focal consolidation in lung

Please try after some time. It is considered a radiologic sign. Lung consolidation is most easily seen on an X-ray. At histology, the initial reaction presents as an alveolar exudate composed by edema, fibrin, and polymorphonuclear leukocytes. bronchial obstruction with no (or minimal collapse). Granulomas can also be caused by other immune. In strategic management, it often refers to the mergers and acquisitions of many smaller companies into much larger ones. The list of causes of consolidation is broad and includes: pneumonia adult respiratory distress syndrome (ARDS) interstitial pneumonias pneumonitis sarcoidosis Radiographic features The lung immediately adjacent to this is normal-appearing, further suggesting a localized lesion. A 63-year-old female patient with amiodarone lung. to maintaining your privacy and will not share your personal information without These tend to resolve spontaneously but can persist to become chronic cavities. Rony Kampalath, MD, is a board-certified diagnostic radiologist specializing in imaging of the abdomen. A malignant pleural effusion is treatable. Air-space consolidations can be seen in a wide variety of diseases affecting the lungs. Consolidation is often a middle-to-late stage feature/complication in pulmonary infections. Death is generally due to respiratory failure and cor pulmonale.4,5. Once lung scarring occurs, it's generally irreversible. CT findings consist of multifocal patchy areas of ground-glass attenuation and high-attenuation areas of consolidation and collapse (Fig. Infection, pulmonary edema, lung cancer, aspiration, and pulmonary hemorrhage are some of the diseases that can cause consolidation. W. Richard Webb, Charles B. Higgins. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. It can cause consolidation that is difficult to distinguish from pneumonia, pulmonary hemorrhage, or other diseases. DOI: Park MS. (2013). Other common causes of lung consolidation can include: With these causes, its good to know what the symptoms are to recognize when you may have lung consolidation. 2005;20:6670. Aspiration is common, but it can increase your risk for health conditions such as pneumonia. This makes your blood vessels weak and leaky, so some of your blood moves into the small airways. Bookshelf Deposition of iodinated oil embolism can occur also after transcatether oil embolization or after lymphangiography. Once the cancer starts to spread, it cant be cured, and treatment is given only to help your symptoms. A pulmonary consolidation is a region of normally compressible lung tissue that has filled with liquid instead of air. I love to write and share science related Stuff Here on my Website. Make no mistake, its going to be less than a picnic for a while. lobar collapsecan be mistaken for lobar consolidation but collapse will show signs of volume loss and usually absence of air bronchograms, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Dr. Amrita Dosanjh answered Pediatric Allergy and Asthma 37 years experience Note significant bilateral pleural effusion. 1 : to join together into one whole : unite consolidate several small school districts. Radiology Illustrated: Chest Radiology. Hospital-acquired pneumonia (HAP) This type of bacterial pneumonia is acquired during a hospital stay. Steam therapy. Skin irritation that may include a rash, swelling or redness. When the fissures are outwardly convex, the appearance is referred to as the bulging fissure sign. Swelling and redness in the mouth. Symptoms are most commonly nonspecific, and include fatigue, weakness, anorexia, weight loss, and mild fever. Hyperinflated lungs are often seen in people with chronic obstructive pulmonary disease (COPD) a disorder that includes emphysema. Clinical features of primary lung cancer presenting as pulmonary consolidation mimicking pneumonia. The term "edema" means swelling. When there is lung involvement, chest CT in the first 5 days after symptoms most commonly reveals ground-glass opacities (GGOs) or mixed GGOs and consolidation in a peripheral and subpleural distribution (25-27) with a peak in acute CT findings around day 10 . It infers an alveolar spread of disease and is most commonly due to pneumonia. Baque-Juston M, Pellegrin A, Leroy S, Marquette CH, Padovani B. Pulmonary tuberculosis is a chronic recurrent infection caused by Mycobacterium tuberculosis. We present a diagnostic approach based on appearance and distribution of these lesions. He is an assistant professor at the University of California at Irvine Medical Center, where he also practices. Once a diagnosis has been made, treatment options will be presented. Congestive heart failure is the most common cause of pulmonary edema. Pneumonia appears as a white consolidation on a chest X-ray. Consolidations with punctate calcifications suggest as differential diagnosis tuberculosis, silicoproteinosis, and parenchymal amyloidosis. Unusual manifestations of metastatic pulmonary calcification: high resolution CT and pathologic findings. 8600 Rockville Pike The dense opacities result from talc deposition within the pulmonary arterioles, capillaries, and interstitium. The association of dense lung air-space consolidations with high density of the liver and spleen is characteristic of amiodarone impregnation. The opacities may be nodular and peribronchovascular in distribution. Tuberculosis, amyloidosis, and silicoproteinosis may have focal calcifications, usually seen as small punctate calcified foci inside the areas of consolidation. Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. It can be caused by pressure outside of your lung, a blockage, low airflow or scarring. Attenuation higher than muscle seen as dense diffuse pulmonary opacities are due to calcium deposits in metastatic pulmonary calcification (MPC) and pulmonary alveolar microlithiasis (PAM), talc powder deposition in talcosis, and iodine accumulation in amiodarone lung toxicity. Lung ultrasound (LUS) is an accurate tool for the diagnosis and follow-up of pneumonia in adults as well as in children. Clinical symptoms are usually absent, and, when present, being characterized as dyspnea on exertion. Though your care provider may suspect lung cancer on the basis of an imaging study, the only way to confirm the diagnosis is through a biopsy, in which a small amount of tissue is removed for analysis in a lab. Most lung nodules are benign, or non-cancerous. Rarely, cough, dyspnea, and hypotension occur. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Get new journal Tables of Contents sent right to your email inbox, Consolidation With Diffuse or Focal High Attenuation: Computed Tomography Findings, Articles in PubMed by Edson Marchiori, MD, PhD, Articles in Google Scholar by Edson Marchiori, MD, PhD, Other articles in this journal by Edson Marchiori, MD, PhD, Chronic Obstructive Pulmonary Disease: Radiology-Pathology Correlation, Pulmonary Complications of Illicit Drug Use: Differential Diagnosis Based on CT Findings, Privacy Policy (Updated December 15, 2022). White Bread. , Beets and beet greens. 2005;54:233245. Sometimes the appearance of lung consolidation on imaging can be helpful in determining the cause. Focal consolidation is a term you might hear in a discussion between medical professionals if you are receiving any type of chest imaging. Normally, your lungs consist of millions of tiny air-filled sacs called alveoli. A conceptual approach and pictorial review, Cardiogenic pulmonary edema: mechanisms and treatment - an intensivist's view, Uncommon causes of noncardiogenic pulmonary edema, Clinical features of primary lung cancer presenting as pulmonary consolidation mimicking pneumonia, Lung cancer with scattered consolidation: detection of new independent radiological category of peripheral lung cancer on thin-section computed tomography. In some cases, lungs can appear hyperinflated on X-rays for reasons unrelated to lung function. Clinical complaints are insidious, consisting of nonproductive cough, dyspnea, and occasionally fever. "Atelectasis" refers to the collapse of lung tissue. LUS is at least as accurate as chest radiography in diagnosing pneumonia. CT findings include lymphadenopathy, pulmonary consolidation, and pleural effusion for primary infection and upper lung-predominant consolidation, cavitation, and . In these cases, the fluid enters the airways from outside their body instead of the inside. Kaushik S, Hussain A, Clarke P, et al. Pneumonia is the most common cause of lung consolidation. The https:// ensures that you are connecting to the 1). . The term "consolidation" is used to describe a disease process that replaces air in the lungs. Your healthcare provider will take a history and perform a physical examination to determine the cause of consolidation and determine whether you are at risk for developing severe disease. Consolidation occurs when the normal, air-filled spaces of the lung are filled with the products of disease. On imaging, atelectasis appears as areas of consolidation and is often hard to distinguish from pneumonia or aspiration. 2). Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. For more information, please refer to our Privacy Policy. Potato chips are filled with salt and saturated fat, two things that are detrimental to lung health. It may appear as a rounded nodule or mass, which may be described as a "spot.". The most common radiographic manifestation of the acute form is focal or multifocal consolidation. Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. What does consolidation mean in medical terms? Are lung nodules cancerous? High-resolution computed tomography with mediastinal window shows hyperdense consolidations in the lower portions of the lungs, and ill-defined confluent nodules in the upper lung areas. The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood (from bronchial tree or hemorrhage from a pulmonary artery). afib&htn well controlled w/meds.regular exercise, physical fit.no issue w/cardio,shortness of breath.what does this mean? 4th ed. High-resolution computed tomography with parenchymal (A) and mediastinal (B) windows demonstrate peripheral consolidations with air bronchogram, increase of heart volume, and right pleural effusion. Home remedies can't treat pneumonia, but they can be used to effectively manage its symptoms. Here's what you can do for coughing, fever, and more. consolidation; high-resolution CT; high attenuation. See additional information. Consolidation also reduces operational costs and facilitates compliance with data laws and regulations. A, Computed tomography through the lung bases shows bilateral areas of. Focal consolidation is a term you might hear in a discussion between medical professionals if you are receiving any type of chest imaging. What does lung consolidation mean in terms of pneumonia? The treatment with this drug results in deposition of iodine in the lung parenchyma, a constituent of the amiodarone molecule. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Punctate calcifications are seen within the, A 33-year-old male sandblaster with silicoproteinosis (A and B). According to the American Cancer Society, lung cancer takes more lives each year than prostate, colon, and breast cancer put together. Search for Similar Articles The consolidated parts of your lung look white, or opaque, on a chest X-ray. Lung consolidation that doesn't go away after treatment raises the suspicion of lung cancer. CT of acute and chronic distal air space (alveolar) disease. Uncommon causes of noncardiogenic pulmonary edema. Linear opacities, architectural distortion adjacent to the conglomerate masses, and evidence of emphysema are also seen. Also known as pulmonary hyperinflation, overinflation of the lungs means you're limited in the amount of new air you can take in. Sometimes, consolidation may be severe enough that it prevents the patient from getting enough oxygen. Twentieth edition. 2013;221-233. doi:10.1007/978-3-642-37096-0_22. Most treatments for lung cancer include surgery, if possible, supported by chemotherapy, immunotherapy, radiation, or targeted therapy. Lobar consolidation is the term used to describe consolidation in one of the lobes of the lung. [1] The condition is marked by induration[2] (swelling or hardening of normally soft tissue) of a normally aerated lung. Medical Definition Focal consolidation is the "replacement of gas within air spaces by fluid, protein, cells, or other material" in a single spot on the lungs. 7). 8). Radiologists and doctors look for several signs of focal consolidation in the lungs on x-rays or other types of imaging. The increased pressure pushes fluid from your blood vessels into the small airways. You may also be given medication to control your cough, chest pain, or fever. Within the practice of radiology, he specializes in abdominal imaging. Among pleural criteria, basal effusion was most often det Postprimary tuberculosis may manifest with cavities, consolidations, and centrilobular nodules. In B, the high-density consolidations are shown. Bronchiectasis is a condition where damage causes the tubes in your lungs (airways) to widen or develop pouches. Consolidation related to tuberculosis (TB) infection is often located in the upper lungs. Consolidation refers to the alveolar airspaces being filled with fluid (exudate/transudate/blood), cells (inflammatory), tissue, or other material. This pictorial essay aims to present various lesions that could present as consolidations with diffuse of focal high attenuation on computed tomography, helping to make the diagnosis more confident and specific. A fulminant course evolving to respiratory failure and early death is seen in some cases.24, HRCT findings are characterized by centrilobular fluffy ground-glass nodular opacities, which contain foci of calcification, seen mainly in the upper pulmonary zones. During an infection, immune cells surround and isolate foreign material, such as bacteria. With appropriate treatment, the consolidation usually goes away and air returns. The most common causes of diffuse hyperdense consolidations are MPC, PAM, amiodarone lung toxicity, talcosis, and deposition of iodinated oil material. Air-space consolidations can be seen in a wide variety of diseases affecting the lungs. Stomach acid and other chemicals can cause inflammation and irritate or injure your lungs, which is called pneumonitis. Auscultation over the same region should help to distinguish between these possibilities, as consolidation generates bronchial breath sounds while an effusion is associated with a relative absence of sound. Although signs and symptoms can occur throughout the transplantation period, viral infections are more common during the early engraftment period. The identification of consolidation with diffuse of focal high attenuation narrows the differential diagnosis. 7. It is considered a radiologic sign. And, there is always a chance that you may have to stay in the hospital for a few days until its cleared up to a certain extent. Chest pain when inhaling or exhaling. Unable to process the form. Lung cancer is hard to treat. Calcium deposition with or without bone formation in the lung. The way the consolidation is distributed on your X-ray may help your doctor figure out the cause, but other tests are almost always needed. Each of these findings tends to be nonspecific and has a long differential diagnosis. Thank you, {{form.email}}, for signing up. Aspiration syndromes: Aspiration pneumonia and aspiration pneumonitis. , Bacterial pneumonia. When the lungs are diseased, the alveoli may be filled with something other than air. The association of consolidation with high attenuation, clinical presentation, and additional CT findings could narrow even more the differential diagnosis (Table 1) avoiding, in some cases, invasive procedures, such as pulmonary biopsy. 5). In this article, we review and discuss characteristic radiographic and clinical findings that can aid the radiologist in prioritizing the differential considerations when faced with multifocal parenchymal consolidative disease. Some error has occurred while processing your request. Early detection is key. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water. High-resolution computed tomography shows in A, extensive consolidations in both lungs, with architectural distortion and cavitary lesions on the left. Youll also be evaluated and treated for swallowing problems, so you dont continue to aspirate. Eventually, early inflammation with caseous formation presents higher phosphatase activity inside the necrotic foci, which invariably calcify9 (Fig. The most common consolidation in lungs causes are normal things that weve all heard of and experienced. The most important parenchymal criterion is the positive air bronchogram within an echopoor area. Select the upper-left cell of the area where you want the consolidated data to appear. Although ethiodized oil may cause pulmonary inflammatory changes, most patients with iodinated oil embolism are asymptomatic. The following diseases are presented: metastatic pulmonary calcification, pulmonary alveolar microlithiasis, amiodarone lung, talcosis, iodinated oil embolism, tuberculosis, silicoproteinosis, and amyloidosis. Consolidation is a stage in a lesson where a topic or new information is enforced. The way the consolidation is distributed on your X-ray may. Lobar consolidation is the term used to describe consolidation in one of the lobes of the lung. But, lung nodules should always be further evaluated for cancer, even if theyre small. The symptoms of lung consolidation depend on what is causing it. In the early stages of the disease, the alveolar walls are normal; eventually interstitial fibrosis develops. The appearance of your lungs on a chest X-ray, and your symptoms, are similar for all these substances. Lung consolidation may be first identified during a physical examination by a healthcare provider. The consolidated parts of your lung look white, or opaque, on a chest X-ray. Consolidations with diffuse or focal high attenuation can result from a variety of different conditions. It is thought to be due to blockage of the small lung airways by secretions. Atelectasis due to excessive lung secretions may be treated by suctioning out the obstructing mucus. Wolters Kluwer Health Histologically, amyloid is a proteinaceous material collecting alongside the pulmonary interstitium, the media of small blood vessels, and the endothelial and epithelial basal membranes, usually assuming a uniform linear or micronodular appearance.11 Foci of calcification inside consolidations and small amyloid nodules can be found in pathologic specimens. Coughing a lot with pus and mucus is the main symptom of bronchiectasis. When your heart cant pump hard enough to move blood forward, it backs up into the blood vessels in your lungs. Atelectasis usually resolves after treating the underlying cause. Marchiori E, Ferreira A, Muller NL. Diagnosis of Diseases of the Chest. Gates J, Hartnell GG, Stuart KE, et al. It may be caused by atelectasis, infection, pulmonary hemorrhage, aspiration, or lung cancer. Pulmonary hemorrhage means youre bleeding in your lungs. A general list of symptoms for lung consolidation can include: If you start recognizing these symptoms, the next step is to seek a doctor for a diagnosis and then a path of treatment. Please enable scripts and reload this page. The identification of the different patterns of consolidation with focal high attenuation narrows the differential diagnosis. Pulmonary infiltrates commonly occur in the febrile neutropenic patient and have a number of causes, especially in the BMT recipient. Dullness detected on percussion, for example, may represent either lung consolidation or a pleural effusion. Extrahepatic chemoembolization material is commonly seen in other organs, but usually do not cause problems.1,8. According to a review article in Tuberculosis & Respiratory Diseases, this is most often caused by vasculitis, or inflammation of your blood vessels. The computed tomography (CT), and especially high-resolution CT (HRCT), when compared with plain films has higher sensitivity to detect mild differences in lung density, morphology, and distribution of the lesions, and associated abnormalities. Osmosis by Elsevier. What Are These Tiny Red Spots on My Skin (Petechiae)? Blebs and bullae are often present, particularly in the lung apices.1,4, Amiodarone-induced pulmonary toxicity is a serious adverse effect seen in patients receiving large doses of amiodarone to prevent cardiac arrhythmias. [High-resolution CT in the differential diagnosis of consolidative lung processes. National Library of Medicine. Disclaimer: Results are not guaranteed*** and may vary from person to person***. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water. However, with a bit of rest and following doctors orders, you will hopefully be back on your feet within a reasonable amount of time and ready to get along with your day. (n.d.). Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation.[3]. If you cant swallow correctly, youre more likely to aspirate when you eat. Receipt of unnecessary antibiotics in patients without confirmed pneumonia is linked to higher mortality. C, Mediastinal window demonstrates. Consolidation. Lung cancer is one of the most frequent malignancies worldwide and considered a major cause of cancer death, with the most common histological type being lung adenocarcinoma (LADC) [].This type has many faces on computed tomography (CT), including a solitary nodule or mass, a thin-walled cystic lesion, focal or diffuse parenchymal consolidation, or multifocal lesions [2,3,4,5,6,7,8,9,10,11]. {"url":"/signup-modal-props.json?lang=us"}, Hacking C, Murphy A, Silverstone L, et al. At the time the article was created Craig Hacking had no recorded disclosures. Some of the causes of pleural effusions, such as congestive heart failure, pneumonia, and lung cancer, also cause lung consolidation. The most common cause of atelectasis is surgery with anesthesia. You may search for similar articles that contain these same keywords or you may Jannette Collins, Eric J. Stern. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. It is considered a radiologic sign.Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. 2 : to make firm or secure : strengthen consolidate their hold on first place He consolidated his position as head of the political party. Doctors often use the term when describing a finding on imaging of the chest, like an X-ray or CT scan. Sometimes, signs of lung cancer do not appear clearly on scans. The patients with tuberculosis may present on CT scans focal areas of air-space consolidation, which could cavitate. If the symptoms are more chronic (weeks to months), the differential may include alveolar proteinosis, neoplasms such as lymphoma or bronchoalveolar cell carcinoma, granulomatous or inflammatory conditions, and lipoid pneumonia. The investment in each subsidiary is replaced by the actual assets and liabilities of that subsidiary. The most common causes of diffuse hyperdense consolidations are MPC, PAM, amiodarone lung toxicity, talcosis, and deposition of iodinated oil material. It may be caused by atelectasis, infection, pulmonary hemorrhage, aspiration, or lung cancer. and transmitted securely. Starting treatment early in your illness usually gives you a better outcome. Large amounts of aspirated material may cause irritation and inflammation of the lungs. When most people use the term, they are referring to inflammation caused by bacterial or viral infection. When you have an infection in your lung, your body sends white blood cells to fight it. Please try again soon. Youll typically be put on antibiotics, antivirals, or antifungals. 2016;2(1):17-21. doi:10.20407/fmj.2.1_17, Matsunaga T, Suzuki K, Hattori A, et al. What Is Pleural Effusion (Fluid in the Chest)? Curr Opin Crit Care. If the symptoms are acute (days to weeks), the most common causes include edema, pneumonia, and hemorrhage. (2013). Your message has been successfully sent to your colleague. Here are a few detox drinks that can help improve your lungs and overall health during the winter season: A pulmonary infiltrate is a substance denser than air, such as pus, blood, or protein, which lingers within the parenchyma of the lungs. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, Lung Cancer: How a Drug Combination May Help Reduce Tumors. Clinical presentation is indolent, and middle or upper zone . Consolidation in the lung is seen on radiographs or computed tomography (CT) as increased areas of attenuation that obscure the underlying pulmonary vasculature. If the lung consolidation is particularly bad, you may need a machine to help you breathe until you are cured. Symptoms that are common to all of these conditions include cough and shortness of breath. Thus, consolidation on thin-section CT could be strongly associated with the invasiveness of lung cancer [4]. National Library of Medicine Learn what causes aspiration and how to prevent it. For example, pneumonia due to infection may be treated with antibiotics or antiviral therapy. 2019;25(4):371-378. doi:10.1097/MCC.0000000000000626. Grgic A, Wilkens H, Heinrich M, Girmann M, Kramann B, Uder M. Semin Roentgenol. A pleural effusion is a collection of fluid in the space between your chest wall and lungs. Lobular pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung. Unable to load your collection due to an error, Unable to load your delegates due to an error. Pneumonia can develop from an upper respiratory infection or following a surgical procedure. Treatment may include medication to remove the extra fluid, lower the pressure in your blood vessels, or make your heart pump better. Bethesda, MD 20894, Web Policies A variety of conditions can cause lung consolidation, including pneumonia, atelectasis, pulmonary edema, pulmonary hemorrhage, aspiration, and lung cancer. The word "pneumonia" refers to inflammation of the lung tissue. Is it possible to get rid of a cellulite? It makes all data management information available quickly and easily, and having all data in one place increases productivity and efficiency. This may be confusing, and it's helpful to understand that "consolidation" is a general term describing several different disease processes. There are different approaches to the therapy for lung cancer. My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. Acute pulmonary toxicity after low-dose amiodarone therapy. Accessibility This might be pus (in the case of an infection), blood (in diseases that cause bleeding in the lungs), or fluid (in many other diseases). Hemoptysis (coughing up blood) may be seen with pneumonia, lung cancer, or pulmonary hemorrhage. Focal consolidation may be segmental or nonsegmental in distribution; occasionally, it involves an entire lobe or lung. The diagnosis is one of exclusion because the signs and symptoms are not specific, and there is no laboratory test allowing the diagnosis.1,6, The most common CT findings include septal thickening, interstitial fibrosis, and consolidations. Calcium deposits may induce a lung reaction with alveolar organizing exudates evolving to fibrosis. Treatment may vary, but no matter what is causing your lung consolidation, its important to see your doctor as soon as you develop symptoms. Small and usually invisible intratumoral arteriovenous shunts allow chemoembolization material to pass into the hepatic veins and thence into the lungs. MedlinePlus. American Lung Association. Am J Respir Crit Care Med. Crazy paving may be present. , Viral pneumonia. Clipboard, Search History, and several other advanced features are temporarily unavailable. The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. You may have seen the term "consolidation" in a radiology report, a chest X-ray, or a computed tomography (CT) scan, for example. There are more than 30 different causes of pneumonia, and theyre grouped by the cause. High iodine content makes possible the detection of amiodarone deposits in the lung by CT as a high-attenuation focal or multiple parenchymal opacities1,4,6 (Fig. why was the sinking of the lusitania important, rev william barber disability,

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