By: Dr.

Arshad Faheem
MO/PGR
Department of Radiology
 Definition, Mechanisms & Types

 Radiological Anatomy

 Radiological Diagnosis & Signs

 Radiological Patterns
 Greek = “incomplete stretching”

 Definition:
“Diminished gas within the lung
associated with reduced lung volume and
radiologic signs”

 Collapse vs Consolidation
 Relaxation/Passive
 Compressive
 Adhesive
 Cicatrization
 Resorption
 Rounded
 Relaxation/Passive
 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)
 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
 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)
 Adhesive

 Induced by surfactant dysfunction.

 Decreased production or inactivation of
surfactant leads to alveolar instability and
collapse
 Respiratory distress syndrome of premature
infants, ARDS, acute radiation pneumonitis, PE
and lung contusion
 Cicatrization

 Diminution of volume as a sequel of severe

parenchymal scarring.

 Etiologies include:
 Granulomatous disease
 Radiation
 Pneumoconioses
 Collagen vascular diseases (e.g., scleroderma,
rheumatoid lung)
 Resorption
 Resorption of gases from alveoli in to
blood
 As a result of bronchial obstruction
Acute----Chronic
e.g., CA Bronchus
 Rounded
 Also called folded lung or Blesofsky
syndrome

 A distinct form of atelectasis associated

with pleural disease, particularly
following asbestos exposure
Obstructive
Non-obstructive
 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
 Causes:
 1). Bronchogenic carcinoma

 2). Bronchial carcinoid

 3). Metastases to the bronchi: most commonly

renal cell carcinoma, breast carcinoma,
melanoma, adenocarcinoma of the colon,
sarcomas
 4). Lymphoma

 5). Tuberculosis

 6). Left atrial enlargement from mitral

stenosis (left lower-lobe atelectasis)

 7). Foreign body obstruction

 Non-obstructive
 Causes:
 Loss of contact between the parietal and
visceral pleura
 Parenchymal compression
 Loss of surfactant
 Replacement of lung tissue by scarring or
infiltrative disease
 RADIOLOGICAL
ANATOMY OF LUNGS
 Plain Radiography (X-rays)

 CT

 MRI (still in experimental phase)

 DIRECT

 INDIRECT
 Displacement of fissures

 Increased opacification of the airless

lobe

 Crowding of pulmonary vessels

 Displacement of hilar structures

 Cardiomediastinal shift toward the side of

collapse

 Narrowing of ipsilateral intercostal spaces

 Elevation of the ipsilateral diaphragmatic

leaflet
 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 etc
 RUL Atelectasis
 RML Atelectasis
 RLL Atelectasis
 Combined RML & RLL Atelectases
 LUL Atelectasis
 LLL Atelectasis
 Combined RLL & LLL Atelectases
 Entire Lung Atelectasis
 Elevation of the right hilum and the
minor fissure

 Convex upward

 Collapsed lobe tends to shift cephalad

and medially
 The RUL collapse results in a movement of the
horizontal fissure that resembles to closing a fan
 This configuration of the minor fissure is
called the S-sign of Golden and indicates a
probable neoplastic etiology for the
obstructive atelectasis

 A juxtaphrenic peak indicates loss of volume

in the upper lobe and can be a helpful sign
of upper lobe atelectasis
With marked collapse of the RUL, the density of the
lobe may blend with that of the right superior
mediastinum
 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
 Total collapse has little impact on
appearance of surrounding structures

 Absent contour of right heart border

 A small triangular opacity pointing

laterally
 On CT scan, the atelectatic right middle
lobe presents as a triangular opacity with its
apex pointing laterally and with its medial
contour apposed against the right heart
border

 This has been called the "tilted ice cream

cone" appearance
 Tethered to the mediastinum by the hilar
structures and the inferior pulmonary
ligament

 Visibility of major fissure – early sign of RLL

collapse on frontal X-ray

 Forms a triangular opacity that obscures the

lower lobe pulmonary artery
 Eventually, the collapsed lobe forms a right
paraspinal mass that projects behind the
right atrium

 Superior mediastinal structures shift to the

right and form a superior paratracheal
triangular opacity
 On CT scan, RLL atelectasis can mimic
a paraspinal mass

 If present, air bronchograms may

reveal the true nature of such a space
occupying lesion
 The most common combined
atelectasis

 Explanation: a simple obstructing

lesion, located within the bronchus
intermedius, can affect the aeration of
both lobes simultaneously
 Common lesions
 mucous plugs
 lung cancer
 foreign bodies
 hamartomas
 carcinoid tumors
 Rare lesions
 Endobronchial tuberculosis
 Histoplasmosis
 Broncholithiasis
 Inflammatory pseudotumors
 Combined RML and RLL collapse can mimic
an elevated right hemidiaphragm or a
subpulmonic effusion

 Obscuring of the right hilum and the

straight contour of the minor fissure
interface help establish the correct diagnosis
 The left upper lobe is larger than the right upper
lobe.
 Because it lacks minor fissure in most cases, the
pattern of collapse is different from that seen with
right upper lobe collapse

 A completely atelectatic left upper lobe tends to

retract more anteriorly than superiorly

 On the frontal view, it produces a faint, hazy

opacity in the left upper hemithorax, which can be
mistaken for pleural thickening
 The left cardiac contour is frequently
obscured by the lingula

 The left hilar structures are retracted

cephalad

 The left lower lobe basilar segmental

arteries are elevated and clearly visible in
retrocardiac location
 The hyperexpanded left lower lobe
occupies most of the left hemithorax,
with the apical segment occupying the
apex, thus mimicking an aerated upper
lobe
 Luftsichel’s sign, is an indirect sign of
left upper lobe atelectasis
 Crescent of aerated lung
 This represents an incomplete major
fissure pulled forward by the atelectatic
upper lobe, interposed between the
atelectasis and the aortic arch
Note the increased opacification of the left upper
lung field with elevation of the left
hemidiaphragm. In addition, there is lucency
adjacent to the aorta. This is the Luftsichel's
sign, representing an overexpanded left lower
lobe
 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
 Collapse of the left lower lobe is frequently
seen after cardiac surgery.
 Compression of the lobe by an enlarged
heart
 Postoperative contusion
 Mucus accumulation due to a slightly more
vertical orientation of the left mainstem
bronchus
 Increased retrocardiac opacity with
obscuring of the left lower lobe vessels and
the left hemidiaphragm

 Caudal displacement of the left hilum

 Posteroinferior displacement of major

fissure
 The left major fissure can parallel the left
cardiac border, and the completely
atelectatic lobe can mimic a left
paraspinal mass

 Mediastinal shift can lead to partial

obliteration of the aortic arch (the top of
the knob sign)
 Total collapse of a lung leads to complete
opacification of an entire hemithorax with
ipsilateral cardiomediastinal shift

 The latter finding distinguishes atelectasis

from a massive pleural effusion, a setting in
which the mediastinum shifts to the
contralateral side
 In the lateral projection, the cardiac
silhouette, one hemidiaphragm, and one
hilum are obscured

 CT scan demonstrates the shift of

cardiomediastinal structures in a better
way
ROUNDED ATELECTASIS
ROUNDED ATELECTASIS
 Can distinguish between obstructive
and non-obstructive atelectasis

 Obstructive atelectasis displays high

signal intensity on T2-weighted images
due to proton-rich mucus
accumulation
 Nonobstructive atelectasis shows low
signal intensity on T1 and T2 images

 The use of MRI in diagnosing

atelectasis is still experimental and
needs more experience