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Pulmonary Collapse

   DR. NIKHIL MURKEY
Definitions


 Collapse or atelectasis is the complete or partial loss
 of volume of lung.
Collapse

 Mechanisms
   Relaxation /
    passive
   Cicatrization

   Adhesive

   Resorption
Causes of collapse

Due to endobronchial obstruction:
 Intrinsic
    Broncogenic carcinoma
    Adenoid cytic carcinoma
    Metastasis
    Lymphoma
    Benign tumours
    Granulomatous diseases (TB, sarcoidosis)
     Miscellaneous conditions (aspirated foreign bodies, mucus
     plugs, gastric contents, malpositioned endotracheal
     tube, bronchial torsion or rupture, amyloidosis, Wegener’s)
 Extrinsic
   Hilar or mediastinal lymphadenopathy

   Mediastinal mases

   Fibrosing mediastinitis

   Aortic aneurysms and congenital vascular anomalies

   Cardiac enlargement



  Lobar collapse without endobronchial obstuction d/t
  pleural diseases, radiation induced collapse, tumour
  replacement (bronchoalveolar cell carcinoma).
Radiological signs of collapse

 Direct
   Displacement of interlobar fissures

   Loss of aeration

   Vascular or bronchial crowding
Radiological signs of collapse

 Indirect
   Elevation of hemidiaphragm

   Mediastinal displacement

   Hilar diaplacement

   Compensatory hyperinflation
 Frontal and lateral chest radiographs. The cause of the collapse is a
  bronchogenic carcinoma; the endobronchial component is visible as an
  abrupt cut-off of the left main bronchus. There is marked displacement
  of the right lung anteriorly and posteriorly across the midline (arrows).
  Note the marked anterior hyperlucency of the thorax on the lateral view.
 Herniation of
 both retrosternal
 lung and azygo-
 esophageal
 reflection.
 Complete collapse of the
  left lung.
 The tip of the
  endotracheal tube is
  beyond the carina and
  down the right
  bronchus, causing
  collapse of the left lung
  and compensatory
  hyperinflation of the
  right lung which has
  herniated across the
  midline.
 Total right lung collapse in a neonate. The patient
 was ventilated for respiratory distress syndrome and
 the cause of the total lung collapse was a mucus plug
Signs in collapse

 Shifting granuloma sign: change in position of the
 granuloma d/t hyperinflation
 Luftsichel sign: overinflated segment of the ipsilateral lower lobe
  occupies the space between the mediastinum and the medial aspect
  of the collapsed upper lobe resulting in a paramedian translucency.
  This sign is commoner on the left side.
 Juxtaphrenic peak
 sign: upper lobe
 collapse (both upper
 and middle lobe on
 the right side) causes
 a small triangular
 density at the highest
 point of the dome of
 diaphragm d/t
 traction and
 reorientation of
 inferior accessory
 fissure.
 Golden S sign: the
 combination of
 collapse and mass
 centrally results in
 a focal convexity
 with a concave
 outine
 peripherally (sign
 is useful only for
 right upper lobe
 and bilateral lower
 lobe)
 CT equivalent
 of Golden S
 sign: concavity
 of fissure with
 adjacent
 convexity
 (useful in all
 lobes), highly
 suggestive of
 bronchogenic
 carcinoma.
 CT mucus bronchogram sign: on contrast enhanced CT there
 are low attenuation areas within the high attenuation collaped
 lung representing inspissated secretions in airways.
 Superior triangle sign:
 triangular density to the
 right of mediastinum seen
 in right lower lobe
 collapse d/t displacement
 of anterior junctional
 structures.
Right upper lobe
Right upper lobe
Tight right upper lobe collapse. Note how the collapsed
lobe (due to a central bronchogenic carcinoma) results
in increased right paramediastinal density
Left upper lobe
Right middle lobe
Right middle lobe
Lingular lobe
Right lower lobe
Right lower lobe
Left lower lobe
Left lower lobe
 Flat waist sign: seen in extensive collapse of
 the left lower lobe d/t flattening of the aortic
 knuckle and main pulmonary artery d/t
 cardiac rotation and displacement to the left.
Round atelectasis
   Combined right middle and right lower lobe collapse. On the frontal view the
    increased density extends to the right costophrenic angle. On the lateral view the
    increased density also extends from the anterior to the posterior chest wall. The
    cause in this case was a bronchogenic carcinoma obstructing the bronchus
    intermedius
 Bilateral lower
 lobe collapse.
 Bilateral
 triangular
 densities are
 seen with
 obscuration of
 the medial
 portions of the
 hemidiaphragm
 s. The cause was
 mucous
 plugging
Consolidation


 Defined as the decreased volume of air in the lung,
 with normal lung volume.
Common causes

 Pnemonia
 Cardiogenic/non cardiogenic pulmonary edema
 Hemorrhage
 Aspiration
 Neoplasms like alveolar cell carcinoma
 Alveolar proteinosis
 Air bronchogram sign: It is produced by the
 radiographic contrast between the column of air in
 airway and the surrounding opaque acini.
Pattern of consolidation on plain film
Right upper lobe consolidation
Right middle lobe consolidation
Right lower lobe consolidation
Lingular lobe
Left upper lobe consolidation
Left lower lobe consolidation
Thank you

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chest radiography: Collapse

  • 1. Pulmonary Collapse DR. NIKHIL MURKEY
  • 2. Definitions  Collapse or atelectasis is the complete or partial loss of volume of lung.
  • 3. Collapse  Mechanisms  Relaxation / passive  Cicatrization  Adhesive  Resorption
  • 4. Causes of collapse Due to endobronchial obstruction:  Intrinsic  Broncogenic carcinoma  Adenoid cytic carcinoma  Metastasis  Lymphoma  Benign tumours  Granulomatous diseases (TB, sarcoidosis)  Miscellaneous conditions (aspirated foreign bodies, mucus plugs, gastric contents, malpositioned endotracheal tube, bronchial torsion or rupture, amyloidosis, Wegener’s)
  • 5.  Extrinsic  Hilar or mediastinal lymphadenopathy  Mediastinal mases  Fibrosing mediastinitis  Aortic aneurysms and congenital vascular anomalies  Cardiac enlargement Lobar collapse without endobronchial obstuction d/t pleural diseases, radiation induced collapse, tumour replacement (bronchoalveolar cell carcinoma).
  • 6. Radiological signs of collapse  Direct  Displacement of interlobar fissures  Loss of aeration  Vascular or bronchial crowding
  • 7. Radiological signs of collapse  Indirect  Elevation of hemidiaphragm  Mediastinal displacement  Hilar diaplacement  Compensatory hyperinflation
  • 8.  Frontal and lateral chest radiographs. The cause of the collapse is a bronchogenic carcinoma; the endobronchial component is visible as an abrupt cut-off of the left main bronchus. There is marked displacement of the right lung anteriorly and posteriorly across the midline (arrows). Note the marked anterior hyperlucency of the thorax on the lateral view.
  • 9.  Herniation of both retrosternal lung and azygo- esophageal reflection.
  • 10.  Complete collapse of the left lung.  The tip of the endotracheal tube is beyond the carina and down the right bronchus, causing collapse of the left lung and compensatory hyperinflation of the right lung which has herniated across the midline.
  • 11.  Total right lung collapse in a neonate. The patient was ventilated for respiratory distress syndrome and the cause of the total lung collapse was a mucus plug
  • 12. Signs in collapse  Shifting granuloma sign: change in position of the granuloma d/t hyperinflation
  • 13.  Luftsichel sign: overinflated segment of the ipsilateral lower lobe occupies the space between the mediastinum and the medial aspect of the collapsed upper lobe resulting in a paramedian translucency. This sign is commoner on the left side.
  • 14.  Juxtaphrenic peak sign: upper lobe collapse (both upper and middle lobe on the right side) causes a small triangular density at the highest point of the dome of diaphragm d/t traction and reorientation of inferior accessory fissure.
  • 15.  Golden S sign: the combination of collapse and mass centrally results in a focal convexity with a concave outine peripherally (sign is useful only for right upper lobe and bilateral lower lobe)
  • 16.  CT equivalent of Golden S sign: concavity of fissure with adjacent convexity (useful in all lobes), highly suggestive of bronchogenic carcinoma.
  • 17.  CT mucus bronchogram sign: on contrast enhanced CT there are low attenuation areas within the high attenuation collaped lung representing inspissated secretions in airways.
  • 18.  Superior triangle sign: triangular density to the right of mediastinum seen in right lower lobe collapse d/t displacement of anterior junctional structures.
  • 21. Tight right upper lobe collapse. Note how the collapsed lobe (due to a central bronchogenic carcinoma) results in increased right paramediastinal density
  • 22.
  • 24.
  • 25.
  • 33.  Flat waist sign: seen in extensive collapse of the left lower lobe d/t flattening of the aortic knuckle and main pulmonary artery d/t cardiac rotation and displacement to the left.
  • 35. Combined right middle and right lower lobe collapse. On the frontal view the increased density extends to the right costophrenic angle. On the lateral view the increased density also extends from the anterior to the posterior chest wall. The cause in this case was a bronchogenic carcinoma obstructing the bronchus intermedius
  • 36.  Bilateral lower lobe collapse. Bilateral triangular densities are seen with obscuration of the medial portions of the hemidiaphragm s. The cause was mucous plugging
  • 37. Consolidation  Defined as the decreased volume of air in the lung, with normal lung volume.
  • 38. Common causes  Pnemonia  Cardiogenic/non cardiogenic pulmonary edema  Hemorrhage  Aspiration  Neoplasms like alveolar cell carcinoma  Alveolar proteinosis
  • 39.  Air bronchogram sign: It is produced by the radiographic contrast between the column of air in airway and the surrounding opaque acini.
  • 40. Pattern of consolidation on plain film
  • 41. Right upper lobe consolidation
  • 42. Right middle lobe consolidation
  • 43. Right lower lobe consolidation
  • 45. Left upper lobe consolidation
  • 46. Left lower lobe consolidation