Transcript Lobar Collapse - Queen Margaret University

Lobar Collapse
Lung Anatomy
(1) aortic arch
(2) pulmonary trunk
(3) left atrial appendage
(4) left ventricle
(5) right atrium
(6) superior vena cava
(7 & 8) diaphragm
(9) transverse fissure
Lung Anatomy
(1) oblique fissure
(2) transverse fissure
(3) retrocardiac space
(4) retrosternal space
Lobar Extent
Lobar Extent
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
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.
Lobar Collapse
• Partial or complete loss of lung volume
• Air resorption
• Atelectasis
Common causes of lobar collapse
• Proximal stenosing bronchogenic carcinoma.
– Middle aged or elderly, almost always smokers.
• Asthma due to mucous plugging
– Young adult or older child ,responds to physiotherapy.
• Inhaled foreign body
– Infants , such as a peanut.
• Retention of secretions
– Any age, frequent cause of post operative collapse.
• Ventilation
– Endotracheal tube is inserted too far, entering one
main bronchus and occluding the other.
Signs of Lobar Collapse
• Lobar
– Shift of fissures
– Crowding of vessels (increased opacity)
• Extra lobar
– Hemi diaphragm elevation
– Mediastinal shift towards side of collapse
– Hilar shift and distortion
– Compensatory hyperinflation
– Rib approximation
– Shift of other structures e.g. granuloma
Right upper lobe collapse
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Minor fissure pivots and bows
Right hilar elevation
May simulate mediastinal widening
Deviation of trachea
Both fissures concave superiorly
Right upper lobe collapse
Golden’s S sign
Golden’s S sign
Right Lower lobe collapse
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Posterior and medial collapse
Obliteration of the right hemi diaphragm
Heart border clearly seen
Transverse fissure pulled inferiorly
Right Lower lobe collapse
Right Middle Lobe Collapse
• Right horizontal and oblique fissure move
towards each other
• often subtle
• blur the normally sharp right-heart border
(silhouette sign)
Right Middle lobe Collapse
Left lower lobe collapse
• Posterior and medial collapse
• triangular opacity – sail sign
• hemidiaphragm may be obscured
Left Lower lobe collapse
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
Left Upper Lobe Collapse
Left Upper Lobe Collapse
‘Luftsichel’
Complete Collapse
Summary Right
• Right Upper lobe
• Right middle lobe
• Right Lower Lobe
Summary Left
• Left upper lobe
• Left lower lobe