Consolidation

Dr/ Hytham Nafady

Replacement of alveolar air by

• fluid,

• blood,

• pus,

• or other materials.

Radiological signs of consolidation

1. Homogenous opacity with obscuration of vascular markings.

2. Fluffy (ill-defined) opacities.

3. Air broncho-gram.

4. CT angio-gram.

5. Preserved lung volume.

6. Extension to pleural surface.

7. Silhouette sign.

Air bronchogram

CT angiogram sign

Causes of consolidation

Patterns of consolidation

Bilateral perihilar consolidation(pulmonary edema)

Bilateral perihilar consolidation

• Pulmonary edema

Bilateral perihilar consolidation

• Cryptogenic organizing pneumonia.

DD of bilateral perihilar consolidation

• Pulmonary edema (especially cardiogenic)

• Pneumonia – aspiration pneumonia– pneumocystis pneumonia (PCP)– viral pneumonia– lipoid pneumonia– COP

• inhalation injury– noxious gas– liquid

• Pulmonary alveolar proteinosis.• Pulmonary hemorrhage (e.g. WG or Goodpasture syndrome)• lymphoma / leukaemia• Broncho-alveolar carcinoma.

Reverse Bat wing pattern

• Chronic eosinophilic pneumonia

Reverse Bat wing pattern• Chronic eosinophilic pneumonia: • Classic radiographic finding is non segmental peripheral airspace

consolidation involving mainly the upper lobes.• ARDS• Lung contusion:• Cryptogenic organizing pneumonia:• Simple pulmonary eosinophilia: Loeffler syndrome. • Migratory peripheral ground-glass opacity or airspace consolidation

involving mainly the middle and upper lung zones. • Pneumonia:• Pulmonary infarction:• Sarcoidosis: Pulmonary nodules and masses when seen in sarcoidosis

(15%–25% of patients with parenchymal opacities) are ill-defined and irregular and represent coalescent interstitial granulomas. They may be located in perihilar or peripheral regions. Small satellite nodules can be seen around them ("galaxy sign", nonspecific).

• Vasculitides:

Multifocal patchy consolidation

• Bronchopneumonia

Multifocal patchy consolidation

Diffuse alveolar hemorrhage (Wegner granulomatosis)

Multifocal patchy consolidation

Acute causes:

• Bronchopneumonia.• Pulmonary hemorrhage.

• Pulmonary edema.

Chronic causes:

• Chronic pneumonia (eosinophilic pneumonia, COP)

• Neoplastic (BAC or lymphoma).

Right upper & middle lobe consolidation with bulging fissure

Round pneumonia

Antibiotic TTT

1 month

Bilateral diffuse consolidation

• ARDS

Atlas of consolidation

Round pneumonia

Round pneumonia

Lingular consolidation

Right UL & ML consolidation

RML consolidation

Medial segment RML consolidation

Superior segment RLL pneumonia

Anteromedial segment LLL pneumonia

RUL pneumonia

RLL pneumonia