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Lobar Collapse

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

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Lobar Collapse

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  1. Lobar Collapse

  2. 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

  3. Lung Anatomy (1) oblique fissure (2) transverse fissure (3) retrocardiac space (4) retrosternal space

  4. Lobar Extent

  5. Lobar Extent

  6. 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

  7. 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.

  8. Lobar Collapse • Partial or complete loss of lung volume • Air resorption • Atelectasis

  9. 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.

  10. 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

  11. Right upper lobe collapse • Minor fissure pivots and bows • Right hilar elevation • May simulate mediastinal widening • Deviation of trachea • Both fissures concave superiorly

  12. Right upper lobe collapse

  13. Golden’s S sign

  14. Golden’s S sign

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

  16. Right Lower lobe collapse

  17. Right Middle Lobe Collapse • Right horizontal and oblique fissure move towards each other • often subtle • blur the normally sharp right-heart border (silhouette sign)

  18. Right Middle lobe Collapse

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

  20. Left Lower lobe collapse

  21. 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

  22. Left Upper Lobe Collapse

  23. Left Upper Lobe Collapse‘Luftsichel’

  24. Complete Collapse

  25. Summary Right • Right Upper lobe • Right middle lobe • Right Lower Lobe

  26. Summary Left • Left upper lobe • Left lower lobe

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