chest radiography: Collapse


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chest radiography: Collapse

  1. 1. Pulmonary Collapse DR. NIKHIL MURKEY
  2. 2. Definitions Collapse or atelectasis is the complete or partial loss of volume of lung.
  3. 3. Collapse Mechanisms  Relaxation / passive  Cicatrization  Adhesive  Resorption
  4. 4. Causes of collapseDue 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. 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. 6. Radiological signs of collapse Direct  Displacement of interlobar fissures  Loss of aeration  Vascular or bronchial crowding
  7. 7. Radiological signs of collapse Indirect  Elevation of hemidiaphragm  Mediastinal displacement  Hilar diaplacement  Compensatory hyperinflation
  8. 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. 9.  Herniation of both retrosternal lung and azygo- esophageal reflection.
  10. 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. 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. 12. Signs in collapse Shifting granuloma sign: change in position of the granuloma d/t hyperinflation
  13. 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. 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. 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. 16.  CT equivalent of Golden S sign: concavity of fissure with adjacent convexity (useful in all lobes), highly suggestive of bronchogenic carcinoma.
  17. 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. 18.  Superior triangle sign: triangular density to the right of mediastinum seen in right lower lobe collapse d/t displacement of anterior junctional structures.
  19. 19. Right upper lobe
  20. 20. Right upper lobe
  21. 21. Tight right upper lobe collapse. Note how the collapsedlobe (due to a central bronchogenic carcinoma) resultsin increased right paramediastinal density
  22. 22. Left upper lobe
  23. 23. Right middle lobe
  24. 24. Right middle lobe
  25. 25. Lingular lobe
  26. 26. Right lower lobe
  27. 27. Right lower lobe
  28. 28. Left lower lobe
  29. 29. Left lower lobe
  30. 30.  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.
  31. 31. Round atelectasis
  32. 32.  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
  33. 33.  Bilateral lower lobe collapse. Bilateral triangular densities are seen with obscuration of the medial portions of the hemidiaphragm s. The cause was mucous plugging
  34. 34. Consolidation Defined as the decreased volume of air in the lung, with normal lung volume.
  35. 35. Common causes Pnemonia Cardiogenic/non cardiogenic pulmonary edema Hemorrhage Aspiration Neoplasms like alveolar cell carcinoma Alveolar proteinosis
  36. 36.  Air bronchogram sign: It is produced by the radiographic contrast between the column of air in airway and the surrounding opaque acini.
  37. 37. Pattern of consolidation on plain film
  38. 38. Right upper lobe consolidation
  39. 39. Right middle lobe consolidation
  40. 40. Right lower lobe consolidation
  41. 41. Lingular lobe
  42. 42. Left upper lobe consolidation
  43. 43. Left lower lobe consolidation
  44. 44. Thank you