Collapse & consolidation made simple - chest X-rayz

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  • 1. LUNG COLLAPSE & CONSOLIDATION. Dr. Nikrish S Hegde
  • 2. What is collapse?  Reduction in volume of air within the lung  Asssociated with reduction in lung volume.  Atelectasis.
  • 3. Mechanisms.  Passive Collapse  Cicatrisation Collapse  Adhesive Collapse  Resorption Collapse
  • 4. Passive Collapse  Lung retracts towards the hilum.  Air or increased fluid in the pleural cavity  Pleural effusion / pneumothrax
  • 5. Passive Collapse
  • 6. Cicatrisation Collapse  Lung is abnormally stiff  Reduction in lung compliance  Resulting in collapse  Pulmonary Fibrosis.
  • 7. Cicatrisation Collapse
  • 8. Adhesive Collapse  Surfactant reduces the surface tension  Disturbance of this mechanism  Collapse of the alveoli  Respiratory Distress Syndrome.
  • 9. Resorption Collapse  Acute bronchial obstruction .  Gases in the alveoli are taken up by the blood.  Modified by collateral air drift and infection.  Chronic  Collapse
  • 10. Resorption Collapse
  • 11. SIGNS  DIRECT:  INDIRECT:
  • 12. Displacement of interlobar fissures.
  • 13. Loss Of Aeration
  • 14. Crowding of vessels and bronchi.
  • 15. Elevation Of Hemidiaphragm.
  • 16. Mediastinal Displacement.
  • 17. Hilar Displacement.
  • 18. Compensatory Hyperinflation 1)ANTERIOR TO ASCENDING AORTA 2)POSTERIOR TO HEART 3)UNDER THE ARCH
  • 19. Air Bronchogram  Almost not seen in resorption collapse  Seen in adhesive and passive collapse.  And in cicatrisation collapse with extensive fibrosis.
  • 20. Pre existing Lung Diseases.  Fibrosis  Plueral Adhesions  May alter the expected anatomical displacements in collapse
  • 21. Reciprocal Relationship  There exists a relationship between the compensatory signs.  Degree of diaphragmatic elevation is directly related to amount of collapse and inversely to the hilar displacement and compensatory hyperinflation.  Eg: Lower lobe collapse, if diaphragmatic elevation is marked, hilar depression is diminished.
  • 22. RUL Collapse
  • 23. RUL Collapse
  • 24. LUL Collapse
  • 25. RML Collapse
  • 26. Lingular Collapse
  • 27. RLL Collapse
  • 28. LLL Collapse
  • 29. Shifting Granuloma sign.
  • 30. Luftsichel Sign:
  • 31. Juxtaphrenic Peak Sign
  • 32. Golden S Sign
  • 33. Superior Triangle Sign
  • 34. Double Lesion Sign  If collapse of multiple segments occurs in certain combination , the likelyhood of bronchogenic carcinoma is small.  Eg: RUL and RML is rarely seen in bronchogenic ca but RML and RLL is frequently seen.
  • 35. Round Atelectasis
  • 36. CONSOLIDATION  Decrease in volume of air within the Lung.  Associated with normal lung volume.  Pulmonary airways 1) Conducting network 2) Acini Replacement of air in the acini with fluid or solid material.
  • 37. Causes:  Pneumonia  Cardiogenic / non cardiogenic pulmonary edema  Aspiration  Haemorrhage  Neoplasms
  • 38. Air Bronchogram  Produced by the radiographic contrast between the column of air in the airway and the surrounding opaque acini.
  • 39. Lobar Consolidation  Homogenous opacity  Air bronchogram  Well defined borders.
  • 40. RUL
  • 41. RML
  • 42. RLL
  • 43. LUL & Lingula
  • 44. LLL
  • 45. Points to Remember  Volume of lung is not reduced.  Collapse and consolidation are often associated with one another.  When consolidation is due to fluid , its distribution is dependent on gravity.