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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.

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]
  • Moreover, intrathoracic involvement by infectious mononucleosis, especially pulmonary consolidation, is uncommon.[journals.lww.com]
Burning Pain
  • He experienced postprandial substernal burning pain that lasted for an hour or two, accompanied by nausea.[nejm.org]
Rigor
  • Besides the above signs, fever with rigors, difficulty in breathing, sharp pain in the chest, productive cough is also seen in pulmonary consolidation. These are the signs useful for a doctor to diagnose pulmonary consolidation.[tandurust.com]
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]
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]
Respiratory Disorders
  • Lung ultrasonography has recently shown to be a reliable method for detection of consolidations, while computed tomography (CT) is the gold standard in visualizing many respiratory disorders and is performed whenever possible.[symptoma.com]
  • It can also be caused due to several other respiratory disorders like tuberculosis, pulmonary hemorrhage, bronchopneumonia, acute respiratory distress syndrome etc. Pulmonary consolidation can be treated in several ways. A few of them are: 1.[reporter365.com]
  • Other respiratory disorders and causes like bronchopneumonia tuberculosis, Acute Respiratory distress syndrome (ARDS), pulmonary hemorrhage and pulmonary eosinophilia.[b4tea.com]
Brown Sputum
  • The symptoms continued until two weeks before admission, when he began to have chills and fever with a cough productive of brown sputum occasionally flecked with blood. A physician diagnosed a viral infection and prescribed a cough syrup.[nejm.org]
Palpitations
  • […] that consolidation may have taken place include: The affected side of the thorax will show a reduced expansion on inhalation Breathing sounds are bronchial The affected side will exhibit increased vocal fremitus, which is a typical vibration felt on palpitating[home-remedies-for-you.com]
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]
Renal Insufficiency
  • . • Chronic pneumonia • Cardiovascular disease • Respiratory deficiency • Thromboembolic complications due to bed rest • Acute renal insufficiency in dehydration B.) Lobar pneumonia Lobar pneumonia usually has an acute progression.[lihyinworld.blogspot.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].

Air Bronchogram
  • 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]
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]
Salmonella Typhi
  • 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.[archbronconeumol.org]
Gram-Positive Bacteria
  • Common causes of pneumonia Virus( influenza, ornithosis) Gram-Positive Bacteria. These bacteria appear blue on the stain and are the most common organisms that cause pneumonia.[lihyinworld.blogspot.com]
Third Degree Atrioventricular Block
  • The fourth patient experienced brief episodes of third-degree atrioventricular block, hypoxemia, and bradycardia during two IPV treatments. IPV was safely restarted and he slowly improved.[ncbi.nlm.nih.gov]

Treatment

  • The consolidation disappeared 17 months later without treatment, and the patient has remained asymptomatic.[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]
  • 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]

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]
  • Vaccines are usually administered to prevent infection by viruses and bacteria.[physio-pedia.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]
  • 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

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: 2019-07-11 20:44