normal (clear and distinct) right hemidiaphragm contour (c.f. Thus, the term consolidation and pneumonia have very similar meaning and are almost used interchangeably. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. The left image is taken with the patient's arms forward resulting in the soft tissues of the upper arm overlying the upper lobes. Chest Radiology. Impression: Partial right upper lobe consolidation. Right middle lobe consolidation in a patient with lobar pneumonia - PA film . Saved by Radiopaedia. Case 2. Culture was positive for TB. 5 A 44-year-old male with mild involvement of the right upper lobe, consolidation patch (black arrow a ), and moderate involvement of both lower lobes with multiple subpleural ground glass patchy opacities (arrows on b – d ). on lateral CXR: triangular opacification superior and anterior to the, 1. The upper lobes are frequently partially obscured by upper arm soft tissues on the lateral view when the hands on head, elbows forward technique is used. Case E: This is a 6-week old female presenting with fever and cold symptoms. This is the thymus in a child. Smoker; Progressive shortness of breath and cough; Diagnosis. Bilateral Upper-Lobe Peripheral Consolidation in a 56-Year-Old Woman. The list of causes of consolidation is broad and includes: 1. pneumonia 2. adult respiratory distress syndrome (ARDS) 3. interstitial pneumonias 4. pneumonitis 5. sarcoidosis The right lateral chest image is taken with the patent's arms crossed across her head and demonstrates the RUL consolidation without the confusing arm soft tissue anatomy overlying the upper lobes. We can assume that this is reactivation of a latent TB. The horizontal fissure, indicated by … Radiology Imaging Medical Imaging Lung Anatomy Silhouette Sign Nuclear Medicine Respiratory Therapy Important Facts Medical Field Physiology. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. D Sunderamoorthy, S Ahuja, A Grant, and T Mian The consolidation is likely to be within the anterior segment of the RUL. This 70 year old man presented with haemoptysis. Predominant upper lobe affection was uncommon (20%), seen only in 6 patients (Table 4). What is lung consolidation? W. Richard Webb, Charles B. Higgins. Check for errors and try again. Chest x-ray showing patchy opacification on the upper right and mid-zone lung with fibrotic shadows, as well as bilateral hilar lymphadenopathy. Dense homogenous opacity in right, middle and lower lobe of primary pulmonary TB. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders. (2010), differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. These findings were seen more in the left upper lobe than the right upper lobe . Consolidation of the lung is simply a “solidification” of the lung tissue due to accumulation of solid and liquid material in the air spaces that would have normally been filled by gas. This is not helping in the demonstration of the patient's upper lobe consolidation. In right upper lobe consolidation, the consolidation is confined by the horizontal fissure inferiorly and the upper half of the oblique fissure posteriorly. Case contributed by Dr Maulik S Patel. 221 The radiologic appearance of a consolidated lobe is a homogeneous confluent opacity that obliterates the normal vascular markings and often contains air bronchograms (see Fig. Consolidation with air bronchograms (arrows) due to radiation pneumonitis at the upper lobe of the right lung. Right upper lobe consolidation. Thus when a radiologist has reported a chest X-ray examination and notes the presence of consolidation he/she is simply stating that some of the lung airspace has been replaced by a fluid. Peripheral right upper lobe consolidation in an | Research Image. Look For; Tubular outlines of the smaller airways. Fig. It is sometimes useful to perform an apical lordotic view to help demonstrate equivocal pathological appearances in the upper lobes. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. Features of right upper lobe consolidation on CXR include: It must be remembered that the homogeneity of the consolidation will be influenced by any underlying lung disease. Case 6: anterior segment of RUL consolidation, Case 7: bulging fissure sign of lobar consolidation, adult respiratory distress syndrome (ARDS), acute unilateral airspace opacification (differential), acute bilateral airspace opacification (differential), acute airspace opacification with lymphadenopathy (differential), chronic unilateral airspace opacification (differential), chronic bilateral airspace opacification (differential), osteophyte induced adjacent pulmonary atelectasis and fibrosis, pediatric chest x-ray in the exam setting, normal chest x-ray appearance of the diaphragm, posterior tracheal stripe/tracheo-esophageal stripe, obliteration of the retrosternal airspace, leflunomide-induced acute interstitial pneumonia, fibrotic non-specific interstitial pneumonia, cellular non-specific interstitial pneumonia, respiratory bronchiolitis–associated interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2011), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018)​, domestically acquired particulate lung disease, lepidic predominant adenocarcinoma (formerly non-mucinous BAC), micropapillary predominant adenocarcinoma, invasive mucinous adenocarcinoma (formerly mucinous BAC), lung cancer associated with cystic airspaces, primary sarcomatoid carcinoma of the lung, large cell neuroendocrine cell carcinoma of the lung, squamous cell carcinoma in situ (CIS) of lung, minimally invasive adenocarcinoma of the lung, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), calcifying fibrous pseudotumor of the lung, IASLC (International Association for the Study of Lung Cancer) 8th edition (current), IASLC (International Association for the Study of Lung Cancer) 7th edition (superseeded), 1996 AJCC-UICC Regional Lymph Node Classification for Lung Cancer Staging, opacification of the right upper zone and/or apex, that may abut and outline the superior margin of the, obscuration of the right superior mediastinal contour (, obscuration of the right hilum, particularly the superior hilum. The horizontal fissure (white line) has been displaced upwards from its original position (red line) Dense opacification (asterisk) of the medial part of the right upper zone; Enlarged right hilum; Clinical information. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Right upper lobe consolidation clearly outlining the horizontal fissure and posterior aspect of the right oblique fissure. Case 1 is a consolidation due to pneumonia in this patient. Jannette Collins, Eric J. Stern. If the clinical presentation includes fever, this is most likely pneumonia. Consolidation can be localized easily on frontal x-rays with basic knowledge of the silhouette sign and lung anatomy. There is a triangular or wedge-shaped density at the right apex (black arrow) that displaces the minor fissure upward (red arrow). The list of causes of consolidation is broad and includes: Consolidation is usually obvious on CT with the anatomical location easy to define through visualization of the pleural fissures, however features can be subtle on chest radiography. : Specialty: Pulmonology Right lung consolidation. Her temperature is 39 degrees rectally. The distribution of the consolidation can vary widely. The horizontal fissure is slightly bowed and elevated suggesting minor collapse of the RUL associated with the consolidation. The right hilum is elevated from volume loss (yellow arrow). She is feeding well. The smooth contour of area of consolidation is typical for ’rounded pneumonia’ most often seen in children. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders. There is an opacity in the medial aspect of the right upper zone that represents the collapsed upper lobe, which has migrated upwards and medially as a result. A: Normal chest X-ray.B: Abnormal chest X-ray with consolidation from pneumonia in the right lung, middle or inferior lobe (white area, left side of image). Right middle lobe consolidation in a patient with lobar pneumonia ... Obscuration of the ascending aorta, suggesting right upper lobe consolidation . This can … Chest radiograph showing consolidation in the right upper lobe bulging the fissure. Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. The RUL is not hidden behind the heart or diaphragm and is relatively uncomplicated except perhaps by the presence of an azygous lobe (normal anatomical variant). Atelectasis, Right Upper Lobe. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. The distribution of the consolidation can vary widely. This 27 year old patient has a focus of consolidation in the upper zone of the right lung – we can deduce that it is in the right upper lobe because its inferior margin is the horizontal fissure (arrows). This page was last edited on 11 November 2020, at 17:38. Sunderamoorthy D(1), Ahuja S, Grant A, Mian T. Author information: (1)dsundar6@hotmail.com A 28 year old fit and healthy Caucasian man had a Bankart's repair of the left shoulder under general anaesthetic for a recurrent dislocation of the shoulder. It is important to note that of all the lobes, the right middle lobe is the most likely to be chronically collapsed. Pulmonary consolidation; Pneumonia as seen on chest X-ray. Right upper lobe collapse; Other investigations There is abnormal opacity within the RUL abutting the horizontal fissure. ( other causes include chronic pneumonia, pulmonary oedema and neoplasm). The arrowed structure should not be mistaken for RUL pathology. Lobar consolidation results from alveolar filling with fluid, exudate, or tumor that solidifies the lung. One of the unfortunate aspects of the term consolidation is that its meaning can be different depending on who is using the term. The horizontal fissure is elevated. b. Rounded Pneumonia A consolidation may be described as focal or by the lobe or segment of lobe affected. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. An urgent contrast enhanced computed tomography (CT) thorax was arranged and noted a loculated right apical homogeneous hypodense pleural effusion (10 Hounsfield Unit) measuring 9.4×11.3×19.4 cm (Figure 2A,B), associated with adjacent collapsed-consolidation of the apical segment of the right upper lobe. There was also mild deviation of the trachea to the right, and both mid and lower lung fields were clear with no hilar adenopathy. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. Air bronchogram sign on CT. c. Illustration of air bronchogram sign. Subsequently the radiograph was reported as right upper lobe consolidation by the radiologist. Chest radiograph performed on admission shows the typical appearance of right upper lobe collapse. The horizontal fissure is normally positioned. The arms forward technique has resulted in superimposed soft tissue from both arms largely obscuring the area of interest. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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