Consolidation – Radiology | Lecturio


[Music] so now let’s discuss one of the most common abnormalities seen on a chest x-ray and that is consolidation so what is consolidation it’s a type of airspace disease so it causes filling of the alveolar spaces on a chest x-ray it appears to have indistinct margins and it presents as fluffy opacities that become confluent over time so if you take a look at this chest x-ray here this area that’s white is an area of consolidation consolidation can occur for many different things the four major things are blood were hemorrhage within the alveolar spaces pus which is an example of pneumonia water which can fill at the alveolar spaces as a result of pulmonary edema and cells from carcinoma so let’s go over some signs of consolidation when you have an area of consolidation it appears white as we saw on a chest x-ray and it may contain what we call air Branko grams so the air that normally surrounds the bronchi becomes ou pacified and appears white while the bronchi remain air filled so it makes them appear like black tubular structures within the area of consolidation so you can see here this area is the area of consolidation in the left upper lobe within this you see these linear black tubular structures that represent air Branko grams and this is one of the key features of consolidation so now let’s talk about the silhouette sign this was briefly mentioned in one of our introductory lectures and it’s a very common radiological sign it occurs when two objects of the same density touch each other so that the margin between the two can no longer be visualized so if you look here there’s an area of consolidation involving the right middle lobe and you can see that the right heart border is no longer visible so the area of consolidation is silhouetting the right heart border and again this occurs because the consolidation is of equal density to the heart and now you can no longer see the margins between the two the spine sign is another sign that we can see with consolidation so in general the thoracic spine gets darker as we get closer to the diaphragm however if there is a lower lobe consolidation the x-ray beam has to penetrate the consolidation and the spine making it appear wider so this is an example of summation of shadows so when you have multiple shadows overlapping each other the area appears wider than you would normally expect so pneumonia can be either localized or diffuse it can also be airspace or interstitial so there are a variety of different ways that pneumonia can present and pneumonia is one of the most common causes of consolidation so let’s go over some signs of pneumonia and some patterns that we may see so these patterns are important to kind of keep in your mind because they come up relatively often and then you can see what the pattern represents so let’s take a look at this frontal chest x-ray what do you see here and as we go through this lecture feel free to pause and take a good look at the at the images so this is an example of right upper lobe consolidation the consolidation abuts the major fissure which produces a sharp margin inferior Li here and it involves the entire right upper lobe you can see that it’s silhouettes the mediastinum on the right so where do you think this consolidation is located we have a frontal and a lateral view in a patient that’s presenting let’s say with cough so this is an example of right middle lobe consolidation so on the frontal view the right heart border is still awaited so that we don’t see it anymore and on the lateral view a middle lobe consolidation will overlap the heart so if you look here the heart appears brighter than it normally would and that’s because this consolidation that you see on the frontal view is located adjacent to the heart anteriorly on the lateral view and this is very typical of a right middle lobe consolidation let’s take a look at this pattern so this patient is also presenting with a consolidation where do you think this consolidation is located which part of the lung do you think it’s in so we have silhouetting of the right hemidiaphragm this is what a right lower lobe consolidation would look like so remember to differentiate between a right middle lobe consolidation and a right lower lobe consolidation on a frontal view the right middle lobe consolidation will silhouette the right heart border while the right lower lobe consolidation will silhouette to the right hemidiaphragm how about this chest x-ray where do you think this consolidation is located so this is an example of a left upper lobe consolidation which again silhouettes the left side of the upper mediastinum in this one you can actually see some of the classic signs of air Bronco Grahams and what do you see on this one so here we have silhouetting of the left heart border you can see that the right heart border is pretty clearly visualized while the left heart border has a sharp margin here and then all of a sudden becomes somewhat hazy here so this is an example of a linger consolidation so the Lingala is actually a portion of the left upper lobe if you recall however it’s in the same location as the right middle lobe so it’s somewhat a separate structure although technically it’s considered part of the left upper lobe so what do we see here this is an example of left lower lobe consolidation so we have silhouetting of the left hemidiaphragm here so you can see a sharp margin here on the right however the left hemidiaphragm which is normally visualized through the heart is no longer seen so this is a left lower lobe consolidation [Music] you

Leave a Reply

Your email address will not be published. Required fields are marked *