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Atelectasis
Greek = incomplete stretching
Definition: diminished gas
within the lung associated with
reduced lung volume and
radiologic signs
Signs of Atelectasis
Direct
Indirect
Direct Signs
Displacement of fissures
Increased opacification of the
airless lobe.
Crowding of pulmonary vessels
Indirect Signs
Displacement of hilar structures
(Katans triangle sign)
Cardiomediastinal shift toward the side
of collapse
Narrowing of ipsilateral intercostal
spaces
Elevation of the ipsilateral
diaphragmatic leaflet (Juxtaphrenic
peak sign)
Indirect Signs
Compensatory hyperexpansion and
hyperlucency of the remaining
aerated parts of the lung
Obscuring of structures adjacent to
the collapsed lung, such as the
diaphragm, heart, or pulmonary
vessels.
Types of Atelectasis
Obstructive
Nonobstructive
Types of Atelectasis
Obstructive
Blockage of an airway.
Air retained distal to the occlusion
is then resorbed from
nonventilated alveoli. Over time,
the affected regions become
totally airless.
Obstructive Atelectasis
Causes:
Obstructive Atelectasis
Causes:
Types of Atelectasis
Nonobstructive
Causes:
Loss of contact between the parietal
and visceral pleura,
Parenchymal compression,
Loss of surfactant,
Replacement of lung tissue by
scarring or infiltrative disease.
Types of Atelectasis
Mechanisms of Atelactasis
Relaxation
Compressive
Adhesive
Cicatrization
Replacement
Rounded
Types of Atelectasis
Relaxation
Contact between the parietal and
visceral pleurae is eliminated.
1). Pleural effusion
2). Pneumothorax
3). Hydrothorax, hemothorax
4). Diaphragmatic hernia
5). Pleural masses (including
metastases and mesothelioma)
Types of Atelectasis
Compressive
Chest wall, pleural, intraparenchymal
masses, or loculated collections of
pleural fluid lead to a diminution in lung
volume below the usual resting volume.
It has much in common with relaxation
atelectasis, but is distinguished by local,
rather than generalized, collapse.
Types of Atelectasis
Compressive
Causes:
peripheral tumor compressing
adjacent normal lung,
extensive air trapping (as seen in
bullous emphysema, lobar
emphysema, interstitial emphysema,
or bronchial foreign body obstruction)
Types of Atelectasis
Adhesive
Types of Atelactasis
Adhesive
In the appropriate clinical setting,
PULMONARY EMBOLISM MUST
ALWAYS BE CONSIDERED in the
patient with SUBSEGMENTAL
atelectasis AND PLEURAL
EFFUSION. Induced by surfactant
dysfunction.
Types of Atelectasis
Cicatrization
granulomatous disease,
late sequelae of TB,
necrotizing pneumonia,
radiation
pneumoconioses
Collagen vascular diseases (e.g.,
scleroderma, rheumatoid lung)
Types of Atelectasis
Replacement
Occurs when the alveoli of an
entire lobe are filled by tumor,
such as bronchioloalveolar cell
carcinoma, with ensuing loss of
volume.
Types of Atelectasis
Rounded
Also called folded lung or
Blesofsky syndrome
A distinct form of atelectasis
associated with pleural disease,
particularly following asbestos
exposure
MRI
Can distinguish between
obstructive and nonobstructive
atelectasis.
Obstructive atelectasis displays
high signal intensity on T2weighted images due to protonrich mucus accumulation.
MRI
Nonobstructive atelectasis
shows low signal intensity on
T1 and T2 images
The use of MRI in diagnosing
atelectasis is still experimental,
and more experience needs to
be accrued
RUL Atelectasis
Medial collapse of the right upper
lobe can occasionally mimic a right
paratracheal mass
Lateral collapse lead to a peripheral
mass-like opacity that mimics a
loculated pleural effusion.
Right middle and lower lobes
hyperexpand superiorly and medially
rather than laterally.
RML(Right Medium
Lobe) Atelectasis
Greater tendency to collapse
because of:
1) decreased collateral
ventilation
2) a long thin curved bronchus
3) Possible compression by a
collar of enlarged lymph nodes
at bronchus origin
RML(Right Medium
Lobe) Atelectasis
Chronic RML Atelactasis
RML syndrome
Frequently nonobstructive
Accompanied by scarring and
bronchiectasis
Often found in elderly women
LUL Atelectasis
The hyperexpanded left lower
lobe occupies most of the left
hemithorax, with the superior
segment occupying the apex,
thus mimicking an aerated
upper lobe.
LUL Atelactasis
Luftsichel, is an indirect sign of
left upper lobe atelectasis
Crescent of aerated lung
This represent an incomplete
major fissure pulled forward by the
atelectatic upper lobe, interposed
between the atelectasis and the
aortic arch
LUL Atelectasis
On the lateral view, the major fissure
is markedly displaced anteriorly
The atelectatic left upper lobe forms
a narrow crescent adjacent to the
anterior chest wall.
The hyperexpanded anterior
segment of the right upper lobe can
herniate across the midline into the
retrosternal clear space, sharply
outlining the anterior contour of the
ascending aorta.
LUL Collapse
CT-scan reveals the anterior
orientation of the collapsed
lobe and displays the aerated
lung tissue of the right upper
lobe interposed between the
aortic arch and the collapsed
left upper lobe.
mucous plugs,
lung cancer,
foreign bodies,
hamartomas
carcinoid tumors
Endobronchial tuberculosis,
Histoplasmosis,
Broncholithiasis
Inflammatory pseudotumors.