Consolidation

What is consolidation?

• Something replacing air within the alveoli• The diagnosis depends on what this

“something” is:– Pus (pneumonia)– Blood (contusion)– Water (pulmonary oedema)– Acid (aspiration)

• The CXR features of these conditions can be identical, and so clinical correlation is vital for diagnosis

Clinical Case:

A 20 year old male is admitted to AMAU with fever, rigors, pleuritic chest pain and a cough

productive of rusty coloured sputum

•Look at his CXR on the next slide. What is the diagnosis?

Consolidation in right lower zone

Diagnosis = right lower lobe pneumonia

Another example of consolidation

What causes this appearance?

The alveoli are full of fluid (pus), but the adjacent small airways remain aerated. Fluid is more dense than air and stops more x-rays, appearing grey. The result is a mottled appearance; sometimes dark branching bronchioles (“air bronchograms”) can be seen, outlined by the adjacent fluid-filled alveoli.

How to tell which lobe has consolidation

• Different lobes lie next to different structures (see presentation “Atelectasis”)

• A consolidated lobe has a similar density to soft tissue

• If two structures with similar densities lie next to each other, the boundary normally seen on CXR is blurred or lost completely

Can’t see... Site of consolidation

• Left diaphragm

• Right diaphragm

• Left cardiac border

• Right cardiac border

• Left lower lobe

• Right lower lobe

• Left upper lobe

• Middle lobe

Example on next slide…

This is lingular (left upper lobe) consolidation. See how the normally clear boundary between the left heart border and the consolidated lung

is blurred

Take Home Points

• Several conditions can cause consolidation

• The diagnosis depends on information gained from history, physical examination, laboratory tests and the CXR

• It is often possible to localise the consolidation to a particular lobe