Right upper lobe consolidation

Last revised by Ian Bickle ◉ on 24 Jan 2023

Citation, DOI, disclosures and article data

Citation:

Hacking C, Bickle I, Bell D, et al. Right upper lobe consolidation. Reference article, Radiopaedia.org (Accessed on 07 Jun 2023) https://doi.org/10.53347/rID-66094

DOI:

https://doi.org/10.53347/rID-66094

Permalink:

https://radiopaedia.org/articles/66094

rID:

66094

Article created:

5 Feb 2019, Craig Hacking ◉ ◈

Disclosures:

At the time the article was created Craig Hacking had no recorded disclosures.

View Craig Hacking's current disclosures

Last revised:

24 Jan 2023, Ian Bickle ◉

Disclosures:

At the time the article was last revised Ian Bickle had the following disclosures:

4ways diagostics, I work for this out sourcing company during non NHS hours (ongoing)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Ian Bickle's current disclosures

Revisions:

15 times, by 5 contributors - see full revision history and disclosures

Systems:

Chest

Sections:

Gamuts

Synonyms:

RUL consolidation
Consolidation of the right upper lobe
right upper lobe (RLL) consolidation

Right upper lobe consolidation refers to consolidation in part (incomplete) or all (complete) of the right upper lobe.

pneumonia
pulmonary edema due to preferential edema from a regurgitant jet of blood through the right superior pulmonary vein (secondary to a ruptured papillary muscle or mitral valve prolapse causing acute myocardial infarction) ²
adult respiratory distress syndrome (ARDS)
interstitial pneumonias
pneumonitis
sarcoidosis

Radiographic features

Consolidation is usually obvious on CT with the anatomical location easy to define through visualization of the pleural fissures, however features can be subtle on chest radiography.

Plain radiograph

Features of right upper lobe consolidation on CXR include:

opacification of the right upper zone and/or apex, that may abut and outline the superior margin of the horizontal fissure
- bulging fissure sign: classically described in Klebsiella pneumonia
obscuration of the right superior mediastinal contour (silhouette sign), such as the SVC, right paratracheal stripe and azygos arch
obscuration of the right hilum, particularly the superior hilum
normal (clear and distinct) right heart border (cf. middle lobe consolidation)
normal (clear and distinct) right hemidiaphragm contour (cf. right lower lobe consolidation)
air bronchograms
on lateral CXR: triangular opacification superior and anterior to the right oblique fissure posteriorly and the horizontal fissure anteriorly

General considerations

It must be remembered that the homogeneity of the consolidation will be influenced by any underlying lung disease.

Occasionally with complete lobar consolidation, there may be an increased volume of the affected lobe, rather than the more frequent collapse. When the fissures are outwardly convex, the appearance is referred to as the bulging fissure sign.

A mnemonic to remember the general features of consolidation is A2BC3.