Consolidation, Atelectasis, Mediastinum, and Hila Flashcards
What are the four causes of lung consolidation?
- Water
- Pus
- Blood
- Cells
What are the water causes of diffuse lung consolidation?
- Cardiogenic (hydrostatic) Pulmonary edema (Heart, Liver, Renal, Volume)
- Noncardiogenic (increased permeability) pulmonary edema (ARDS, Drug, Blood Reaction)
- Mixed Edema (emboli, surgical, reexpansion/perfusion, tocolysis)
Big features are volume overload states, ARDS, embolic disease, and iatrogenic
What are the blood causes of diffuse lung consolidation?
- Aspiration
- Bleeding Sensitivity (AC, Chemo, Cancer, low PLTs)
- Collagen disease
- Trauma
- Vasculitis (SLE, Behcets, Antiphospholipid, Wegener, Henoch-schonlein, etc)
Bigs things here are causes that effects the bleeding, vessel injury or predisposition, and direct aspiration
What are the pus causes of diffuse lung consolidation?
- PNA (bacteria, TB, NTB, fungal»_space; viral)
Infection really is the only cause. Can’t have pus without infection
What are the cell causes of diffuse lung consolidation?
- Neoplastic (adenocarcinoma, lymphoma)
- Eosinophilic PNA
- Interstitial Disease (OP, NIP, DIP)
- Granulomatous disease (sarcoid)
Either mutated cells, inflammatory, or interstitial
What are the other substances that can cause diffuse lung consolidation?
- alveolar proteinosis
- Lipoid pneumonia
Lipid or protein.
What type of consolidation pattern is this?
Perihilar, or bat wing
Note the sparing of the periphery.
In rapid pulmonary edema, which consolidation pattern is most evident?
Perihilar, as the peripheral lung has better lymphatic clearance
What are the causes of perihilar consolidation?
- Pulmonary edema (both hydrostatic and permeability)
- Hemorrhage
- PNA (bacterial, PCP, viral)
- inhalational injury
Think of any pulmonary edema, as it is considered diffuse, blood (vessels are close to hilum), Infection always, or inhalation (you get more damage to the larger bronchi)
What is the pattern of consolidation?
Peripheral, or subpleural consolidation
What are the causes of peripheral consolidation?
- Eosinophilic PNA
- Organizing PNA
- Sarcoid
- Radiation
- Trauma (contusion)
- Neoplastic (mucinous adenocarcinoma)
EOS (infective, inflammatory) - NTR (non inflammatory/infectious)
Complicated, but classically, Eosinophilic PNA is the key. Think of pleural diseases/injury (trauma, mucinous adenocarcinoma, radiation). Also multiple peripheral consolidations in sarcoid.
What is the pattern of consolidation?
Diffuse Patchy consolidation
These consolidations can include lobules, subsegements or segments.
What are the causes of diffuse patchy consolidation?
- Any PNA
- Pulmonary edema (diffuse)
- ARDS
- Aspiration/inhalation
- Eosinophilic
- Neoplastic
Pretty much anything that can cause diffuse consolidation is the same.
What is the pattern of consolidation?
Diffuse air-space nodules
This is an example of bronchopneumonia
What are the causes of diffuse air-space nodules?
- Infection (TB, MAC, Bronchopneumonia, Viral)
- Neoplastic (adenocarcinoma with endobronchial spread)
- Hemorrhage
- Aspiration
Multiple nodules think of infection, then neoplastic, then less likely blood or aspiration
What are the broad causes of focal consolidation
- Water (edema, uncommon)
- Blood (hemorrhage, also uncommon)
- Pus (PNA)
- Cells (neoplastic)
- Other substances (lipoid pneumonia)
This is numerous, nearly the exact same causes as diffuse consolidation, however pulmonary edema and hemorrhage as much less likely
What are the water causes of focal consolidation?
- Heart and vessel (papillary muscle rupture if RUL, PE, hypoplastic PA, Swyer-James, pulmonary vein occlusion, systemic to pulm artery shunt)
- Iatrogenic (decubitus, re-expansion)
- Aspiration
- Drowned lung atelectasis
Remember, water causes are extremely uncommon, so knowing this is extremely low yield.
What are the blood causes of focal consolidation?
- Trauma (contusion)
- Infarction
- Aspiration
- Vasculitis
What are the pus causes of focal consolidation?
- PNA (all organisms»_space; viral, PCP)
- Aspiration
- Atelectasis from post obstructive PNA
Pretty much all infection and sequelae
What are the other substances causes of focal consolidation?
Lipoid pneumonia
Still very rare, low yield.
What are the main causes of single lobe or more than one lobar consolidation?
PNA versus bronchial obstructive causes
can include neoplastic
How can you localize lobar consolidation?
By the fissures on radiograph if apparent, or CT
What is the pathophysiology of lobar consolidation due to pneumonia?
anatomic structure, border
interalveolar spread of disease via pores of kohn until fissure or pleural surface reached.
What is the pathophysiology of lobar consolidation due to neoplastic disease?
specific name
Lepidic growth using the alveolar walls as a scaffold
What is the differential diagnosis of bronchial obstruction?
- Neoplastic
- enlarged lymph node
- Inflammatory lesion
- stricture
- foreign body
These should be very apparent. Think of things that block holes.
What type of consolidation can a patient with acute MI present with?
Right upper lobe consolidation
Papillary Muscle rupture and mitral valve prolapse. This is due to pulmonary edema seconday to regurgitant blood flowing into the right superior pulmonary vein
What are the causes of round or spherical consolidation?
- Neoplastic
- Round PNA (early lobar PNA)
What is the relationship between round and lobar pneumonia?
Organisms invade through the pores of kohn to eventually involve the entire lobe.
How do you define a segmental or subsegemental pneumonia?
By definition, a wedge-shaped opacity of a few centimeters with the apex pointing toward the hilum
