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.
Entire Body System
- Pathologist
Pathologists have long described the mascroscopic changes associated with consolidation as “hepatization” of the lung. The sonographic appearance of frank consolidation looks remarkably liver-like and is also termed hepatization. [lifeinthefastlane.com]
Respiratoric
- 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]
Michael Wilkes, MD-- UC Davis and UCLA Schools of Medicine) Bronchial Breath Sounds Vesicular Breath Sounds Crackles Wheeze Stridor Normal Voice E Egophony Listen to more lungs sounds from Rales Repository of Lung Sounds. [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]
- Persistent Cough
Cough and sputum (see the separate Chronic Persistent Cough in Adults and Chronic Cough in Children articles). Haemoptysis. Chest pain. Wheeze (see the separate Bronchial Asthma and Wheezing in Children articles). [patient.info]
Surgery - removing area containing tumors Laser surgery - lasers destroy tumors Symptoms of lung cancer include a persistent cough, chest pain, and recurring bronchitis. makes breathing difficult and painful no negative pressure in diaprahm and hard to [quizlet.com]
Gastrointestinal
- Dysphagia
Signs & Sxs: -voice change, hoarseness and aphonia, tickling sensation in the throat, clearing the throat a lot -symptoms vary; may be severe with pain and dysphagia, dyspnea -can accompany other URI, allergies -Acute: lasts less than a few days -Chronic [quizlet.com]
Jaw & Teeth
- Halitosis
Environmental exposures revealed in social history Travel Psittacosis: Exposure to birds Legionellosis: Exposure to water, air-conditioners Tobacco use EXTRAPULMONARY EXAMINATION: HALITOSIS : Some possible causes Campylobacter Pylori colonization of stomach [kumc.edu]
Musculoskeletal
- Shoulder Pain
A 6-year-old boy with shoulder pain. Pediatric Annals, 40 (2011), pp. 342-344 [3] N. Nelken, J. Ignatius, M. Skinner, N. Christensen. Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. [archbronconeumol.org]
Neurologic
- Confusion
In consolidation, the patient develops fever with chills, cough with yellow/green/blood stained sputum, chest pain, breathlessness, confusion etc. In both cases, X-ray and CT scans of chest will help to diagnose the condition. [differencebetween.net]
It's often confusing since they do mention in pulmonary path things like "diffuse bilateral infiltrates" or "lobar infiltrates", when it's obviously more complex. [forums.studentdoctor.net]
(Quick note to avoid confusion: X-rays are viewed so that the left side of the image is the right side of the patient, as if the patient is facing you). Top image: normal chest x-ray. [auntminnie.com]
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].
X-Ray
- 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]
Chest Radiology > Interpretation > Signs > Air Bronchogram Air Bronchogram An air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates. [med-ed.virginia.edu]
- 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]
- 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]
Pleura
- Pleural Adhesions
[…] space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions" [12] [13] Causes There are many different causes of pneumonia which can be classified as infective or aspiration pneumonia. [physio-pedia.com]
Treatment
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]
Multidisciplinary contributions on medical treatment, radiation oncology, and surgery and anesthesia are included. Highlights include new material on minimally invasive procedures and thoroughly updated diagnostic and treatment information. [books.google.com]
Bowel Movement Soft and Hard – Causes and Diet Pet Allergies (Cat and Dog Allergy) Causes, Symptoms, Tests, Treatment Psoriatic Arthritis (Inflamed Joints with Psoriasis) Causes, Symptoms, Treatment 5 Signs of Whiplash (Neck Strain) and Late Whiplash [slideshare.net]
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]
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]
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]
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]
Abstract 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]
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]
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]
Pneumonia due to Haemophilus influenzae type b is not uncommon in developing countries (although rare in many Western countries) but it can be prevented by the use of a conjugate vaccine, as used for meningitis. [isradiology.org]
References
- 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.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- 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.
- Ünlüer EE, Karagöz A. A dynamic sign of alveolar consolidation in bedside ultrasonography: Air bronchogram. Interv Med Appl Sci. 2014;6(1):40-42.
- 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
- 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.