Collapse & consolidation made simple - chest X-rayz

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Collapse & consolidation made simple - chest X-rayz

  1. 1. LUNG COLLAPSE & CONSOLIDATION. Dr. Nikrish S Hegde
  2. 2. What is collapse?  Reduction in volume of air within the lung  Asssociated with reduction in lung volume.  Atelectasis.
  3. 3. Mechanisms.  Passive Collapse  Cicatrisation Collapse  Adhesive Collapse  Resorption Collapse
  4. 4. Passive Collapse  Lung retracts towards the hilum.  Air or increased fluid in the pleural cavity  Pleural effusion / pneumothrax
  5. 5. Passive Collapse
  6. 6. Cicatrisation Collapse  Lung is abnormally stiff  Reduction in lung compliance  Resulting in collapse  Pulmonary Fibrosis.
  7. 7. Cicatrisation Collapse
  8. 8. Adhesive Collapse  Surfactant reduces the surface tension  Disturbance of this mechanism  Collapse of the alveoli  Respiratory Distress Syndrome.
  9. 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. 10. Resorption Collapse
  11. 11. SIGNS  DIRECT:  INDIRECT:
  12. 12. Displacement of interlobar fissures.
  13. 13. Loss Of Aeration
  14. 14. Crowding of vessels and bronchi.
  15. 15. Elevation Of Hemidiaphragm.
  16. 16. Mediastinal Displacement.
  17. 17. Hilar Displacement.
  18. 18. Compensatory Hyperinflation 1)ANTERIOR TO ASCENDING AORTA 2)POSTERIOR TO HEART 3)UNDER THE ARCH
  19. 19. Air Bronchogram  Almost not seen in resorption collapse  Seen in adhesive and passive collapse.  And in cicatrisation collapse with extensive fibrosis.
  20. 20. Pre existing Lung Diseases.  Fibrosis  Plueral Adhesions  May alter the expected anatomical displacements in collapse
  21. 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. 22. RUL Collapse
  23. 23. RUL Collapse
  24. 24. LUL Collapse
  25. 25. RML Collapse
  26. 26. Lingular Collapse
  27. 27. RLL Collapse
  28. 28. LLL Collapse
  29. 29. Shifting Granuloma sign.
  30. 30. Luftsichel Sign:
  31. 31. Juxtaphrenic Peak Sign
  32. 32. Golden S Sign
  33. 33. Superior Triangle Sign
  34. 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. 35. Round Atelectasis
  36. 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. 37. Causes:  Pneumonia  Cardiogenic / non cardiogenic pulmonary edema  Aspiration  Haemorrhage  Neoplasms
  38. 38. Air Bronchogram  Produced by the radiographic contrast between the column of air in the airway and the surrounding opaque acini.
  39. 39. Lobar Consolidation  Homogenous opacity  Air bronchogram  Well defined borders.
  40. 40. RUL
  41. 41. RML
  42. 42. RLL
  43. 43. LUL & Lingula
  44. 44. LLL
  45. 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.

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