdali H, AL-Ghanem S, Gouda A. Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient. Ann Thorac Med. 2009;4(3):149-157.
  2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
  4. Ünlüer EE, Karagöz A. A dynamic sign of alveolar consolidation in bedside ultrasonography: Air bronchogram. Interv Med Appl Sci. 2014;6(1):40-42.
  5. Nazerian P, Volpicelli G, Vanni S, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med. 2015;33(5):620-625
  6. Biederer J, Mirsadraee S, Beer M, et al. MRI of the lung (3/3)—current applications and future perspectives. Insights Imaging. 2012;3(4):373-386.

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Last updated: 2018-06-21 23:32