This presentaion is prepared by Dr Parikha Rampal, Senior Resident, Department of Radiodiagnosis, ABVIMS & Dr RML Hospital, New Delhi.

1. PULMONARY COLLAPSE AND
CONSOLIDATION
PRESENTER : PARIKHA RAMPAL
MODERATOR : SONIA SANDIP

2. PULMONARY CONSOLIDATION
• Air space or pulmonary or parenchymal consolidation represents of
alveolar air by
• Fluid (as in various types of pulmonary edema)
• blood ( as in pulmonary haemorrhage)
• pus (as in pneumonia)
• Cells ( as in bronchioalveolar carcinoma, lymphoma, eosinoplhilic
pneumonia etc.)
• Pulmonary consolidation could be diffuse or focal.

3. Radiographic findings in pulmonary
consolidation
• 1. Air bronchograms

4. • 2. Fluffy opacities
•

5. • 3. Patchy opacities

6. • 4.Air space nodules

7. 5. CT angiogram sign

8. PATTERN OF DISTRIBUTION
• 1. Perihilar “batwing” consolidation
• Central consolidation
• Sparing of lung periphery
• Seen in pulmonary edema, pulmonary haemorrhage, various pneumonias,
inhalational lung injury

9. • 2. Peripheral subpleural consolidation (reverse batwing consolidation)
• Consolidation is seen adjacent to the chest
• wall with sparing of the perihilar regions.
• Seen in patients of chronic lung disease,
sarcoidosis, radiation pneumonitis,
bronchioloalveolar carcinoma

10. • 3. Diffuse patchy consolidation
• The patchy opacities correspond to the consolidation of lobules,
segments or subsegments
• Seen in pulmonary edema, ARDs, aspiration, inhalational injury.
• 4. Diffuse air space nodules
Indicates endobronchial spread of disease in infection such as TB, MAC
or bronchioloalveolar carcinoma, BOOP.

11. • s

12. • Spherical consolidation Consolidation causing lobar
expansion

13. • Lobar consolidation
• Most typical pattern in pneumonia and abnormalities associated with
bronchial obstruction.
• It can involve any lobe in the bilateral lungs.
•

14. SILHOUETTE SIGN
• The borders of soft tissue structures such as mediastinum, hila and
hemidiaphragm are visible on chest radiographs because they are
outlined by adjacent air containing lung. When consolidated lung
contacts one of these structures, its border becomes invisible. This is
termed the “silhouette sign” and is used to diagnose the presence of
a lung abnormality and localize it to a specific lobe or lung region.

16. RUL CONSOLIDATION
The border of the right superior mediastinum and
superior vena cava is silhouetted.
On the lateral radiograph, the consolidated upper
lobe is outlined superiorly by the upper aspect of the
major fissure and inferiorly by the minor fissure.

17. RML CONSOLIDATION
• Right heart border is obscured.
• The opacity is marginated superiorly
by the minor fissure and inferiorly
by the major fissure.
• Right diaphragm remains visible.

18. RLL CONSOLIDATION
• Obscuration of the right dome of the diaphragm with
right heart border being visible.
• Inferior part of the right hilum is obscured.
• Radiopacity visible on the lateral radiograph being
outlined by the major fissure anteriorly.

19. LUL CONSOLIDATION
Left superior mediastinum and aortic arch
are obscured.
Superior left hilum is obscured.
Descending aorta remains visible
Left hemidiaphragm remains visible.

20. LLL CONSOLIDATION
The left hemidiaphragm is partially obscured by the
consolidation.
The inferior part of the left hilum is partially obscured.
The descending aorta is obscured.
The left heart border remains visible.

21. ATELECTASIS
The term atelectasis or collapse is used to indicate loss of volume of
lung tissue associated with a decrease in the amount of air it contains.
Types of atelectasis

24. Radiographic image of collapse

25. Pattern of collapse
Complete collapse Lobar collapse
Involving the entire lung involves only a lobe of the
lung

26. X RAY SIGNS OF COLLAPSE
Direct signs
• Displacement of fissures
• Crowding of vessels
Indirect signs
• Diaphragmatic elevation
• Mediastinal shift
• Compensatory overinflation of
normal lung
• Hilar displacement
• Reorientation of the hilum or
bronchi
• Approximation of the ribs
• Increased lung opacity
• Absence of air bronchograms
• Shifting granuloma sign

27. Normal anatomy of interlobar fissures

28. Other indirect signs of atelectasis
• Golden’s S sign - seen in right upper lobe atelectasis
• Juxtaphrenic peak – in upper lobe atelectasis
• Luftsichel sign – upper lobe atelectasis (usually of the left upper lobe)
• Flat waist sign – left lower lobe atelectasis
• Comet tail sign – rounded atelectasis

29. Signs of RUL collapse
• Right hemidiaphragm is elevated
• Minor fissure bowed upwards.
• Right hilum is elevated.
• Descending pulmonary artery is rotated outward.
• Juxtaphrenic peak of right hemidiaphragm.

30. RML collapse
• Ill defined wedge shaped radiopacity with its apex at
the hilum obscuring the right heart border.
• Downward displacement of the minor fissure and
anterior displacement of the major fissure.

31. RLL atelectasis
Typical triangular appearance of the right lower
lobe marginated by the major fissure.
Diwnward bowing of the minor fissure.
Major fissure is sharply defined because it is
posteriorly rotated.
Right hilum is displaced downward
Interlobar pulmonary artery is poorly defined.
Opacified arteries are visible within the collapsed
right lower lobe.

32. LUL collapse
Left hilum is elevated
Left hemidiaphragm is higher than the right.
Left main and eft upper lobe bronchi are
elevated and appear more horizontal.

33. Signs of LLL collapse
• Obscuration of left hemidiaphragm.
• Heart displaced to the left.
• Left pulmonary artery is poorly defined.
• Flattening of the left heart border due to
leftward rotation of the heart and great
vessels ( flat waist sign)
• Left ribs appear close together.
• Posterior displacement of the major
fissure

34. Special types of atelectasis
Disc atelectasis

35. Rounded atelectasis
• Elliptical opacity, peripheral in location,
in contact with the pleural surface.
• Vessels curve into the edge of the lesion
(comet tail sign)
• Posterior displacement of the major
fissure