Alveolar consolidation

Figure 9 HRCT scan demonstrates dense alveolar consolidation, multiple nodules, sarcoid galaxies, and traction bronchiectasis. Note the cavitary lesion with a mycetoma. Abbreviation-. HRCT, high-resolution thin-section CT.

Figure 3 Idiopathic chronic eosinophilic pneumonia. CT scan of the chest showing multifocal alveolar consolidation in the periphery of the lung.

Extrinsic lipoid pneumonia may be caused by aspiration of mineral oil-based laxatives or oil nose drops. Histological findings are charactoistic and show abundance of lipid-laden macrophages. Imaging studies typically show alveolar consolidation in the lower lung zones with low-attenuation infiltrates on the CT scan. 

CEP is a disorder characterized by an abnormal proliferation of eosinophils within the lung (68,69). CXRs reveal patchy subpleural alveolar infiltrates with a predilection for the upper lobes, described as the photographic negative of pulmonary edema (69-71). CT demonstrates airspace consolidation in nearly all patients with CEP, with a predilection for the middle and upper lobes and a peripheral distribution (61,71-73) (Fig. 10). GGO are present in >80% of cases... 

Akira et al. examined initial and follow-up CT scans in 40 patients with pulmonary sarcoidosis (95). Predominantly nodular or multiple large nodules disappeared or decreased in size at follow-up. A conglomeration pattern shrank and evolved into bronchial distortion and decline in FEVi/FVC ratio. Interestingly, GGO and consolidation evolved into honeycombing in some patients. Because sarcoidosis has the potential to evolve over time, initial CT features have limited prognostic value (76). However, certain CT features have predictive value. Focal nodules, alveolar opacities, consolidation, or GGO suggest an active inflammatory component that may reverse with therapy (76,85,96). In contrast, distortion of lung parenchyma, coarse or hnear bands, bronchiectasis, cystic radiolucencies, and bullae reflect irreversible fibrosis (78,79,85,96). 

Figure 2 Chest X-ray demonstrating diffuse alveolar opacities with areas of consolidation. Bronchoalveolar lavage revealed pink hemorrhagic fluid that became bloodier as more ahquots of sahne were instilled and recovered.

In the acute phase, chest radiography may be normal during an early phase, but most often shows diffuse or predominantly basal ill-defined air-space consolidation which reflects alveolar filling by various cells (Fig. 13.1). The air-space disease resolves... 

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