34. Resorption/Obstructive Atelectasis
Causes of central airway obstruction
Neoplasm
Lung cancer (most common cause)
Metastatic cancer(腎細胞癌、乳癌、黑色素瘤、鼻咽喉癌), lymphoma
Less frequent: broncholith, bronchial stenosis; bronchial carcinoid,
lipoma, granuloma)
Foreign body; mucus plugs
Stricture
Endobronchial TB, inflammation (TB, sarcoidosis)
External compression
LAP, mass, aneurysm, cardiomegaly ( especially LAE )
35. Peripheral airway obstruction
Subsegmental:又叫做 discoid (plate-like)
atelectasis
Horizontal or oblique line in middle or lower lung
Negative bronchoscopy exam
Opacity is less uniform (containing gas)
Resorption/Obstructive Atelectasis
36. Causes of peripheral airway obstruction
Mucus plug
AE COPD, asthma, emphysema, BO
Diaphragm
手術 Severe chest or abdominal pain
CNS depressants use
Inflammatory
Bronchopneumonia
Bronchitis
Bronchiectasis
Resorption/Obstructive Atelectasis
48. Indirect Sign
Mediastinal structure deviation
Trachea, Heart
Narrowing of intercostal space
More frequently encountered in children
Mainly in acute atelectasis
Juxtaphrenic peak (JP) sign:
Upper lobe collapse, esp. R’t side
Stretching of the
inferior pulmonary ligament
53. RUL Collapse: PA view
Elevation of minor fissure
Complete RUL collapse:
widening of the superior mediastinum
Indirect sign (hilum elevation) may be
evident
Specific signs of RUL collapse
Reverse S sign
J-P sign
54. RUL Collapse Lateral view
Minor fissure
Shift upward
Superior half of the major fissure
Shift forward
61. Reverse S Sign of Golden
On in PA view of
RUL collapse + R’t hilar tumor
Bronchogenic cancer, mediastinal
tumor, or enlarged LAP.
The upper part:
The elevated minor fissure
The lower part:
The tumor mass responsible for
collapse.
63. Reverse S sign of Golden
RUL collapse with
central tumor
64. RML Collapse: PA view
R’t lower heart border 不清楚
Maybe a faint shadow on the PA view
Lordotic view is helpful
Relatively small shrinkage in volume
Usually no indirect signs
65. RML Collapse Lateral view
Easier identification
Minor Fissure:
Inferior displacement
Lower part of the major fissure:
Anterior shift
85. Luftsichel sign (LUL collaspe)
(Luft = air; sichel = crescent)
Aortic Knob
Superior segment
of LLL LB6
hyperinflation
produces a crescent
of lucency along the
mediastinum and
aortic knuckle.
86. LUL collapse
Loss of aortic
knob shadow
Loss of upper portion
of L’t heart border
103. Total lung collapse
Causes:
Obstruction: tumor, foreign body, sputum
Total pneumonectomy
D/D with massive pleural effusion
Massive effusion:
Volume expansion
Mediastinum(trachea) shift to contralateral side
Total collapse:
Volume reduction
Thoracic cage retraction
ICS narrowing
Mediastinum(trachea) shift to the same side
111. Round Atelectasis
Passive atelectasis
due to PE
Infolding of
visceral pleura
Fibrinous parietal
pleural adhesion
maintain the infolding
and tilting lung
當pleural effusion吸
收後,collapsed
lung會re-expand,
除了round
atelectasis處
Pleuropulmonary fibrosis
with organization and
contraction
114. Round Atelectasis
Mass like density
Pleural based
Base of lungs
Blunting of costophrenic angle
Pleural thickening
Pulmonary vasculature curving into the
density
Esophageal surgical clips.
127. LUL Atelectasis
1.Mediastinal shift to left
2.Density left upper lung field
3.Loss of aortic knob and left hilar
silhouettes
4.Compensatory hyperinflation of
right lung