Respiratory system and chest
David A Lisle in Imaging for Students, 2012
‘Pulmonary consolidation’ refers to filling of the pulmonary alveoli with fluid (pus, blood and oedema), protein or cells. Radiographic signs of alveolar opacification are described above. Consolidation of a pulmonary lobe or segment is usually due to pneumonia, with other less common causes, such as pulmonary infarct or contusion, usually differentiated on the basis of clinical history. Organisms that commonly cause pneumonia include Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and Mycoplasma pneumoniae. Early subtle areas of alveolar shadowing may progress to dense lobar consolidation. Expansion of a lobe with bulging pulmonary fissures may be seen with Klebsiella. Necrosis and cavitation may complicate severe cases of lobar pneumonia. Small pleural effusions commonly accompany pneumonia. More aggressive organisms, such as Staphylococcus aureus and Pseudomonas may cause more extensive consolidation. This may involve multiple lobes, with cavitation leading to abscess formation. Other complications of pneumonia include empyema and bronchopleural fistula. For further information on pulmonary infections in children, see Chapter 13.
Consolidation, collapse and cavitation
Paul F. Jenkins in Making Sense of the Chest X-ray, 2013
This chapter discusses the radiographic patterns of pulmonary consolidation and illustrates the various pathological processes that can cause it. It also describes the features of partial and complete collapse of the major lobes of the lungs. We are all aware that it may be difficult to decide if there is abnormal parenchymal shadowing on a chest radiograph and most of us will also have missed subtle changes of lobar collapse at some stage in our careers. However, there is a systematic approach to the identification of both consolidation and collapse, and in this chapter I seek to share it. I guarantee that if the system is adopted and practised then eventually ‘pattern recognition’ will take over – in other words, ‘I have seen this pattern of abnormality lots of times before and I know what it is’. However, before any of us reaches this stage of experience, it is vital to be obsessional about following a systematic approach – but then this applies to all aspects of clinical medicine.
Vasculitis
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
Behcet’s disease is relatively more common than Takayasu’s arteritis. Vascular inflammation in Behcet’s disease involves the pulmonary arteries, veins, capillaries, and superior vana cava and may spread to the pleura and mediastinum. Pulmonary involvement is seen in 5% to 10% of patients. The classic presentation is the triad of oral and genital ulcerations and uveitis. Genetic factors and immune complexes are postulated to play a role in pathogenesis (51). The most common pulmonary symptom is hemoptysis. Patients develop multifocal necrotizing vasculitis with diffuse pulmonary hemorrhages, infarction, and organizing pneumonia. Pulmonary hypertension and infarcts can cause fever, malaise, and weight loss (52). Pulmonary consolidation and alveolar infiltrates may be seen. Imaging techniques such as MRI and tomodensitometry can demonstrate the pulmonary vascular lesions.
Pertussis-like syndrome often not associated with Bordetella pertussis: 5-year study in a large children’s hospital
Published in Infectious Diseases, 2020
Qin Xiong, Shiying Hao, Lei Shen, Jian Liu, Tingting Chen, Guoqin Zhang, Yu-juan Huang
This retrospective study was performed at Shanghai Children’s Hospital, Shanghai Jiaotong University School of Medicine. Patients showing signs of pertussis at admission between 1 January 2013 and 31 December 2017 were considered as having PLS and thus included in the study. Signs of pertussis included cough lasting for 14 days or more, together with at least one of the following symptoms: paroxysmal cough, inspiratory whoop, post-cough vomiting, and apnoea with or without cyanosis (for patients less than 1 year old) [24]. Diagnostic criteria of pneumonia complicated with PLS included a) pulmonary consolidation on chest radiographs, b) a history of aforementioned cough, and c) auscultatory findings. Chest radiographs were evaluated based on consultation from radiologists and respiratory physicians. Patients with a history of asthma, chronic cardiac and pulmonary disease, or immunodeficiency were excluded. This study was approved by the Bioethics Review Committee of the Shanghai Children’s Hospital.
Management of pleural infections
Published in Expert Review of Respiratory Medicine, 2018
Lucía Ferreiro, José M. Porcel, Silvia Bielsa, María Elena Toubes, José Manuel Álvarez-Dobaño, Luis Valdés
The term PPE assumes that the origin of pleural effusion is a bacterial infection of the underlying lung parenchyma. However, there is evidence that the microbiological pattern of pleural infection is often different from that of pneumonia, suggesting a different etiology. In addition, in the MIST2 study, 30% of patients with pleural space infection did not show radiological pulmonary consolidation [9]. Yet, pulmonary consolidation might have occurred earlier, thereby triggering pleural effusion, or it might have occurred within an adjacent passive atelectasis. Since pleural effusion is not always due to an underlying pulmonary infection, the term ‘pleural infection’ seems more accurate, whether pleural drainage is needed or not. In this review, the term ‘pleural infection’ will be used to refer to a bacterial infection of the pleural space.
Thoracic endometriosis presented as catamental hemoptysis: a case series of a rare disease
Published in Current Medical Research and Opinion, 2021
Yi Dai, Meng-Hui Li, Yong-Jian Liu, Bing Liu, Yu-Shi Wu, Jing-He Lang, Zhen-Yu Zhang, Jin-Hua Leng
All patients underwent CT scanning during menstruation period and 2 or 3 weeks after periods, and presumed pulmonary lesions could be observed in the CT scans during menstruation. The focal consolidation with a relatively well-defined margin and ground-glass opacity (GGO) (Figure 1(1A, 2A, 3A, 4A, 5A, 6A, 7A)) was observed in CT scanning during menstruation in all patients. The location of the lesions in 7 patients were confined to the right lung, including the middle and lower lobe in 5 cases, whereas the right superior lobe in two cases. The lesion of 4 patients were located in left lung, and 3 patients were confined to the segments of both sides of the lung (Table 2). Conversely, CT scans performed 2–3 weeks after menstruation demonstrated marked improvement of pulmonary consolidation, especially ground-glass opacity (Figure 1(1B, 2B, 3B, 4B, 5B,6B, 7B)) at the same location of the involved segments as in the previous CT scans performed during menstruation (Table 2). For the patients whose lesions were partially absorbed, CT scan was repeated after 3 doses of GnRHa diagnostic treatment, and complete absorption of the original lesions was observed (Figure 1(6C)) (Table 2). Considering the correlation between the episodes of hemoptysis and changes in the series of chest CT scan findings, the possible presence of thoracic endometriosis was suspected.
Related Knowledge Centers
- Bleeding
- Pneumonia
- Pulmonary Artery
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- Fremitus
- Exudate
- Pulmonary Edema
- Radiologic Sign
- Pulmonary Alveolus
- Crackles