Consolidation with air bronchograms (arrows) due to radiation pneumonitis at the upper lobe of the right lung. Right middle lobe consolidation in a patient with lobar pneumonia - PA film . Air Bronchograms. ( other causes include chronic pneumonia, pulmonary oedema and neoplasm). Case E: This is a 6-week old female presenting with fever and cold symptoms. 14.1, A and B). The smooth contour of area of consolidation is typical for ’rounded pneumonia’ most often seen in children. on lateral CXR: triangular opacification superior and anterior to the, 1. 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. 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 ). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Culture was positive for TB. W. Richard Webb, Charles B. Higgins. Her temperature is 39 degrees rectally. Air bronchogram sign on CT. c. Illustration of air bronchogram sign. Bilateral Upper-Lobe Peripheral Consolidation in a 56-Year-Old Woman. 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. Case contributed by Dr Maulik S Patel. 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. Exam VS T39.1 (rectal), P125, R45, BP 75/35, oxygen saturation 98% in room air. Lobar consolidation results from alveolar filling with fluid, exudate, or tumor that solidifies the lung. The Meaning of the Term Consolidation. What is lung consolidation? If the clinical presentation includes fever, this is most likely pneumonia. It is sometimes useful to perform an apical lordotic view to help demonstrate equivocal pathological appearances in the upper lobes. 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. Consolidation can be localized easily on frontal x-rays with basic knowledge of the silhouette sign and lung anatomy. The right upper lobe is “too white” and too small. Saved by Radiopaedia. normal (clear and distinct) right hemidiaphragm contour (c.f. 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 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.. 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). Diagnosis: Right Upper Lobe Consolidation, Rounded Pneumonia, with Air Bronchograms – Community Acquired Pneumonia. 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). Right upper lobe consolidation. Pulmonary consolidation; Pneumonia as seen on chest X-ray. Atelectasis, Right Upper Lobe. Related Case Studies. 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). {"url":"/signup-modal-props.json?lang=us\u0026email="}. Subsequently the radiograph was reported as right upper lobe consolidation by the radiologist. Chest x-ray showing patchy opacification on the upper right and mid-zone lung with fibrotic shadows, as well as bilateral hilar lymphadenopathy. Rounded Pneumonia This can … The arms forward technique has resulted in superimposed soft tissue from both arms largely obscuring the area of interest. 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 horizontal fissure, indicated by … Right upper lobe consolidation Right middle lobe consolidation Download Here Free HealthCareMagic App to Ask a Doctor. Case 1. normal (clear and distinct) right heart border (c.f. Case 1 is a consolidation due to pneumonia in this patient. 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). When a clinician uses the term consolidation he/she is usually referring to a consolidation associated with acute pneumonia. 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. 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 hilum is elevated from volume loss (yellow arrow). This is the thymus in a child. The distribution of the consolidation can vary widely. The horizontal fissure is normally positioned. Chest computed tomography demonstrating centrilobular nodules confluent to the right in … Unable to process the form. Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe. The horizontal fissure is elevated. The horizontal fissure is slightly bowed and elevated suggesting minor collapse of the RUL associated with the consolidation. : Specialty: Pulmonology A mnemonic to remember the general features of consolidation is A2BC3. Dense opacity seen above the horizontal fissure. It is important to note that of all the lobes, the right middle lobe is the most likely to be chronically collapsed. 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. Fig. Jannette Collins, Eric J. Stern. Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. One of the unfortunate aspects of the term consolidation is that its meaning can be different depending on who is using the term. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. Predominant upper lobe affection was uncommon (20%), seen only in 6 patients (Table 4). Right lung consolidation. b. 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 list of causes of consolidation is broad and includes: 1. pneumonia 2. adult respiratory distress syndrome (ARDS) 3. interstitial pneumonias 4. pneumonitis 5. sarcoidosis Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. Dense homogenous opacity in right, middle and lower lobe of primary pulmonary TB. This is not helping in the demonstration of the patient's upper lobe consolidation. 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 ( … The right upper lobe is “too white” and normal in size. 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 … Check for errors and try again. 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