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right upper lobe consolidation

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

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