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Atelectasis and pulmonary consolidation are two different conditions that affect the lungs. Differentiating between the two can be a tricky affair and is done by examining x-rays or CT scans of the lungs. To understand the difference between the two conditions it is first necessary to have some understanding of the causes and symptoms of the two conditions.

Atelectasis is a term used to describe the partial or in rare instances, the complete collapse of a lung. It is caused by a blockage of the airways or bronchioles or by pressure exerted on the lung from the outside. It has been observed commonly in patients who have been hospitalized or have undergone surgery. Anesthesia, foreign objects that block the airways, lung diseases, mucus plugs, pressure on the lungs due to fluid buildup, prolonged bed rest and tumors blocking airways are some of the factors that increase the risks of developing atelectasis. The symptoms of atelectasis include difficulty in breathing, chest pain and cough.

Pulmonary consolidation on the other hand, is a symptom of lobar pneumonia. It is a term used to describe a region of the lung tissue which has filled with liquid and is characterized by a swelling or a hardening of the normally soft lung tissue. It is considered to be a radiological sign that occurs due to the accumulation of inflammatory cellular exudate in the alveoli and the adjoining ducts. The fluid may be pulmonary edema, an inflammatory exudate, pus cells, blood or even water or fluid that has been inadvertently inhaled. Signs that indicate that consolidation may have taken place include:

• The affected side of the thorax will show a reduced expansion on inhalation
• Breathing sounds are bronchial
• The affected side will exhibit increased vocal fremitus, which is a typical vibration felt on palpitating the affected area
• Percussion is dull in the affected area
• There is increased vocal resonance which can be detected with the help of a stethoscope
• Using a stethoscope may also reveal the presence of a “pleural rub”.

Examining x-rays of the two conditions will also reveal differences. In the case of atelectasis, an x-ray will reveal the following:

• Loss of lung volume can be detected
• Several segments of the affected lung will show an opaqueness starting from the hilum
• Shift of structures such as the interlobar fissures or the hilum towards the side with volume loss
• A crowding of the ribs may be detected
• Elevation of the hemi diaphragm
• The adjoining lung may show signs of hyperinflation as a compensatory measure

In the case of pneumonia where pulmonary consolidation has occurred, the x-rays will reveal the following:

• The lung volume is unaffected
• The bronchioles and the alveoli are clogged with microorganisms, bacteria, white cells and inflammatory debris
• There is no shift of structures towards the affected regions as evinced in atelectasis
• There is no crowding of ribs
• Masses that are radiopaque such as tumors may be difficult to differentiate from the opaqueness of consolidation, but are more clearly defined
• Air bronchograms may be detected
• In the case of aspirated pneumonia, the affected lobes will be dependent on the flow of aspirated contents under the influence of gravity
• Destruction of lung tissue or the presence of abscesses may be detectable

The approach to treatment for both these conditions will also differ. In the case of atelectasis, the goal of treatment is to re-expand the collapsed lung tissue. It may involve percussion on the chest to loosen mucus plugs, aspirating fluid that may be exerting pressure on the lung, bronchoscopy to remove blockages, treating tumors if any or using aerosol based inhalants to open the airways. The prognosis is usually good, especially in the milder cases. In severe cases, complications such as pneumonia may occur.

Treatment for pneumonia involves the use of antibiotics given either orally or intravenously, oxygen therapy and other breathing treatments.

References:

• http://www.aic.cuhk.edu.hk/web8/Very%20BASIC%20CXR%20lungs.htm
• http://www.umm.edu/ency/article/000065all.htm

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