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Journal of Bioequivalence & Bioavailability
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DOI: 10.4172/0975-0851.1000374
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ISSN: 0975-0851 y
Case Report Open
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Case Presentation on Diagnosis and Treatment of Pulmonary Consolidation
Sekhar Jyoti Deka* and Chitralekha Baruah
Department of Medicine, Guwahati Medical College and Hospital, India
Abstract
A pulmonary consolidation is a case where the lung tissues gets filled with fluid instead of air. The person suffers
from a condition of induration (inflammation or thickening of soft tissue) of lung where left lower lobe (LLL) is more
prone to consolidation. The case includes all the examination leading to the findings of the disease, symptoms, and
the treatment. The patient’s records have been kept confidential and private.
Keywords: Diagnosis; Pulmonary consolidation; Past illness The patient is a non-vegetarian and consumes an average rice-
based Assamese diet 3 times a day. He takes one minor meal a day
Case Details consisting of tea and biscuits. He does not take alcohol, nor does he
smoke but chews betel nut occasionally.
Symptoms
The patient lives in a mud house consisting of 2 living rooms and
- Fever for 5 days
a separate kitchen. The rooms are well ventilated. Cooking is done
- Cough for 5 days in firewood. They intake water from tube-well after filtration. Waste
disposal is in community pits. They don’t keep any pets at home.
- Breathlessness for 3 days
There is no history of long term use of any drugs. The patient is not
History of present illness known to be allergic to any known ingestant, inhalant or contactant.
The patient complains of fever for the last 5 days. It was gradual General Examination
in onset and continuous in nature. The fever was not documented
but it was severe in intensity and associated with chills. It remains all The patient is average built, having a height of 170 cm and weight
throughout the day and subsides only on taking medication. The fever of 62 kg, conscious, alert, co-operative and well oriented to time, place,
was associated with sweating and headache and was not associated with and person.
rash or burning micturition. - Pulse: 106/min, regular in rhythm, volume is normal, character
There was also history of cough for the last 5 days which was gradual is normal, condition of the arterial wall is normal, no radio-radial
in onset and progressive in nature. The cough was dry initially but after or radio-femoral delay, all the peripheral pulses are bilaterally and
2 days, it was associated with sputum production 4 to 5 times daily. symmetrically palpable.
The sputum was rusty coloured, amount was half a teaspoonful with - Respiratory Rate: 32/min, regular, abdominothoracic in type
no foul odour. The cough got aggravated mostly on exposure to cold
and on lying down and got relieved on sitting. There was no passage of - Temperature: 101˚F in right axilla
blood in the sputum. - BP: 110/70 mm of Hg in the right upper arm in supine position
The patient also complains of breathlessness for the last 3 days, Systemic Examination
which was gradual in onset. There was no diurnal variation and
postural variation. The difficulty in breathing was relieved only on Examination of respiratory system
taking oxygen after being admitted to the hospital.
The shape and size of the chest is showing normal and bilaterally
There was history of anorexia with generalized body weakness and symmetrical, but movement of the chest has diminished on left side.
no history of chest pain, palpitation, hoarseness of voice, pain abdomen Accessory muscles of respiration were working fine with no signs of
or vomiting. His bowel and bladder habits are normal. No significant volume loss nor scar/pigmentation/engorged vein/sinus over the skin
weight loss. Sleep is disturbed due to cough. of the chest [1].
History of past illness Palpation:
There is no history of similar illness in the past. The patient suffered -Temperature: increased
from malaria 4 months back from which he recovered after taking
medications. He is not a known diabetic or a hypertensive. There is no
history of tuberculosis, asthma, jaundice or any surgery. The patient *Corresponding author: Sekhar Jyoti Deka, Department of Medicine, Guwahati
also does not have any history of upper respiratory tract infection in Medical College and Hospital, India; E-mail: [email protected]
the past. Received April 10, 2017; Accepted March 09, 2018; Published March 23, 2018
Patient record for verification Citation: Deka SJ, Baruah C (2018) Case Presentation on Diagnosis and Treatment of
Pulmonary Consolidation. J Bioequiv Availab 10: 33-35. doi: 10.4172/0975-0851.1000374
There are 3 members in his family and no similar illness among
Copyright: © 2018 Deka SJ, et al. This is an open-access article distributed under
his family members. There is no history of diabetes, hypertension, the terms of the Creative Commons Attribution License, which permits unrestricted
tuberculosis, asthma and also no smoking habits among his family use, distribution, and reproduction in any medium, provided the original author and
members. source are credited.
J Bioequiv Availab, an open access journal
ISSN: 0975-0851 Volume 10(2): 33-35 (2018) - 33
Citation: Deka SJ, Baruah C (2018) Case Presentation on Diagnosis and Treatment of Pulmonary Consolidation. J Bioequiv Availab 10: 33-35. doi:
10.4172/0975-0851.1000374
- No tenderness. place and person. All the cranial nerves are intact and motor system
showed normal tone and power of the muscle in all the four limbs.
- Trachea is in midline.
Sensory system, peripheral nerves and the superficial and deep reflexes
- Apex beat: is felt in left 5th ICS, 1.25 cm medial to the midclavicular detected to be normal.
line.
Provisional and Differential Diagnosis
- Chest Expansion is 3 cm and reduced on the left side at the level
of the nipple. The patient 23-year old male, complaining of fever and cough
for the continuous 5 days and breathlessness for almost 3 days and
- Vocal fremitus: diminished on left side in the inframammary and provisionally diagnosed to be a case of left lower lobe pulmonary
infra-axillary region. consolidation [3].
Percussion: Diagnosis for collapse of the lung [4], fibrosis of the lung [5],
pulmonary tuberculosis and bronchogenic carcinoma has also been
- percussion along the mid clavicular line: dull note on left 6 ICS.
th
done (Table 1 and Figure 1).
- percussion along the mid axillary line: dull note on left 6th to 8th
ICS. Treatment
- percussing the back: normal resonant sound heard Generally proper rest and nutrition (high calories and plenty of
fluid) is recommended. The procedure further followed by symptomatic
- right side normal resonant note heard all over chest. treatment and specific treatment.
- Kronig’s isthmus bilaterally normal. Symptomatic treatment
Auscultation: Bronchial breath sound on left side was Examination of severity is done i.e., CURB-65 also known as
Inframammary and Infra-axillary with normal breath sound over the the CURB criteria, a clinical prediction rule for the validation of
back and right side of the chest. Vocal resonance is increased over left community-acquired pneumonia [6,7], so that to provide the level of
side in the inframammary and infra-axillary regions and whispering care (OPD, Ward, ICU). Drugs such as Methadone and Pholcodine are
pectoriloquy present. Bronchophony present with coarse crepitations, provided for cough suppression. Analgesic & Antipyretic (Paracetamol/
pleural rub sound vibrations were detected [2].
Examination of cardiovascular system Test Name Result Reference Range
Blood Count
The precordium shown to be normal as there was no visible WBC 16.21 4-11 Thousand/μL
pulsation or engorged veins seen. The palpation showed apex beat Haemoglobin 13.1 14-16 g/dl
appreciated in Lft. 5th ICS at MCL. Auscultation was normal.
Platelets 101 150-400 Thousand/μL
Examination of abdomen Differential Leucocyte Count
Neutrophils 81.2 37-72%
Inspection: Lymphocytes 12.8 20-40%
- Shape: normal Eosinophils 2.4 1-6%
Basophils 0 0%
- Umbilicus: Midline, inverted.
Monocytes 3.9 2-10%
- Skin: normal Liver Function Test
AST/SGOT 34.0 IU/L 15-46 IU/L
- Venous prominence: not seen
ALT/SGPT 35. IU/L 13-69 IU/L
- Movement with respiration: Equal on both sides Alkaline Phosphatase 98.0 IU/L 38-126 IU/L
Bilirubin Total 0.25 mg/dl 0.2-1.30 mg/dl
- Hernial sites: Intact
Unconjugated 0.21 mg/dl 0-1.10 mg/dl
- Scrotal oedema: absent Conjugated 0.00 mg/dl 0-0.3 mg/dl
Delta 0.4 mg/dl 0.0-0.2 mg/dl
- No visible pulsation, no peristalsis, no lump seen
Total Protein 6.8 gm/dl 6.4-8.2 gm/dl
Palpation: Superficial palpation showed normal temperature and Albumin 3.82 gm/dl 3.4-5 gm/dl
no signs of superficial tenderness, muscle guard or rigidity having Globulin 2.9 gm/dl 2.3-3.5 gm/dl
spino-umbilical equal distance on both sides with intact hernial sites. A/G 1.3
Deep palpation showed absence of tenderness and liver and spleen not GGTP 30.0 U/L 12-58 U/L
palpable by dipping method and kidney is not palpable. Renal Function Test
Percussion: Shifting dullness is absent and upper border of liver Urea 27.2 mg/dl 15-43 mg/dl
elicited dullness in the right 6th intercostal space in mid-clavicular line Creatinine 0.68 mg/dl 0.6-1.3 mg/dl
with no fluid thrill. Auscultation showed no bowel abnormalities or Sodium 1.39 mmol/L 1.37-1.45 mmol/L
hepatic, splenic bruit. Potassium 3.40 mmol/L 3.5-5.1 mmol/L
Serum Amylase 49.0 U/L 30-110 U/L
Examination of central nervous system Serum Lipase 32.0 U/L 23-300 U/L
Patient is conscious, alert, cooperative and well oriented to time, Table 1: Routine blood examination.
J Bioequiv Availab, an open access journal
ISSN: 0975-0851 Volume 10(2): 33-35 (2018) - 34
Citation: Deka SJ, Baruah C (2018) Case Presentation on Diagnosis and Treatment of Pulmonary Consolidation. J Bioequiv Availab 10: 33-35. doi:
10.4172/0975-0851.1000374
spectrum antibiotics like Erythromycin (500 mg) or Amoxycillin (500
mg). Oral treatment QDS or TDS was also done. Nebulization with
Duolin and doses of Pantaprazole was recommended. Multivitamins
were prescribed in the course.
Results
The cough subsided to an extent and the reliving effect started.
The patient showed positive signs of recovery and the medication was
continued for the recurring symptoms to be eliminated. The treatment
was effective.
Conclusion
There may be various factors that might cause lung consolidation.
Sometimes it can be major or serious, but it is often easily treated
and cured. Treatments may differ but seeing a doctor as soon as one
develops symptoms, is advisable. An early treatment usually gives
better results.
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J Bioequiv Availab, an open access journal
ISSN: 0975-0851 Volume 10(2): 33-35 (2018) - 35
