Pulmonary Consolidation

Clinical Presentation

Dyspnea is present in approximately 80% of patients with pulmonary consolidation, according to the European Society of Cardiology 1
Chest pain, including pleuritic chest pain (52% of cases) and retrosternal chest pain (12% of cases), is a common symptom of pulmonary consolidation, as reported by the European Society of Cardiology 1
Cough is present in 20% of patients with pulmonary consolidation, as noted by the European Society of Cardiology 1
Hemoptysis occurs in approximately 11% of cases of pulmonary consolidation, according to the European Society of Cardiology 1
Syncope may present in 19% of patients, especially in extensive consolidations, as reported by the European Society of Cardiology 1
Tachypnea (>20 breaths/min) is present in 70% of cases, and tachycardia (>100 beats/min) is observed in 26% of patients with pulmonary consolidation, according to the European Society of Cardiology 1
Fever (>38.5°C) is present in 7% of cases, more common in infectious etiology, as noted by the European Society of Cardiology 1
Cyanosis is visible in 11% of patients with pulmonary consolidation, as reported by the European Society of Cardiology 1

Dullness to percussion is a characteristic of the consolidated area, although no specific citation is provided for this fact
Increased transmission of vocal vibrations (fremitus) and tubular breath sounds or bronchial breath sounds are common physical examination findings in patients with pulmonary consolidation, although no specific citation is provided for these facts
Bronchophony, egophony, and pectoriloquy are also observed in patients with pulmonary consolidation, although no specific citation is provided for these facts
Crackles are especially present in the borders of the consolidation, although no specific citation is provided for this fact

Air bronchogram is visualized as lines of air-filled bronchi within the consolidated area, as reported by the European Society of Cardiology 1 and the Society of Critical Care Medicine 2
Diaphragmatic elevation is present in 36% of cases, and associated pleural effusion is visible in 46% of patients with pulmonary consolidation, according to the European Society of Cardiology 1
Pleural-based opacity (infarct) is observed in 23% of cases, as reported by the European Society of Cardiology 1
Subpleural hypoechoic region or tissue-like echotexture is a characteristic ultrasound finding in pulmonary consolidation, as noted by the Society of Critical Care Medicine 2
High sensitivity (93-96%) for detecting pulmonary consolidation is reported with ultrasound, according to the American College of Radiology 3 and the Society of Critical Care Medicine 2
Higher sensitivity than radiography for detecting consolidation is observed with CT scans, as reported by the American College of Radiology 4
Areas of increased attenuation that obscure pulmonary vessels are characteristic of pulmonary consolidation on CT scans, although no specific citation is provided for this fact
Air bronchogram is more clearly visualized on CT scans than on radiography, as reported by the American College of Radiology 4
CT scans permit better characterization of the extension and distribution of the consolidation, according to the American College of Radiology 4

Pulmonary embolism with pulmonary infarcts is a possible etiology of pulmonary consolidation, as reported by the European Society of Cardiology 1
Pneumonia, pulmonary edema, pulmonary hemorrhage, acute respiratory distress syndrome (ARDS), and aspiration can cause lung consolidation 2
Organizing pneumonia, malignancy, granulomatous diseases, alveolar proteinosis, and lipoid pneumonia can also cause lung consolidation 2

The presence of consolidation in patients with chronic obstructive pulmonary disease (COPD) is associated with higher mortality, although no specific citation is provided for this fact
Lung ultrasound allows monitoring of the resolution of the consolidation and the response to treatment, as reported by the Society of Critical Care Medicine 2
Management depends on the underlying cause, with appropriate antimicrobial therapy for infectious consolidation, diuretics and treatment of underlying cardiac condition for cardiogenic pulmonary edema, corticosteroids for organizing pneumonia, and oncologic treatment for malignancy 2
When evaluating lung consolidation, consider infectious causes, non-infectious inflammatory causes, vascular causes, neoplastic causes, and other causes such as atelectasis, aspiration, and radiation pneumonitis 2, 5, 6
The stages of lung consolidation include early/ultra-early stage with patchy ground-glass opacities, early stage with multiple scattered patchy or agglomerated ground-glass opacities, rapid progression stage with fused large-scale consolidation, consolidation stage with multiple patchy consolidations, and dissipation stage with reduced consolidation 5