This presentation is from 15th chapter of Grainger and Allison--Diagnostic Radiology A TEXTBOOK OF MEDICAL IMAGING. My aim behind all these presentation is to provide authentic images. As our all radiology revolve around images of diseases. We can put these ppts in our androids for study and references.

1. 14
Pulmonary Lobar Collapse:
Essential Considerations

2. • FIGURE 14-1 ■ Total left
lung collapse. (A) Frontal
and (B) lateral chest
radiographs. The cause of
the collapse is a
bronchogenic carcinoma;
the endobronchial
component is visible as an
abrupt cutoff of the left
main bronchus. Note the
marked displacement of the
right lung anteriorly and
posteriorly across the
midline (arrows). Note the
marked anterior
hyperlucency of the thorax
on the lateral view (B).

3. • FIGURE 14-2 ■ Total right lung collapse in a
neonate. The patient was ventilated for
respiratory distress syndrome and the cause of
the total lung collapse was a mucus plug.

4. • FIGURE 14-3 ■ Shifting
granuloma sign. (A)
Before and (B) after
right lower lobe
collapse.

5. • FIGURE 14-4 ■
Luftsichel sign. (A) A
left upper lobe
collapse
demonstrating
paramediastinal
lucency (arrow). (B) CT
shows interposition of
aerated lung between
the collapse and the
mediastinum (arrow).
There is also a large
right paratracheal node
causing some
distortion of the SVC.

6. • FIGURE 14-5 ■ Juxtaphrenic peak sign. A
small triangular density (arrow) is seen in a
left upper lobe collapse. The sign is due to
reorientation of an inferior accessory fissure.

7. • FIGURE 14-6 ■ Golden’s S sign. A right upper lobe
collapse demonstrating peripheral concavity and central
convexity (arrows) due to an underlying bronchogenic
carcinoma resulting in a reverse S shape.

8. • FIGURE 14-7 ■ Air bronchograms in a collapsed and
consolidated right lower lobe. The sign can be helpful
in excluding a central obstructing mass and in this case
the cause was a bacterial pneumonia.

9. • FIGURE 14-8 ■ Enhancement of
atelectatic lung versus pneumonia.
(A) Axial intravenous contrast
enhanced CT in a patient with
passive atelectasis of the right
lower lobe due to a large pleural
effusion. Note the dense
homogeneous enhancement of the
collapsed right lower lobe. (B) Axial
intravenous contrast enhanced CT
of a patient with right upper lobe
pneumonia, right pleural effusion
and pericardial effusion. Note the
relative lack of enhancement of the
posterior right upper lobe (arrow)
resulting in less clear
differentiation of pulmonary
parenchyma from pleural fluid than
demonstrated in (A).

10. • FIGURE 14-9 ■ CT of a
collapsed right upper
lobe due to a squamous
cell carcinoma. Note the
peripheral air
bronchograms (arrow) in
(A) despite a central
obstructing mass with
amorphous calcification
(B). There is a convex
border of the collapsed
lobe (arrows) (B) which
is the CT equivalent of
Golden’s S sign.

11. • FIGURE 14-10 ■ CT of right upper lobe collapse due to
bronchogenic carcinoma. Note how the attenuation
of the necrotic tumour is lower than the adjacent
collapsed lung which enhances with intravenous
contrast medium.

12. • FIGURE 14-11 ■ Left lung
collapse. (A, B) Contrast
enhanced CT sections of
whole lung collapse due
to a squamous cell
carcinoma in the left main
bronchus (arrow in A).
There is also a left pleural
effusion and a small
pericardial effusion. Note
the low attenuation areas
relative to the densely
enhancing left lower lobe
parenchyma (B) which
represent mucus filled
airways—the CT mucous
bronchogram sign.

13. • FIGURE 14-12 ■ Left lower lobe collapse. Contrast
enhanced CT showing a tight left lower lobe collapse.
Normal mediastinal structures (particularly left sided)
may cause a focal bulge in the contour of a lobar
collapse (in this case by the well opacified descending
thoracic aorta) and should not be confused with a
Golden’s S sign due to tumour.

14. • FIGURE 14-13 ■ Resolution
of left lower lobe collapse.
(A) An initial high resolution
CT of a young female patient
with symptoms of recurrent
respiratory tract infections
shows a collapsed left lower
lobe with possible
bronchiectatic airways,
raising the possibility of
chronicity. (B) Follow up
conventional CT at the same
level several months later
shows complete resolution of
the left lower lobe collapse
and normal airways. This
case illustrates the difficulty
in making an accurate
assessment of the airways in
patients with lobar collapse.

15. • FIGURE 14-14 ■ Ultrasound demonstrating a
linear collapsed lower lobe with a large pleural
effusion. The asterisks demonstrate the distance
between the collapsed lung and hemidiaphragm.

16. • FIGURE 14-15 ■ Intravenous contrast enhanced
CT demonstrating right middle lobe collapse (A).
Image from a CT PET study at the same level (B)
shows increased uptake of radioisotope within
the collapse. A targeted ultrasound guided biopsy
was performed (C), and bronchogenic carcinoma
confirmed. Continued

17. • FIGURE 14-15 ■ Intravenous contrast enhanced
CT demonstrating right middle lobe collapse (A).
Image from a CT PET study at the same level (B)
shows increased uptake of radioisotope within
the collapse. A targeted ultrasoundguided biopsy
was performed (C), and bronchogenic carcinoma
confirmed.

18. • FIGURE 14-16 ■ Right upper lobe collapse.
Typical example of a collapsed right upper
lobe demonstrating the slightly concave
inferior border of the opacified lung due to
the horizontal fissure.

19. • FIGURE 14-17 ■
Right upper lobe
collapse. An
example of right
upper lobe
collapse mimicking
an apical cap of
fluid (arrow).

20. • FIGURE 14-18 ■ Tight right upper lobe
collapse. Note how the collapsed lobe (due to
a central bronchogenic carcinoma) results in
increased right paramediastinal density.

21. • FIGURE 14-19 ■ CT of right upper lobe
collapse. The collapsed lobe forms a
triangular wedge of soft tissue anteriorly in
the right hemithorax.

22. • FIGURE 14-20 ■ Left upper
lobe collapse. (A) A typical
example of left upper lobe
collapse demonstrating
increased angulation
between the left main
bronchus and the lower lobe
bronchus arrow) on the
frontal view. The aortic
knuckle is visible in this
example due to
compensatory hyperinflation
of the left lower lobe. (B) The
lateral view demonstrates
anterior displacement of the
oblique fissure. Note the
increased retrosternal
lucency (see Fig. 14.21).

23. • FIGURE 14-21 ■ Left upper lobe collapse. Intravenous
contrast enhanced CT of left upper lobe collapse
shows increased wedge shaped density of the left
upper lobe adjacent to the mediastinum. Note the
displacement of the right lung across the midline
anteriorly, resulting in retrosternal hyperlucency and
increased clarity of the anterior ascending thoracic
aorta on the lateral view (see Fig. 14.20).

24. • FIGURE 14-22 ■ Atypical left upper lobe collapse. (A) The
frontal radiograph demonstrates the inferior concave
border of the collapsed lobe and resembles a right upper
lobe collapse. (B, C) CT images show increased triangular
density to the left of the mediastinum (B), which does not
extend along the left heart border (C), a feature usually
seen in left upper lobe collapse. The appearance is due to
sparing of the lingular segments.

25. • FIGURE 14-22 ■ Atypical left upper lobe collapse. (A) The
frontal radiograph demonstrates the inferior concave border of
the collapsed lobe and resembles a right upper lobe collapse.
(B, C) CT images show increased triangular density to the left of
the mediastinum (B), which does not extend along the left heart
border (C), a feature usually seen in left upper lobe collapse.
The appearance is due to sparing of the lingular segments.

26. • FIGURE 14-23 ■ Lingular collapse. (A) Frontal view of
isolated collapse of the lingular segments of the left
upper lobe showing loss of clarity of the left heart
border and a raised hemidiaphragm. (B) The similarity
to a right middle lobe collapse can be appreciated on
the lateral view.

27. • FIGURE 14-24 ■ Right middle lobe collapse.
(A) Frontal view of a typical example showing
loss of clarity of the right heart border. (B)
The lateral view shows the wedge shaped
density extending anteriorly from the hilum.

28. • FIGURE 14-25 ■ Right middle lobe collapse. An
example showing a triangular shaped density
adjacent to the right heart border.

29. • FIGURE 14-26 ■ Middle lobe syndrome. High
resolution CT showing right middle lobe collapse
and bronchiectasis due to previous tuberculous
infection.

30. • FIGURE 14-27 ■ Right
lower lobe collapse. (A)
Frontal view of an
example of right lower
lobe collapse
demonstrating a
triangular density which
does not obscure the
right hemidiaphragm
silhouette. (B) The lateral
radiograph shows the
typical features of
increased density of the
posterior costophrenic
angle and loss of the
silhouette of the right
diaphragm posteriorly.

31. • FIGURE 14-28 ■ Left lower lobe collapse. A
typical appearance of left lower lobe collapse
resulting in a triangular density behind the
heart (arrowheads). The contour of the medial
left hemidiaphragm is lost.

32. • FIGURE 14-29 ■ Superior triangle sign. (A) An initial
image shows the normal appearances (note the lower
lobe artery is clearly visible). (B) The subsequent image
shows a right lower lobe collapse demonstrating the
superior triangle sign (arrow) (which should not be
confused with a right upper lobe collapse). The lower
lobe artery can no longer be seen.

33. • FIGURE 14-30 ■
Schematic
appearances of the
various lobar
collapses on frontal
and lateral
radiographs. RUL,
right upper lobe;
RML, right middle
lobe; RLL, right lower
lobe; LUL, left upper
lobe; LLL, left lower
lobe.

34. • FIGURE 14-31 ■ Combined right middle and right lower lobe collapse. (A)
On the frontal view the increased density extends to the right
costophrenic angle. (B) On the lateral view the increased density also
extends from the anterior to the posterior chest wall. The cause in this
case was a bronchogenic carcinoma obstructing the bronchus intermedius.

35. • FIGURE 14-32 ■ Bilateral lower lobe collapse. Bilateral triangular
densities are seen with obscuration of the medial portions of the
hemidiaphragms. The cause was mucus plugging.