Download - Atelectasis Radiology Report by Dr. Gian Hao
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AtelectasisGiankarlo Hao MD
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Definition:
• Ateles (incomplete) and ektasis (stretching)
• Loss of lung volume
• Collapse is often used synonymously with atelectasis it should be reserved for complete atelectasis
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Physiologic Division of Atelectasis
Obstructive Non- obstructive
most common type
results from reabsorption of gas from the alveoli when communication between the alveoli and the trachea is obstructed.
caused by loss of contact between the parietal and visceral pleurae, compression, loss of surfactant, and replacement of parenchymal tissue by scarring or infiltrative disease
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Mechanisms of Atelectasis
Resorptive (obstructive)
Passive (compressive)
Adhesive (subsegmental)
Cicatrization (scarring)
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Mechanisms of Atelectasis
Resorptive (obstructive)
Passive (compressive)
Adhesive (subsegmental)
Cicatrization (scarring)
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Mechanisms of Atelectasis
Resorptive (obstructive)
General considerations:
Air will disappear from healthy,obstructed lobe in 18-24 hours
Oxygen much more readily absorbedthan air
Will become apparent within an hour if highpO2
Bronchogenic carcinoma
Bronchial obstruction from metastatic neoplasm
Inflammatory etiology (eg, tuberculosis, fungal infection)
Aspirated foreign body
Mucous plug
Malpositioned endotracheal tube
Extrinsic compression of an airway by neoplasm, lymphadenopathy, aortic aneurysm, or cardiac enlargement
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Resorptive (obstructive)
Adhesive (subsegmental)
Cicatrization (scarring)
Passive (compressive)
Mechanisms of Atelectasis
Collapse 2° space-occupying lesion• Pneumothorax• Hydrothorax
Density of the collapsed lung doesn’tincrease until lung reaches 1/10 normalvolume
>Air bronchograms may be seenbecause bronchi do not collapse
>Round atelectasis is form of passiveatelectasis
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Resorptive (obstructive)
Passive (compressive)
Cicatrization (scarring)
Adhesive (subsegmental)
Mechanisms of Atelectasis
surfactant deficiency
Seen in patients:
• Are post-op• Have closed chest trauma• Have pleuritic chest pain
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Resorptive (obstructive)
Passive (compressive)
Adhesive (subsegmental)
Cicatrization (scarring)
Mechanisms of Atelectasis
Underlying pathology is fibrosis
Localized form• Characterized by scarring in the upper lobefrom TB
Generalized form• May occur in diffuse interstitial fibrosis
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Indirect
Radiologic Signs of Atelectasis
Direct Displacement of interlobar fissures
Crowding of vessels and bronchi (“crowded air-bronchogram”)
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Indirect
Radiologic Signs of Atelectasis
Direct Displacement of interlobar fissures
Crowding of vessels and bronchi (“crowded air-bronchogram”)
Local opacityDiaphragmatic elevationMediastinal shiftApproximation of ribsCompensatory overinflationDisplacement of the hilumAbsence of an air bronchogramMiscellaneous signs: shifting granuloma/mass
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Patterns of Atelectasis
Total Pulmonary Atelectasis
Lobar Atelectasis
Combined Lobar Atelectasis
Segmental Atelectasis
Linear (Plate-like) Atelectasis
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Patterns of Atelectasis
Total Pulmonary Atelectasis
Lobar Atelectasis
Combined Lobar Atelectasis
Segmental Atelectasis
Linear (Plate-like) Atelectasis
Mediastinum most affected
• Mediastinal shift toward the side of atelectasis
elevation of the hemidiaphragm
Usually secondary to obstruction of the main bronchus
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Patterns of Atelectasis
Total Pulmonary Atelectasis
Lobar Atelectasis
Combined Lobar Atelectasis
Segmental Atelectasis
Linear (Plate-like) Atelectasis
RUL Atelectasis
> Collapsed RUL shifts medially and superiorly elevation of the right hilum and the minor fissure> Tenting of the diaphragmatic pleura juxtaphrenic peak
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RUL Atelectasis
> Collapsed RUL shifts medially and superiorly elevation of the right hilum and the minor fissure> Tenting of the diaphragmatic pleura juxtaphrenic peak
Patterns of Atelectasis
Lobar Atelectasis
LUL Atelectasis Major fissure moves forward• Superior segment of lower lobe creeps over apical segment“Luftsichel” (air crescent) sign
LUL Atelectasis
LATERAL: forward and medial displacement of the major fissureBroad linear opacity contiguous and parallel to the anterior chest wall
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Patterns of Atelectasis
Lobar Atelectasis
LUL Atelectasis
LATERAL: forward and medial displacement of the major fissureBroad linear opacity contiguous and parallel to the anterior chest wall
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Lobar Atelectasis
Patterns of Atelectasis
RML Atelectasis Easy on lateral Most difficult on PA
> Approximation of the lower half of major fissure and minor fissure> Obliteration of right cadiac border (silhouette sign)
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Lobar Atelectasis
Patterns of Atelectasis
RML Atelectasis Easy on lateral Most difficult on PA
> Approximation of the lower half of major fissure and minor fissure> Obliteration of right cadiac border (silhouette sign)
Lingular Atelectasis
Basically follows the same pattern as RML atelectasis
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Patterns of Atelectasis
Total Pulmonary Atelectasis
Lobar Atelectasis
Segmental Atelectasis
Linear (Plate-like) Atelectasis
Combined Lobar Atelectasis
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Patterns of Atelectasis
Combined Lobar Atelectasis
RUL – RML AtelectasisRML – RLL AtelectasisRUL – RLL Atelectasis
** Silhoutte sign
Homogenous opacity conforms to the anatomic distribution of a bronchopulmonary segment
Common in post op patients
Segmental Atelectasis
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Patterns of Atelectasis
Homogenous opacity conforms to the anatomic distribution of a bronchopulmonary segment
Common in post op patients
Segmental AtelectasisLinear (Plate-like) Atelectasis
Plate-like / Discoid Atelectasis, Fleischner lines
1-3 mm in thickness, 4-10 cm in length
Associated with diminished diaphragmatic excursion
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“You will not grow if you sit in a beautiful flower garden, but you will if you are sick, in pain, experience losses and if you do not put your head in the sand but take the pain and learn to accept it, not as a curse or punishment but as a gift to you with a very, very specific purpose.”
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