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normal (clear and distinct) right hemidiaphragm contour (c.f. 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. 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. Fig. Acute pneumonia is the commonest cause but not the only cause of consolidation. The consolidation is likely to be within the anterior segment of the RUL. Chest radiograph performed on admission shows the typical appearance of right upper lobe collapse. 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 A consolidation could be described as “patchy”, “homogenous”, or generalised”. There is abnormal opacity within the RUL abutting the horizontal fissure. The horizontal fissure, indicated by … The horizontal fissure is elevated. When the fissures are outwardly convex, the appearance is referred to as the bulging fissure sign. 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 She is feeding well. 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. Figure 3. Chest computed tomography demonstrating centrilobular nodules confluent to the right in … The right upper lobe is “too white” and too small. Culture was positive for TB. There was also mild deviation of the trachea to the right, and both mid and lower lung fields were clear with no hilar adenopathy. ( other causes include chronic pneumonia, pulmonary oedema and neoplasm). 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). (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. (2019), 2. The distribution of the consolidation can vary widely. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. If the clinical presentation includes fever, this is most likely pneumonia. 49. Right upper lobe consolidation clearly outlining the horizontal fissure and posterior aspect of the right oblique fissure. Impression: Partial right upper lobe consolidation. The distribution of the consolidation can vary widely. 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. Dense opacity seen above the horizontal fissure. 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. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. 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. 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. Refers to fluid in the airspaces of the lung, Consolidation may be complete or incomplete. 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. A consolidation could be described as “patchy”, “homogenous”, or generalised”. 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 … Thus, the term consolidation and pneumonia have very similar meaning and are almost used interchangeably. 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. Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation. Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. The left image is taken with the patient's arms forward resulting in the soft tissues of the upper arm overlying the upper lobes. The horizontal fissure is normally positioned. Case 1. 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. Case contributed by Dr Maulik S Patel. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. With right upper lobe (RUL) collapse, the collapsed RUL shifts medially and superiorly, resulting in elevation of the right hilum and the minor fissure. Look For; Tubular outlines of the smaller airways. Right upper lobe consolidation – CXR. Chest radiograph showing consolidation in the right upper lobe bulging the fissure. : Specialty: Pulmonology Consolidation - Right upper lobe. 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. Pulmonary edema accompanying mitral regurgitation should be suspected whenever right upper lobe consolidation develops in a patient with known or suspected mitral valve disease. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. % ), P125, R45, BP 75/35, oxygen saturation %... Endotracheal intubation, consolidation may be an increased volume of the lungs help. Have very similar meaning and are almost used interchangeably recurrent bilateral pleural effusion secondary to fluid overload and hence attempts. Ask a Doctor clear and distinct ) right heart border ( c.f chronically! 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