lobar collapse xray.pptx

radiology xray lung

1. LOBAR COLLAPSE OF LUNGS - Dr. Pradeep Patil Dr. D. Y. Patil Medical College Hospital, Kolhapur Dept. of Radiodiagnosis

2. Lobes of Lungs

3. R

4. lobar anatomy- Left lung- 2 lobes

5. LOBAR COLLAPSE

6. LOBAR COLLAPSE Lobar collapse refers to collapse of an entire lobe of the lung. it is a sub type of atelectasis.  Individual lobes of the lung may collapse due to obstruction of the supplying bronchus. 

7. C auses of lobar collapse extrinsic compression by adjacent mass luminal aspirated foreign material mucous plugging endobronchial mass misplaced endotracheal tube mural bronchogenic carcinoma

8. Signs of Lobar Collapse Lobar Shift of fissure Crowding of pulmonary vessels (increased opacity) Extra lobar I/L Hemi diaphragm elevation Mediastinal shift towards side of collapse Hilar displacement towards the collapse Compensatory hyperinflation of normal lobes Rib approximation (crowding of ipsilateral ribs) Shift of other structures

9. Right upper lobe collapse RUL collapse Horizontal fissure displaced upward Hilum is elevated Tracheal deviation to right Compensatory hyperinflation of right middle and lower lobes may be seen

10. Right upper lobe collapse On the lateral projection it is harder to identify as the soft tissues of the shoulders usually obscure the upper zones, and the collapse is mostly medial. Elevation of the horizontal fissure and upper part of the oblique fissure may be visible Both fissures concave superiorly

11. Right upper lobe collapse

12. Golden ’ s S sign The sign refers to the S shape ( or more accurately , reverse S on the right) of the fissure due to the combination of collapse and mass centrally resulting in a focal convexity with a concave outline.

13. Golden ’ s S sign

14. Juxtaphrenic peak sign The juxtaphrenic peak sign, which occurs in upper lobe atelectasis, describes the triangular opacity projecting superiorly at the medial half of the diaphragm.

15. D/D The differential diagnosis of collapse of the right upper lobe includes: consolidation of the right upper lobe a mass in the medial aspect of the right upper lobe a mass in on the right side of the superior mediastinum

16. Right Middle Lobe Collapse Horizontal fissure and oblique fissure move towards one another Obscuration of right heart border Volume of this lobe is small so indirect signs rarely present.

17. Right Middle Lobe collapse

18. Silhouette Sign If two soft tissue densities lie in apposition, then they will not be visible separately If they are separated by air, the boundaries of both will be seen

19. Uses of Silhouette Localisation without a lateral view Loss of clarity of a structure suggests there is adjacent soft tissue shadowing even when the abnormality itself is not clearly visualised. This is particularly valuable in some cases of lobar collapse.

20. Right Middle lobe Collapse 1: Right horizontal and oblique fissure move towards each other often subtle 2: Blur the normally sharp right-heart border (silhouette sign)

21. Posteroanterior (PA) (left) and lateral chest (right) radiographs. A right middle lobe collapse obliterates the right heart border on the PA image and projects as a wedge-shaped opacity on the lateral view.

22. D/D Frontal projection On frontal (PA or AP) projection, right middle lobe collapse should be distinguished from: consolidation of the right middle lobe pectus excavatum: downward sloping ribs and shift of the heart away from the right are clues. Lateral projections makes the distinction easy.  2. Lateral projection On the lateral projection, right middle lobe collapse should be distinguished from: fluid within the oblique fissure (pseudotumour): horizontal fissure should be visible as separate to the opacity 2 fat within the oblique fissure consolidation of the right middle lobe

23. Right Lower lobe collapse Depression of horizontal fissure Increase opacity of collapse lower lobe In case of complete collapse of lower lobe it may be so small that it merges with mediastinum and produce a thin wedge shape shadow. Mediastinal parts and adjacent diaphragm obscured Hila depressed Diaphragm elevation is not usual

24. Right Lower lobe collapse Posterior and medial collapse Obliteration of the right hemi diaphragm Heart border clearly seen Transverse fissure pulled inferiorly

25. The lateral view is usually definitive- there will be postero-inferior movement of the oblique fissure whilst maintaining the same slope The lower lobes collapse downward medially toward the spine and posteriorly

26. Superior Triangle Sign triangular density to the right of mediastium seen in right lower lobe collapse due to displacement of anterior junctional stuctures

27. right lower lobe collapse that results in volume loss, obliteration of the right side of the diaphragm, and a posterior opacity.

28. D/D The characteristic shape associated with volume loss usually does not allow for any significant differential diagnosis. As always one should consider: consolidation (of the medial basal segment of the right lower lobe) a pulmonary or posterior mediastinal mass The location is also a favourite for pulmonary sequestration.

29. Left Upper Lobe Collapse veil like opacity aortic knuckle, left hilum, and left-heart border initially ill defined but may progress to become sharp almost vertical oblique fissure

30. Loss of volume on left side I/L shift of trachea and mediastinum Compensatory hyperinflation of left lung Raised left hemidiaphragm ( compare with right with tenting) Haziness over the aortic knuckle ( silhouette sign)

31. Oblique fissure displaced anteriorly Opacification anterior to the oblique fissure Anterior displacement of entire oblique fissure Aortic knuckle obscured LEFT UPPER LOBE COLLAPSE LATERAL VIEW

32. With increasing collapse upper lobe retracts posteriorly and loses contact with anterior chest wall. The space between the collapsed lung and sternum is occupied by either hyperinflated left lower lobe or herniated right upper lobe. When complete collapse occurs LUL lose contact with chest wall and diaphragm and retract medially against the mediastinum

33. Luftsichel sign The word “ Luftsichel” in German means “ air crescent” This sign is seen in severe left upper lobe collapse . Due to the lack of a minor fissure on the left side, upper lobe collapse causes vertical positioning and anterior and medial displacement of the major fissure. The superior segment of the left lower lobe migrates superior and anteriorly between the arch of the aorta and the atelectatic lobe. The crescent-shaped radiolucency around the aortic arch is called the Luftsichel sign

34. Left Upper Lobe Collapse ‘ Luftsichel ’

35. Left lower lobe collapse Posterior and medial collapse triangular opacity – sail sign hemidiaphragm may be obscured

36. The PA view will show a triangular area of increased opacity behind the left heart shadow. There may be loss of visualisation of the left hemi-diaphragm behind the heart The lower lobes collapse downward medially toward the spine and posteriorly

37. In the lateral view a triangular opacity will be seen at the base of the lung with a sharply defined anterior margin formed by the oblique fissure

38. Left Lower lobe collapse

39. D/D The characteristic shape associated with volume loss usually does not allow for any significant differential diagnosis. As always one should consider: consolidation (of the medial basal segment of the right lower lobe) a pulmonary or posterior mediastinal mass

40. Summary Right Right Upper lobe Right middle lobe Right Lower Lobe

41. Summary Left Left upper lobe Left lower lobe

42. Thank You