Incomplete Consolidation in Pneumococcal Lobar Pneumonia Complicating Pulmonary Emphysema

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Abstract
Chest roentgenograms and hospital records of 104 patients with pneumonia whose admission blood cultures were positive for pneumococci were reviewed. Clinical characteristics, laboratory and chest roentgenographic findings, and response to treatment were noted. Two basic patterns of consolidation were encountered. In patients under age 40 all but one had classical homogeneous consolidation. Among patients over age 40, 6 of 22 men and 15 of 16 women had chest X-ray films that also showed typical consolidation. In the remaining 16 men and 1 woman over age 40 and in one 37-year-old man the films showed a pattern of incomplete consolidation interrupted by air-filled spaces. In the one patient with the pattern of incomplete consolidation who died, pathologic examination demonstrated foci of emphysema with surrounding pneumonia. Other diseases such as suppurative bronchopneumonia and tuberculosis may produce incomplete consolidations that require differentiation from pneumococcal lobar pneumonia superimposed on pulmonary emphysema.

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