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{{Atelectasis}}
{{Atelectasis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{Cherry}}  
==Overview==
==Overview==
There are no x-ray findings associated with [disease name].
An x-ray may be helpful in the diagnosis of atelectasis. Findings on an x-ray suggestive of atelectasis include [[displacement]] of [[Fissure|fissures]], [[rib]] crowding, elevation of ipsilateral [[Thoracic diaphragm|diaphragm]], volume loss on ipsilateral hemithorax, [[Hilum|hilar]] displacement and compensatory hyperlucency of the remaining lobes. Complete lung atelectasis and atelectasis involving different parts of the lung have their own characteristic appearance. While complete atelectasis of the lung may lead to opacification of the entire hemithorax and ipsilateral shift of the [[mediastinum]], a right midle and lower lobe atelectasis may show [[Pleural effusions|subpulmonic effusions]] along with right [[Thoracic diaphragm|hemidiaphragmatic]] elevation on X-ray.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


==X Ray==
==X Ray==
*Atelectasis of the lung is a very common abnormality seen on chest radiographs. Abnormalities on chest X-ray due to atelectasis help in the delineation of the underlying pathology.<ref name="pmid11227785">{{cite journal |vauthors=Ashizawa K, Hayashi K, Aso N, Minami K |title=Lobar atelectasis: diagnostic pitfalls on chest radiography |journal=Br J Radiol |volume=74 |issue=877 |pages=89–97 |date=January 2001 |pmid=11227785 |doi=10.1259/bjr.74.877.740089 |url=}}</ref>
*Different types of atelectasis have their own characteristic radiographic pattern and etiology.
*An x-ray may be helpful in the diagnosis of atelectasis. Findings on an x-ray suggestive of atelectasis include:<ref name="pmid16716813">{{cite journal |vauthors=Qureshi NR, Gleeson FV |title=Imaging of pleural disease |journal=Clin. Chest Med. |volume=27 |issue=2 |pages=193–213 |date=June 2006 |pmid=16716813 |doi=10.1016/j.ccm.2006.02.001 |url=}}</ref>
**Signs of lobar collapse such as:
***[[Mediastinal|Shifting of the mediastinum]] towards the collapsed [[Lung|lung lobe]]
***[[Hilum|Hilar]] displacement
***Silhouetting of the [[Thoracic diaphragm|diaphragm]] or the heart border
***[[Rib]] crowding
***Compensatory hyperlucency of the remaining lobes
***Elevation of [[Diaphragm|ipsilateral diaphragm]]
***Opacification of the collapsed lung lobe
***Displacement of [[Fissure|fissures]]
***Volume loss on ipsilateral hemithorax
***Air bronchograms help delineate the site of [[obstruction]]


*There are no x-ray findings associated with [disease name].
*X-ray findings in cases with complete atelectasis of the lung include:<ref name="pmid8820022">{{cite journal |vauthors=Woodring JH, Reed JC |title=Radiographic manifestations of lobar atelectasis |journal=J Thorac Imaging |volume=11 |issue=2 |pages=109–44 |date= 1996 |pmid=8820022 |doi= |url=}}</ref><ref name="pmid7394541">{{cite journal |vauthors=Proto AV, Tocino I |title=Radiographic manifestations of lobar collapse |journal=Semin Roentgenol |volume=15 |issue=2 |pages=117–73 |date=April 1980 |pmid=7394541 |doi= |url=}}</ref>
OR
**Opacification of the entire hemithorax due to complete collapse of a lung
*An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include:
**Ipsilateral shift of the [[mediastinum]], that helps distinguish atelectasis from [[pleural effusion]]
**[Finding 1]
*X-ray findings suggestive of right upper lobe (RUL) collapse include:
**[Finding 2]
**Medial and superior shift of RUL
**[Finding 3]
**Sign of Golden S: Concave appearance of minor [[fissure]]
OR
**Right minor [[fissure]] elevation
*There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include:
**Right [[Hilum|hilar]] elevation
**[Complication 1]
*X-ray appearance of right middle lobe collapse:
**[Complication 2]
**Triangular opacity
**[Complication 3]
*X-ray appearance of right lower lobe (RLL) collapse:
CXR
**Posterior and inferior shift of RLL due to collapse
Chest radiograph
**Superior triangle sign: Rightward shift of structures in the superior [[mediastinum]]
Signs of lobar collapse may be visualised on CXR
**Blurring of the right hemidiaphragm (posterior third)
Direct signs:
**Visibility of the major [[fissure]], which is usually not seen
Displacement of fissures
*X-ray appearance of a right middle and lower lobe atelectasis:<ref name="pmid8820023">{{cite journal |vauthors=Stark P, Leung A |title=Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax |journal=J Thorac Imaging |volume=11 |issue=2 |pages=145–9 |date= 1996 |pmid=8820023 |doi= |url=}}</ref>
Opacification of the collapsed lung lobe
**[[Pleural effusion|Subpulmonic effusion]]
Indirect signs:
**Elevation of the right hemidiaphragm
Hilar displacement
*X-ray appearance of left upper lobe (LUL) collapse:
Shifting of the mediastinum towards collapsed lung lobe
**Atelectatic left upper lobe shifts anteriorly and superiorly  
Volume loss on ipsilateral hemithorax
**PA view: Faint opacity of the atelectatic lobe in the left upper hemithorax
Elevation of ipsilateral diaphragm
Rib crowding
Compensatory hyperlucency of the remaining lobes
Silhouetting of the diaphragm or the heart border
 
Complete atelectasis of an entire lung:
Opacification of the entire hemithorax due to complete collapse of a lung Ipsilateral shift of the mediastinum, that helps distinguish atelectasis from pleural effusion
 
Right upper lobe (RUL) collapse:
Medial and superior shift of collapsed RUL  
Right hilum elevation
Right minor fissure elevation
Sign of Golden S: Concave appearance of minor fissure  
 
 
Right middle lobe (RML) collapse:
Appears as a triangular opacity
 
Right lower lobe (RLL) collapse:
Posterior and inferior shift of collapsed RLL  
The major fissure, which normally is not visible, is seen
Superior triangle sign: shift of superior mediastinal structure to the right
Collapsed RLL blurs the posterior third of the right hemidiaphragm. Concomitant RML and RLL atelectasis:
Appears as an elevated right hemidiaphragm or a subpulmonic effusion
 
Left upper lobe (LUL) collapse:
Atelectatic LUL shifts anteriorly and superiorly  
PA view: Atelectatic LUL produces a faint opacity in the left upper hemithorax


Left lower lobe (LLL) collapse:
* X-ray appearance of left lower lobe (LLL) collapse:
Retrocardiac opacity  
** Retrocardiac opacity  
Downward displacement of the hilum  
** Downward displacement of the [[hilum]]
Aortic-knob sign: obliteration of the aortic arch by the superior mediastinum
** Aortic-knob sign: Obliteration of the [[aortic arch]] by the [[superior mediastinum]]
Lateral radiographs
** Lateral view: Indistinct appearance of the posterior third of the [[Thoracic diaphragm|diaphragm]] due to opacity
Opacity makes the posterior third of the left diaphragm indistinct


 
* X-ray appearance of rounded atelectasis:  
Rounded atelectasis:
** Subpleural mass 
Formation of fibrous bands which adhere the lung to the pleura in patients with asbestosis
** Location of rounded atelectasis: Right middle lobe, lower lobes or [[lingula]]
Location: Lower lobes, lingula, or RML
** Comet-tail sign or talon sign: Bronchovascular structures projecting out of the mass toward the [[hilum]], in a swirl appearance  
Chest radiographs:
** [[Pleural plaque|Parietal pleural plaque]]
Subpleural mass
* X-ray appearance of post-surgical atelectasis:
Comet-tail sign: bronchovascular structures projecting out of the mass toward the hilum, in a swirl appearance
** Bibasal pattern
parietal pleural plaque  
* CXR also helps determine the efficacy of [[chest physiotherapy]] in [[Patient|patients]] with atelectasis.  
 
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Post-surgical atelectasis will be bibasal in pattern.
 
Images shown in this section are courtesy of RadsWiki and copylefted.
 
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Latest revision as of 16:05, 22 February 2018

Atelectasis Microchapters

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Overview

Historical Perspective

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Differentiating Atelectasis from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

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Physical Examination

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Chest X Ray

CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

An x-ray may be helpful in the diagnosis of atelectasis. Findings on an x-ray suggestive of atelectasis include displacement of fissures, rib crowding, elevation of ipsilateral diaphragm, volume loss on ipsilateral hemithorax, hilar displacement and compensatory hyperlucency of the remaining lobes. Complete lung atelectasis and atelectasis involving different parts of the lung have their own characteristic appearance. While complete atelectasis of the lung may lead to opacification of the entire hemithorax and ipsilateral shift of the mediastinum, a right midle and lower lobe atelectasis may show subpulmonic effusions along with right hemidiaphragmatic elevation on X-ray.

X Ray

  • Atelectasis of the lung is a very common abnormality seen on chest radiographs. Abnormalities on chest X-ray due to atelectasis help in the delineation of the underlying pathology.[1]
  • Different types of atelectasis have their own characteristic radiographic pattern and etiology.
  • An x-ray may be helpful in the diagnosis of atelectasis. Findings on an x-ray suggestive of atelectasis include:[2]
  • X-ray findings in cases with complete atelectasis of the lung include:[3][4]
    • Opacification of the entire hemithorax due to complete collapse of a lung
    • Ipsilateral shift of the mediastinum, that helps distinguish atelectasis from pleural effusion
  • X-ray findings suggestive of right upper lobe (RUL) collapse include:
    • Medial and superior shift of RUL
    • Sign of Golden S: Concave appearance of minor fissure
    • Right minor fissure elevation
    • Right hilar elevation
  • X-ray appearance of right middle lobe collapse:
    • Triangular opacity
  • X-ray appearance of right lower lobe (RLL) collapse:
    • Posterior and inferior shift of RLL due to collapse
    • Superior triangle sign: Rightward shift of structures in the superior mediastinum
    • Blurring of the right hemidiaphragm (posterior third)
    • Visibility of the major fissure, which is usually not seen
  • X-ray appearance of a right middle and lower lobe atelectasis:[5]
  • X-ray appearance of left upper lobe (LUL) collapse:
    • Atelectatic left upper lobe shifts anteriorly and superiorly
    • PA view: Faint opacity of the atelectatic lobe in the left upper hemithorax
  • X-ray appearance of left lower lobe (LLL) collapse:
  • X-ray appearance of rounded atelectasis:
    • Subpleural mass
    • Location of rounded atelectasis: Right middle lobe, lower lobes or lingula
    • Comet-tail sign or talon sign: Bronchovascular structures projecting out of the mass toward the hilum, in a swirl appearance
    • Parietal pleural plaque
  • X-ray appearance of post-surgical atelectasis:
    • Bibasal pattern
  • CXR also helps determine the efficacy of chest physiotherapy in patients with atelectasis.

Images shown in this section are courtesy of RadsWiki and copylefted.

  • Right lower lobe collapse

    Right lower lobe collapse

  • Right lower lobe collapse. The same patient. Lateral view.

    Right lower lobe collapse. The same patient. Lateral view.

  • Left upper lobe collapse

    Left upper lobe collapse

  • Left upper lobe collapse

    Left upper lobe collapse

  • Left lower lobe collapse

    Left lower lobe collapse

  • S Sign of the Golden

    S Sign of the Golden

  • S Sign of the Golden

    S Sign of the Golden

References

  1. ↑ Ashizawa K, Hayashi K, Aso N, Minami K (January 2001). "Lobar atelectasis: diagnostic pitfalls on chest radiography". Br J Radiol. 74 (877): 89–97. doi:10.1259/bjr.74.877.740089. PMID 11227785.
  2. ↑ Qureshi NR, Gleeson FV (June 2006). "Imaging of pleural disease". Clin. Chest Med. 27 (2): 193–213. doi:10.1016/j.ccm.2006.02.001. PMID 16716813.
  3. ↑ Woodring JH, Reed JC (1996). "Radiographic manifestations of lobar atelectasis". J Thorac Imaging. 11 (2): 109–44. PMID 8820022.
  4. ↑ Proto AV, Tocino I (April 1980). "Radiographic manifestations of lobar collapse". Semin Roentgenol. 15 (2): 117–73. PMID 7394541.
  5. ↑ Stark P, Leung A (1996). "Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax". J Thorac Imaging. 11 (2): 145–9. PMID 8820023.

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