1. Consolidation

2. What is consolidation? Something replacing air within the alveoli
The diagnosis depends on what this “something” is:
Pus (pneumonia)
Blood (contusion)
Water (pulmonary oedema)
Acid (aspiration)
The CXR features of these conditions can be identical, and so clinical correlation is vital for diagnosis

3. Clinical Case: A 20 year old male is admitted to AMAU with fever, rigors, pleuritic chest pain and a cough productive of rusty coloured sputum
Look at his CXR on the next slide. What is the diagnosis?

5. Consolidation in right lower zone
Diagnosis = right lower lobe pneumonia

6. What causes this appearance?
Another example of consolidation
What causes this appearance?
The alveoli are full of fluid (pus), but the adjacent small airways remain aerated. Fluid is more dense than air and stops more x-rays, appearing grey. The result is a mottled appearance; sometimes dark branching bronchioles (“air bronchograms”) can be seen, outlined by the adjacent fluid-filled alveoli.

7. How to tell which lobe has consolidation
Different lobes lie next to different structures (see presentation “Atelectasis”)
A consolidated lobe has a similar density to soft tissue
If two structures with similar densities lie next to each other, the boundary normally seen on CXR is blurred or lost completely

8. Can’t see... Site of consolidation
Left diaphragm
Right diaphragm
Left cardiac border
Right cardiac border
Left lower lobe
Right lower lobe
Left upper lobe
Middle lobe
Example on next slide…

9. This is lingular (left upper lobe) consolidation
This is lingular (left upper lobe) consolidation. See how the normally clear boundary between the left heart border and the consolidated lung is blurred

10. Take Home Points Several conditions can cause consolidation
The diagnosis depends on information gained from history, physical examination, laboratory tests and the CXR
It is often possible to localise the consolidation to a particular lobe