Lung Consolidation - Causes, Symptoms, Management and Complications.

Introduction

Lung consolidation is a region of normal lung tissue that is filled with other substances like fluid instead of air. Pulmonary consolidation usually represents an exudate or other products of diseases that replaces the alveolar air and makes the lung solid. It increases lung attenuation and obscures the margins of vessels and walls of the airway.

What Is Lung Consolidation?

Lung consolidation occurs when a normal lung tissue region is replaced with substances like pus, blood, fluid, or other products of diseases. It causes swelling of the normal lung tissues. It occurs due to the accumulation of inflammatory cellular exudate in the alveoli and their adjoining ducts. It is an important diagnostic sign of pneumonia.

What Is the Difference Between Lung Consolidation and Pleural Effusion?

A pleural effusion is the collection of fluid in the pleural space between the chest wall and lungs. It appears as white areas on chest X-ray against the dark air-filled areas in th lungs. Since pleural effusion is a fluid in a space, it moves when the position of the patient changes. A lung consolidation can also be fluid, but it is present inside the lungs, unlike pleural effusion, which is present in the space outside the lungs. Hence, lung consolidation cannot move when the position is changed. This criterion is used to differentiate pleural effusion and lung consolidation. The conditions that cause pleural effusion, like congestive heart failure, pneumonia, and lung cancer, can also cause lung consolidation. Therefore, it is possible to have both pleural effusion and lung consolidation at the same time.

What Are the Causes of Lung Consolidation?

Lung consolidation can be caused by the following causes:

• Pneumonia - Pneumonia is the common cause of lung consolidation. Bacterial, viral, or fungal pneumonia can cause consolidation. Cryptogenic organizing pneumonia and chronic eosinophilic pneumonia cause consolidation. It causes subpleural or patchy areas of consolidation in both lungs. Chronic eosinophilic pneumonia results in the infiltration of eosinophils in the interstitium and results in the formation of consolidated mass.

• Pulmonary Edema - Pulmonary edema is usually caused by congestive heart failure. The fluid from edema can cause consolidation.

• Pulmonary Hemorrhage - Pulmonary hemorrhage is the bleeding in the lungs caused by vasculitis or inflammation of the blood vessels. This causes the blood from the vessels to move into the lungs.

• Aspiration - Aspiration occurs when food particles or other contents from the stomach are breathed into the lungs. Stomach acid or other chemicals can irritate the lungs and cause inflammation.

• Lung Cancer can also cause consolidation.

• Radiation Pneumonitis can cause alveolar damage, acute interstitial pneumonia, and interstitial lymphocytic infiltration. It results in vascular intimal fibrosis and consolidation.

• Churg-Strauss Syndrome - It is a disorder that is caused due to blood vessel inflammation. It causes pulmonary consolidation.

What Are the Signs of Lung Consolidation?

Signs that show the presence of consolidation include:

• Thoracic expansion that occurs on inspiration is reduced on the affected side.

• Increased vocal fremitus (vibration of the vocal cords during speech) on the affected side is observed.

• The affected side presents with dull percussion.

• Bronchial breath sounds are observed.

• Medium, late, or pan-inspiratory crackles (clicking, rattling, or crackling noises during inspiration) are present.

• Increased vocal resonance is noted in which the voice can be clearly heard, as opposed to healthy lungs, where the speech sound is muffled.

• A pleural rub (audible sign present in pleurisy) may be present.

• The alveolar oxygen pressure is lower than that calculated in the alveolar gas equation.

What Are the Symptoms of Lung Consolidation?

The symptoms associated with lung consolidation include:

• Cough with dark green or bloody sputum.

• Hemoptysis (coughing up blood).

• Dry cough.

• Noisy breathing sounds.

• Chest pain or congestion.

• Rapid breathing.

• Fever.

• Fatigue.

What Are the Complications of Lung Consolidation?

Consolidation causes breathing difficulty. Air cannot pass through the consolidation, and gas exchange becomes difficult. This causes shortness of breath. It results in complications like cyanosis (bluish discoloration of the skin) due to lack of oxygen.

How Does Lung Consolidation Appear in Radiographs?

High-resolution computed tomography (HRCT) scan is helpful in the diagnosis of lung consolidation. It appears as white areas in the radiographs.

• Cryptogenic organizing pneumonia presents with unilateral or bilateral areas of consolidation with the subpleural or peribronchial distribution.

• Chronic eosinophilic pneumonia shows the presence of non-segmental areas of airspace consolidation with peripheral predominance.

• Churg-Strauss syndrome presents with a patchy or subpleural distribution of consolidation.

• Radiation pneumonitis presents with lung attenuation and patchy or discrete consolidation.

• Viral pneumonia shows the presence of segmental consolidation.

• Acute interstitial pneumonia presents with patchy or diffuse bilateral ground glass opacity and airspace consolidation.

• Bilateral ground glass opacity and consolidation are seen in diffuse alveolar hemorrhage.

How Is Lung Consolidation Diagnosed?

Radiographs are taken to diagnose lung consolidation. It appears as white, opaque areas on the radiograph. Other tests are also performed to identify the causes. This includes:

• Blood Tests - Blood tests are performed to diagnose pneumonia and to determine blood cell levels.

• Sputum Culture - Sputum test is performed to diagnose the presence of infection and its cause.

• CT (Computed Tomography) Scan - CT scan is performed to determine the characteristic imaging of the consolidation.

• Bronchoscopy - A small tube with a fiber optic camera is inserted into the lungs to obtain samples and to study them.

How Is Lung Consolidation Treated?

The treatment for lung consolidation is based on the cause of consolidation. It includes

• Pneumonia - Medications like antibiotics, antivirals, or antifungals are given against the causative organisms. Medications are also given to treat cough, chest pain, and fever. Purchasing a lung exerciser device can help to clear mucus and in lung expansion.

• Pulmonary Edema - Medications are given to remove the fluid and lower the pressure on the blood vessels.

• Pulmonary Hemorrhage - Steroids and immunosuppressants are given to treat vasculitis and prevent bleeding.

• Aspiration - Antibiotics are given to treat aspiration pneumonia and evaluated and treated for swallowing problems. Steroids are given to treat inflammation in pneumonitis.

• Cancer - Chemotherapy, radiotherapy, or surgical removal is performed to treat lung tumors.

Conclusion

Lung consolidation is a condition that is caused by various factors. It is treated after identifying the underlying illness. It may result in life-threatening complications like shortness of breath. Proper diagnosis and treatment can help in the management of lung consolidation.