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. 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. A mnemonic to remember the general features of consolidation is A2BC3. Consolidation may be limited to a particular lobe of the lung; This image shows consolidation of the right upper lobe which is confined inferiorly by the horizontal fissure; If the consolidation is due to infection, then the term ‘lobar pneumonia’ is correctly used There was also mild deviation of the trachea to the right, and both mid and lower lung fields were clear with no hilar adenopathy. Bilateral Upper-Lobe Peripheral Consolidation in a 56-Year-Old Woman. normal (clear and distinct) right hemidiaphragm contour (c.f. Figure 3. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. Impression: Partial right upper lobe consolidation. Atelectasis, Right Upper Lobe. Case 1 is a consolidation due to pneumonia in this patient. Right middle lobe collapse (or simply termed middle lobe collapse) has distinctive features, but can be subtle on frontal chest radiographs.. For a general discussion please refer to the article on lobar collapse.. Right upper lobe collapse. 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). Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. Chest computed tomography demonstrating centrilobular nodules confluent to the right in … Right upper lobe consolidation – CXR. This is the thymus in a child. on lateral CXR: triangular opacification superior and anterior to the, 1. Strictly speaking, the term consolidation does not imply any particular aetiology or pathology. Chest radiograph showing consolidation in the right upper lobe bulging the fissure. Cavity in the right upper lobe. The smooth contour of area of consolidation is typical for ’rounded pneumonia’ most often seen in children. Culture was positive for TB. 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. Dense opacity seen above the horizontal fissure. Unable to process the form. 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 upper lobe collapse; Other investigations Check for errors and try again. The horizontal fissure is normally positioned. Right middle lobe consolidation in a patient with lobar pneumonia - PA film . Saved by Radiopaedia. : Specialty: Pulmonology Radiological appearances common to all lobes are: 7.Opacification of the lung behind the heart shadow or below the diaphragms, 2.Increase in the size and number of lung markings, 3.Loss of clarity of the diaphragm on the AP and/or lateral views, 4.Loss of clarity of the heart border on the AP and/or lateral views, 6.Loss of the normal darkening inferiorly of the thoracic vertebral bodies on the lateral view, http://books.google.com.au/books?id=Bif0zpmEWtAC, http://www.amazon.com/Chest-Roentgenology-Benjamin-Felson/dp/0721635911/ref=sr_1_2?ie=UTF8&s=books&qid=1252240078&sr=1-2, https://www.wikiradiography.net/index.php?title=Right_Upper_Lobe_Consolidation&oldid=31582. Jannette Collins, Eric J. Stern. There is a triangular or wedge-shaped density at the right apex (black arrow) that displaces the minor fissure upward (red arrow). 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). Radiology Imaging Medical Imaging Lung Anatomy Silhouette Sign Nuclear Medicine Respiratory Therapy Important Facts Medical Field Physiology. The lower border of the consolidation is sharply delinated by the horizontal fissure suggesting it lies in the anterior segment of the RUL, Dense opacity in the RUL sharply bordered by the horizontal and oblique fissures suggesting involvement of the anterior and posterior segments of the RUL. W. Richard Webb, Charles B. Higgins. This page was last edited on 11 November 2020, at 17:38. This can … The right upper lobe is “too white” and too small. Pulmonary consolidation; Pneumonia as seen on chest X-ray. She is feeding well. Thoracic Imaging. 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). Dense homogenous opacity in right, middle and lower lobe of primary pulmonary TB. The horizontal fissure is slightly bowed and elevated suggesting minor collapse of the RUL associated with the consolidation. Right upper lobe (RUL) consolidation is a relatively straightforward diagnosis. When the fissures are outwardly convex, the appearance is referred to as the bulging fissure sign. Diagnosis: Right Upper Lobe Consolidation, Rounded Pneumonia, with Air Bronchograms – Community Acquired Pneumonia. 14.1, A and B). It is also advantageous to direct patients to cross their arms across their heads for the lateral view (as opposed to hands on head and elbows forward). The horizontal fissure, indicated by … It is important to note that of all the lobes, the right middle lobe is the most likely to be chronically collapsed. (2019), 2. Right upper lobe (RUL) consolidation is a relatively straightforward diagnosis. Look For; Tubular outlines of the smaller airways. Chest radiograph performed on admission shows the typical appearance of right upper lobe collapse. The right hilum is elevated from volume loss (yellow arrow). This is not helping in the demonstration of the patient's upper lobe consolidation. Air bronchogram sign on CT. c. Illustration of air bronchogram sign. Right lung consolidation. 49. Air Bronchograms. Case E: This is a 6-week old female presenting with fever and cold symptoms. 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. Her temperature is 39 degrees rectally. The right upper lobe is “too white” and normal in size. The Meaning of the Term Consolidation. The arrowed structure should not be mistaken for RUL pathology. The distribution of the consolidation can vary widely. Case contributed by Dr Maulik S Patel. 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. The left image is taken with the patient's arms forward resulting in the soft tissues of the upper arm overlying the upper lobes. {"url":"/signup-modal-props.json?lang=us\u0026email="}. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. Lobar consolidation results from alveolar filling with fluid, exudate, or tumor that solidifies the lung. Rounded Pneumonia Consolidation can be localized easily on frontal x-rays with basic knowledge of the silhouette sign and lung anatomy. Case 1. One of the unfortunate aspects of the term consolidation is that its meaning can be different depending on who is using the term. Related Case Studies. 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 ). A consolidation may be described as focal or by the lobe or segment of lobe affected. Fig. Chest x-ray showing patchy opacification on the upper right and mid-zone lung with fibrotic shadows, as well as bilateral hilar lymphadenopathy. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. The right middle lobe has two pulmonary segments which are situated side by side; the more lateral segment, approximates the size of its adjacent neighbour ( … Exam VS T39.1 (rectal), P125, R45, BP 75/35, oxygen saturation 98% in room air. Consolidation - Right upper lobe. The distribution of the consolidation can vary widely. If the clinical presentation includes fever, this is most likely pneumonia. Right middle lobe consolidation in a patient with lobar pneumonia ... Obscuration of the ascending aorta, suggesting right upper lobe consolidation . D Sunderamoorthy, S Ahuja, A Grant, and T Mian There is abnormal opacity within the RUL abutting the horizontal fissure. We can assume that this is reactivation of a latent TB. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders. The arms forward technique has resulted in superimposed soft tissue from both arms largely obscuring the area of interest. The consolidation is likely to be within the anterior segment of the RUL. Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. 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. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. 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. Chest Radiology. 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 Right upper lobe consolidation. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders. Peripheral right upper lobe consolidation in an | Research Image. A consolidation could be described as “patchy”, “homogenous”, or generalised”. In right upper lobe consolidation, the consolidation is confined by the horizontal fissure inferiorly and the upper half of the oblique fissure posteriorly. Acute pneumonia is the commonest cause but not the only cause of consolidation. normal (clear and distinct) right heart border (c.f. 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. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. 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. (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. Consolidation with air bronchograms (arrows) due to radiation pneumonitis at the upper lobe of the right lung. This 70 year old man presented with haemoptysis. ( other causes include chronic pneumonia, pulmonary oedema and neoplasm). Case 2. 2. Smoker; Progressive shortness of breath and cough; Diagnosis. Predominant upper lobe affection was uncommon (20%), seen only in 6 patients (Table 4). Right upper lobe consolidation clearly outlining the horizontal fissure and posterior aspect of the right oblique fissure. Thus, the term consolidation and pneumonia have very similar meaning and are almost used interchangeably. USG consolidation • Sonography of the left lung reveals loss of normal aeration of the lung parenchyma with echogencity and texture similar to that of the spleen below. Right upper lobe consolidation Right middle lobe consolidation Download Here Free HealthCareMagic App to Ask a Doctor. b. These findings were seen more in the left upper lobe than the right upper lobe . 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. 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. A consolidation could be described as “patchy”, “homogenous”, or generalised”. What is lung consolidation? Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. With right upper lobe (RUL) collapse, the collapsed RUL shifts medially and superiorly, resulting in elevation of the right hilum and the minor fissure. Right upper lobe consolidation representing pulmonary edema may occur in patients with acute myocardial infarction resulting in papillary muscle rupture and mitral valve prolapse; it occurs because a jet of regurgitant blood is directed into the right superior pulmonary vein. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. A CXR some years later on the right shows: Right upper lobe atelectasis; Deviation of the trachea; Scarring and cavitation of the remnants of the upper lobe; In left upper lobe … Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. 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