Pulmonary Consolidation
February 15th, 2021
On this page:Lobar ConsolidationDiffuse ConsolidationSilhouette SignsAir BronchogramsBat-Wing Appearance
Overview
Look For
- Opacification obscuring pulmonary vessels
- Silhouette signs - obliteration of normally clear outlines between lung fields and adjacent structures
- Air bronchograms - tubular outlines of smaller airways
- No loss of lung volume
Significance
- Consolidation indicates filling of the alveoli and bronchioles in the lung with pus (pneumonia), fluid (pulmonary oedema), blood or neoplastic cells.
Causes of Pulmonary Consolidation
- Pneumonia - lobar pneumonia, bronchopneumonia, fungal pneumonia, viral pneumonitis
- Fluid - pulmonary oedema (cardiogenic / non-cardiogenic)
- Neoplasm - primary lung cancer, metastases, lymphoma
- Vascular - pulmonary haemorrhage, contusion or infarct; septic embolism
- Inflammation - systemic lupus erythematosus, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangitis, Goodpasture's syndrome, Henoch-Schonlein purpura
- Cryptogenic organising pneumonia
- Eosinophilic pneumonia
- Pulmonary alveolar proteinosis
- Aspiration pneumonitis
- Sarcoidosis
Lobar Consolidation
Look For
- Consolidation of a single pulmonary lobe, without crossing any pleural lines.
Causes of Lobar consolidation
- Lobar pneumonia
- Neoplasm - lung cancer, lymphoma
- Vascular - pulmonary haemorrhage, pulmonary infarction
- Cryptogenic organising pneumonia
- Eosinophilic pneumonia
- Sarcoidosis
Example
- Right middle lobe consolidation in a patient with lobar pneumonia - PA film
![Right middle lobe consolidation in a patient with lobar pneumonia - PA film]()
- Right middle lobe consolidation in a patient with lobar pneumonia - lateral film
![Right middle lobe consolidation in a patient with lobar pneumonia - lateral film]()
Diffuse Consolidation
Look For
- Consolidation affecting multiple pulmonary lobes.
Example
- Diffuse consolidation in a patient with tuberculosis
![Diffuse consolidation in a patient with tuberculosis]()
Causes of Multifocal Consolidation
- Pulmonary oedema
- Infection - bronchopneumonia, fungal pneumonia, viral pneumonitis, tuberculosis
- Vascular - septic embolism
- Inflammation - systemic lupus erythematosus, granulomatosis with polyangiitis, Goodpasture's syndrome, Henoch-Schonlein purpura
- Tumour - primary lung cancer, lymphoma, metastases
- Pulmonary alveolar proteinosis
- Aspiration pneumonitis
Silhouette Signs
Look For
- Obliteration of normally clear outlines between the lung fields and adjacent structures such as the heart, aorta or hemidiaphragm.
Significance
- Loss of normal borders appears when the adjacent area of lung is consolidated or collapsed.
Interpretation
- Upper right heart border / ascending aorta - anterior right upper lobe
- Upper left heart border - anterior left upper lobe
- Aortic knob / arch - apical left upper lobe
- Right heart border - right middle lobe
- Left heart border - lingular lobe
- Anterior hemidiaphragms - lung bases / lower lobes
Examples
- Obscuration of the right hemidiaphragm suggesting right lower lobe consolidation
![Obscuration of the right hemidiaphragm suggesting right lower lobe consolidation]()
- Obscuration of the left hemidiaphragm suggesting right lower lobe consolidation
![Obscuration of the left hemidiaphragm suggesting right lower lobe consolidation]()
- Obscuration of the ascending aorta, suggesting right upper lobe consolidation
![Obscuration of the ascending aorta, suggesting right upper lobe consolidation]()
Air Bronchograms
Look For
- Tubular outlines of the smaller airways.
Significance
- Appear when the alveoli surrounding the airway collapse or are filled with fluid.
Causes of Air Bronchograms
- Pneumonia
- Atelectasis
- Pulmonary oedema
- Acute respiratory distress syndrome
- Bronchoalveolar carcinoma
Bat-Wing Appearance
Look For
- A central, peri-hilar distribution of consolidation on chest x-ray.
Significance
- The bat-wing appearance is classically a sign of pulmonary oedema.
Example
- Batwing opacities consistent with acute pulmonary oedema
![Batwing opacities consistent with acute pulmonary oedema]()
Causes of Bat-Wing Appearance
- Pulmonary oedema (cardiogenic / noncardiogenic)
- Atypical infection - PJP, fungal pneumonia
- Aspiration pneumonitis
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