Lung Consolidation

Relevant physical signs

• General
  • Productive cough
  • May not look well
  • Signs of respiratory distress
  • May be warm if vasodilated and having a fever
  • Sinus tachycardia or atrial fibrillation secondary to sepsis
  • Mucous membranes may be dry in hypovolaemic states
• Chest
  • Decreased chest expansion on the affected side
  • Dull percussion note
  • Bronchial breathing on the affected side
  • May have coarse crepitations
  • Increased vocal resonance on the affected side

Differential diagnosis

• Consolidation
• Underlying malignancy
• Bronchiectasis
• Pulmonary fibrosis (would expect crepitations to be fine_
• Pulmonary oedema (if bilateral)

Investigations

• Arterial blood gas, full blood count, renal function
• Chest radiograph to look for consolidation
• Sputum culture and Gram stain
  • CAP: S. pneumoniae, H. influenzae, S. aureus, Klebsiella
  • Atypical CAP: Legionella, mycoplasma, Chlamydia, Coxiella
  • HAP: Klebsiella, E. coli, Pseudomonas, Acinetobacter, S. aureus, fungi

Management

• Basic resuscitative measures: oxygen supplementation, fluid resuscitation
• Early institution of broad-spectrum antibiotics: Augmentin/ceftriaxone + azithromycin for CAP
• Tazocin for HAP
• Consider invasive ventilation if deteriorating clinically