Revision 33 for 'Air-space opacification (summary)'

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Air-space opacification (summary)

Air-space opacification is a descriptive term that refers to filling of the pulmonary tree with material that attenuates x-rays more than the surrounding lung parenchyma. It is equivalent to the pathological diagnosis of pulmonary consolidation.

Reference article

This is a summary article; read more in our article on air-space opacification.

Summary

  • anatomy
  • pathophysiology
    • material fills the lung parenchyma
      • fluid: pulmonary edema 
      • pus: pneumonia
      • blood: pulmonary hemorrhage
      • cells: cancer
      • protein: alveolar proteinosis (rare)
    • appearance
      • patchy
        • air-space filling is incomplete and non-contiguous
        • residual gas within the alveoli
      • lobar
        • complete filling of a lobe of the lung
        • clear delineation between consolidation and adjacent gas-filled structures
          • the remainder of the lung or in bronchi traveling through the lobe
        • no margin between consolidation and other soft-tissue density structures
          • mediastinum or diaphragm
    • distribution
      • multi-focal
        • symmetrical or asymmetrical
        • peri-hilar or peripheral
        • often non-specific without clinical history and examination findings
  • common pathology

Imaging

chest x-ray | CT chest

  • role of imaging
    • confirm air-space opacification
    • help to determine the cause, e.g. other signs of heart failure
    • identify complications, e.g. abscess formation
    • demonstrate accompanying pathology, e.g. effusion or empyema
    • determine severity, e.g. number of lobes involved
  • radiographic features
    • chest x-ray
      • the normal air-filled lung is black
      • air-space opacification is radio-opaque (white)
      • aerated bronchi
    • CT chest
      • air-space opacification looks very similar to the chest x-ray
        • distribution can be assessed more accurately
        • assessment of complications is more accurate

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