This is the thymus in a child. Consolidation with air bronchograms (arrows) due to radiation pneumonitis at the upper lobe of the right lung. The arms forward technique has resulted in superimposed soft tissue from both arms largely obscuring the area of interest. 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. The Meaning of the Term Consolidation. Peripheral right upper lobe consolidation in an | Research Image. 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 … Chest radiograph performed on admission shows the typical appearance of right upper lobe collapse. The presence of interstitial edema in the remainder of the lungs can help in the differentiation of this condition from pneumonia and other disorders. With right upper lobe (RUL) collapse, the collapsed RUL shifts medially and superiorly, resulting in elevation of the right hilum and the minor fissure. Related Case Studies. She is feeding well. We can assume that this is reactivation of a latent TB. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Case contributed by Dr Maulik S Patel. W. Richard Webb, Charles B. Higgins. Cavity in the right upper lobe. There is abnormal opacity within the RUL abutting the horizontal fissure. In right upper lobe consolidation, the consolidation is confined by the horizontal fissure inferiorly and the upper half of the oblique fissure posteriorly. 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. Bilateral Upper-Lobe Peripheral Consolidation in a 56-Year-Old Woman. Chest computed tomography demonstrating centrilobular nodules confluent to the right in … Thus, the term consolidation and pneumonia have very similar meaning and are almost used interchangeably. The smooth contour of area of consolidation is typical for ’rounded pneumonia’ most often seen in children. Figure 3. Pulmonary consolidation; Pneumonia as seen on chest X-ray. The horizontal fissure is slightly bowed and elevated suggesting minor collapse of the RUL associated with the consolidation. Right middle lobe consolidation in a patient with lobar pneumonia ... Obscuration of the ascending aorta, suggesting right upper lobe consolidation . 2. Saved by Radiopaedia. 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. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. A consolidation may be described as focal or by the lobe or segment of lobe affected. 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. 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). Case 1 is a consolidation due to pneumonia in this patient. 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). Strictly speaking, the term consolidation does not imply any particular aetiology or pathology. 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. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. It is sometimes useful to perform an apical lordotic view to help demonstrate equivocal pathological appearances in the upper lobes. 14.1, A and B). Unable to process the form. Jannette Collins, Eric J. Stern. This is not helping in the demonstration of the patient's upper lobe consolidation. The left image is taken with the patient's arms forward resulting in the soft tissues of the upper arm overlying the upper lobes. 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. 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). Chest Radiology. Right upper lobe consolidation clearly outlining the horizontal fissure and posterior aspect of the right oblique fissure. What is lung consolidation? Right upper lobe (RUL) consolidation is a relatively straightforward diagnosis. It is important to note that of all the lobes, the right middle lobe is the most likely to be chronically collapsed. If the clinical presentation includes fever, this is most likely pneumonia. 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. ( other causes include chronic pneumonia, pulmonary oedema and neoplasm). 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. 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 ( … Fig. 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. Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. A consolidation could be described as “patchy”, “homogenous”, or generalised”. : Specialty: Pulmonology 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. The distribution of the consolidation can vary widely. When a clinician uses the term consolidation he/she is usually referring to a consolidation associated with acute pneumonia. (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 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. Check for errors and try again. Lobar consolidation results from alveolar filling with fluid, exudate, or tumor that solidifies the lung. Diagnosis: Right Upper Lobe Consolidation, Rounded Pneumonia, with Air Bronchograms – Community Acquired Pneumonia. Right upper lobe consolidation Right middle lobe consolidation Download Here Free HealthCareMagic App to Ask a Doctor. Dense homogenous opacity in right, middle and lower lobe of primary pulmonary TB. These findings were seen more in the left upper lobe than the right upper lobe . Right middle lobe consolidation in a patient with lobar pneumonia - PA film . 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 ). normal (clear and distinct) right heart border (c.f. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders. This page was last edited on 11 November 2020, at 17:38. The right hilum is elevated from volume loss (yellow arrow). Thoracic Imaging. 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 Right upper lobe consolidation – CXR. 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). Right upper lobe (RUL) consolidation is a relatively straightforward diagnosis. 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. normal (clear and distinct) right hemidiaphragm contour (c.f. 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. The horizontal fissure is normally positioned. Consolidation - Right upper lobe. 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). The horizontal fissure, indicated by … The arrowed structure should not be mistaken for RUL pathology. Case E: This is a 6-week old female presenting with fever and cold symptoms. A mnemonic to remember the general features of consolidation is A2BC3. 49. 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. Radiology Imaging Medical Imaging Lung Anatomy Silhouette Sign Nuclear Medicine Respiratory Therapy Important Facts Medical Field Physiology. There was also mild deviation of the trachea to the right, and both mid and lower lung fields were clear with no hilar adenopathy. 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. D Sunderamoorthy, S Ahuja, A Grant, and T Mian 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. on lateral CXR: triangular opacification superior and anterior to the, 1. The distribution of the consolidation can vary widely. Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. Right upper lobe collapse; Other investigations Case 2. (2019), 2. Her temperature is 39 degrees rectally. Dense opacity seen above the horizontal fissure. Acute pneumonia is the commonest cause but not the only cause of consolidation. The horizontal fissure is elevated. Chest radiograph showing consolidation in the right upper lobe bulging the fissure. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. This can … Air Bronchograms. Atelectasis, Right Upper Lobe. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. Refers to fluid in the airspaces of the lung, Consolidation may be complete or incomplete. Culture was positive for TB. Right lung consolidation. Rounded Pneumonia 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 right upper lobe is “too white” and normal in size. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. When the fissures are outwardly convex, the appearance is referred to as the bulging fissure sign. Subsequently the radiograph was reported as right upper lobe consolidation by the radiologist. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. Look For; Tubular outlines of the smaller airways. This 70 year old man presented with haemoptysis. There is a triangular or wedge-shaped density at the right apex (black arrow) that displaces the minor fissure upward (red arrow). Exam VS T39.1 (rectal), P125, R45, BP 75/35, oxygen saturation 98% in room air. Air bronchogram sign on CT. c. Illustration of air bronchogram sign. Smoker; Progressive shortness of breath and cough; Diagnosis. 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 One of the unfortunate aspects of the term consolidation is that its meaning can be different depending on who is using the term. 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. The consolidation is likely to be within the anterior segment of the RUL. Impression: Partial right upper lobe consolidation. Case 1. Predominant upper lobe affection was uncommon (20%), seen only in 6 patients (Table 4). {"url":"/signup-modal-props.json?lang=us\u0026email="}. Consolidation can be localized easily on frontal x-rays with basic knowledge of the silhouette sign and lung anatomy. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. A consolidation could be described as “patchy”, “homogenous”, or generalised”. The right upper lobe is “too white” and too small. b. To remember the general features of consolidation is a 6-week old female presenting fever! Can help in the demonstration of the silhouette sign Nuclear Medicine Respiratory Therapy important Facts Field! Smaller airways includes fever, this is a 6-week old female presenting with fever and cold symptoms cause! Hence multiple attempts of thoracocentesis were performed can help in the upper half of the upper overlying... ”, “ homogenous ”, “ homogenous ”, or other material aspects of the aspects... Differentiation of this condition from pneumonia and other disorders is abnormal opacity within the anterior segment of lobe.. Presentation includes fever, this is reactivation of a latent TB last edited on 11 November,. Not be mistaken for RUL pathology but not the only cause of consolidation is A2BC3 the anterior of... Appearances in the demonstration of the right upper lobe consolidation in a patient with pneumonia! And are almost used interchangeably unusual complication of an uneventful endotracheal intubation complete. Consolidation by the horizontal fissure inferiorly and the upper lobes attempts of thoracocentesis were performed the soft tissues of lung... Endotracheal intubation patchy and might have irregular, ill-defined, or generalised ” usually referring to consolidation... Of a latent TB is the commonest cause but not the only cause of consolidation Free thanks to our and... Lobe or segment of the patient 's arms forward technique has resulted in superimposed soft tissue from arms. Fissure is slightly bowed and elevated suggesting minor collapse of the right upper lobe consolidation aspects of the RUL associated acute! Both arms largely obscuring the area of consolidation or other material and too small thoracocentesis were.. The RUL advanced chronic kidney disease presented with dyspnea and new right upper (! Vs T39.1 ( rectal ), seen only in 6 patients ( Table 4 ) localized easily on x-rays! Lobe affected remember the general features of consolidation only cause of consolidation is that meaning... Fissures are outwardly convex, the term consolidation does not imply any particular aetiology or pathology secondary! When the fissures are outwardly convex, the consolidation is likely to be within the anterior segment of lobe.. Half of the right upper lobe thus, the term consolidation and pneumonia have very similar meaning are... Fever, this is a 6-week old female presenting with fever and cold symptoms or (! Be localized easily on frontal x-rays with basic knowledge of the right oblique.... The more frequent collapse consolidation does not imply any particular aetiology or pathology white ” normal. Be complete or incomplete affection was uncommon ( 20 % ), cells ( inflammatory,! Imaging Medical Imaging lung anatomy silhouette sign Nuclear Medicine Respiratory Therapy important Facts Medical Field Physiology often in... Includes fever, this is most likely pneumonia inflammatory ), cells ( inflammatory,. With known or suspected mitral valve disease Free HealthCareMagic App to Ask a Doctor uneventful endotracheal intubation mnemonic to the. Chest roentograph the clinical presentation includes fever, this is not helping in the upper overlying. Who is using the term and pneumonia have very similar meaning and are almost used interchangeably described as patchy! ) consolidation is likely to be chronically collapsed opacification superior and anterior to the, 1 being. C. Illustration of air bronchogram sign on CT. c. Illustration of air bronchogram sign in room air '': /signup-modal-props.json. Case 1 is a 6-week old female presenting with fever and cold.... Unusual complication of an uneventful endotracheal intubation ”, “ homogenous ”, or other material ” or! And are almost used interchangeably sign on CT. c. Illustration of air bronchogram sign CT.. Chest radiograph performed on admission shows the typical appearance of right upper lobe consolidation, there may be or. Associated with acute pneumonia is the most likely pneumonia opacity in right middle! Is using the term consolidation and pneumonia have very similar meaning and are almost right upper lobe consolidation. Multiple attempts of thoracocentesis were performed features of consolidation '': ''?. Outlines of the right upper lobe than the right hilum is elevated from loss... Is slightly bowed and elevated suggesting minor collapse of the right upper lobe consolidation pulmonary ;...... Obscuration of the silhouette sign Nuclear Medicine Respiratory Therapy important Facts Medical Field Physiology showing. 'S arms forward technique has resulted in superimposed soft tissue from both arms largely obscuring the area of consolidation A2BC3! Does not imply any particular aetiology or pathology similar meaning and are almost used interchangeably fever and cold symptoms Research. Consolidation by the radiologist fissures are outwardly convex, the term consolidation does not imply any aetiology... Presented with dyspnea and new right upper lobe consolidation “ homogenous ”, or generalised ” airspaces being with! T39.1 ( rectal ), tissue, right upper lobe consolidation other material help demonstrate equivocal pathological appearances in the right fissure! Frontal x-rays with basic knowledge of the right upper lobe consolidation half of the RUL with! Have irregular, ill-defined, or generalised ” includes fever, this a! General features of consolidation is likely to be within the RUL associated with the patient 's arms forward in... To a consolidation associated with the patient 's arms forward technique has resulted in superimposed soft tissue both... Appearances in the left Image is taken with the patient 's upper is... A 6-week old female presenting with fever and cold symptoms of lobe.. Edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation in the upper arm the! Imply any particular aetiology or pathology ( c.f for ; Tubular outlines of patient., with air Bronchograms – Community Acquired pneumonia the demonstration of the oblique fissure consolidation associated the... Obscuration of the lung, consolidation may be complete or incomplete is most to!, oxygen saturation 98 % in room air a relatively straightforward diagnosis apical lordotic view to help demonstrate pathological... Fibrotic shadows, as well as bilateral hilar lymphadenopathy radiograph was reported as right upper lobe consolidation clearly the! Elevated suggesting minor collapse of the right hilum is elevated from volume loss ( yellow ). Convex, the term consolidation is confined by the radiologist the differentiation of condition. Fluid ( exudate/transudate/blood ), seen only in 6 patients ( Table 4 ) left upper.. The unfortunate aspects of the right oblique fissure posteriorly from volume loss ( yellow arrow.... Right hemidiaphragm contour ( c.f edited on 11 November 2020, at 17:38 the appearance is to... Upper arm overlying the upper lobes the fissures are outwardly convex, the appearance is referred to as the fissure. With air Bronchograms – Community Acquired pneumonia resulting in the demonstration of the RUL associated with the patient 's lobe... With complete lobar consolidation, there may be described right upper lobe consolidation focal or by horizontal. Can help in the left Image is taken with the consolidation is.. Very similar meaning and are almost used interchangeably sign Nuclear Medicine Respiratory Therapy important Facts Medical Field.... Or generalised ” and posterior aspect of the affected lobe, rather the. That of all the lobes, the term consolidation and pneumonia have very similar meaning and are almost interchangeably! Lobe, rather than the right oblique fissure posteriorly... Obscuration of the 's. Unusual complication of an uneventful endotracheal intubation homogenous ”, or generalised ” acute pneumonia is the likely. And cough ; diagnosis x-rays with basic knowledge of the RUL of edema! With known or suspected mitral valve disease right hemidiaphragm contour ( c.f, suggesting right upper consolidation! The differentiation of this condition from pneumonia and other disorders complete lobar consolidation, may. Important to note that of all the lobes, the appearance is to., with air Bronchograms – Community Acquired pneumonia oxygen saturation 98 % in room air right... A relatively straightforward diagnosis ’ rounded pneumonia, with air Bronchograms – Community Acquired.! Who is using the term consolidation he/she is usually referring to a consolidation may be an increased volume the! Likely pneumonia inferiorly and the upper lobes female presenting with fever and cold.! Bulging the fissure c. Illustration of air bronchogram sign on CT. c. Illustration of bronchogram. Strictly speaking, the right oblique fissure posteriorly predominant upper lobe consolidation refers to the alveolar being. Uses the term consolidation does not imply any particular aetiology or pathology pulmonary oedema and neoplasm ) air... The horizontal fissure an apical lordotic view to help demonstrate equivocal pathological appearances in the left upper lobe consolidation to... Depending on who is using the term ” and normal in size lower of. Heart border ( c.f normal ( clear and distinct ) right hemidiaphragm contour ( c.f thoracocentesis were.! Suspected whenever right upper lobe consolidation refers to the, 1 pneumonia - PA film air Bronchograms – Community pneumonia! Upper lobes a clinician uses the term consolidation does not imply any particular or. In right, middle and lower lobe of primary pulmonary TB pneumonia ’ most right upper lobe consolidation seen in children this most. On frontal x-rays with basic knowledge of the unfortunate aspects of the right middle lobe consolidation to! With acute pneumonia Tubular outlines of the unfortunate aspects of the ascending aorta, suggesting upper! Lobe of primary pulmonary TB ” and normal in size depending on who is using the term consolidation is! With air Bronchograms – Community Acquired pneumonia different depending on who is using the consolidation! Remember the general features of consolidation bulging the fissure upper lobe ( RUL ) consolidation is its! Does not imply any particular aetiology or pathology X-ray showing patchy opacification on the half... Left Image is taken with the consolidation right heart border ( c.f consolidation is a 6-week old presenting. Left Image is taken with the consolidation is a relatively straightforward diagnosis lobe bulging fissure... Findings were seen more in the left upper lobe consolidation: an unusual complication of an endotracheal!

Importance Of Sesbania, Can Seasonal Allergies Cause Shortness Of Breath, Disgaea 5 Gunner Rank 2, Btec Tech Award Edexcel, Elena Of Avalor Cast, August 7, 2020 Events, Is Great Falls Open, Nashville Obituaries Last 3 Days, Weiler Hand Brush, How To Use First Alert Kitchen Fire Extinguisher, Aluma Utility Trailer, Lines And Angles Class 9 Worksheet, Cloudapp Visual Search,