Atelectasis, 348 adhesive, 349 chest ultrasound, 939 cicatricial, 348 combined middle and RLL, 351

compressive, 348 LLL, 350 lobar, 349 LUilli:ogular, 350 middle lobe, 350 obstructive, 348 passive, 348
pediatric chest, 1128 relaxation, 348 resorptive, 348 right upper lobe, 350 RLL, 350 rounded, 350
segmental, 349 subsegmental (platelike), 349

Atelectasis

 loss of lung volume

 literally means "incomplete expansion”
 usually but not invariably associated with an increase in radiographic density

4 basic mechanisms of atelectasis:

 Resorptive/ Obstructive
 Relaxation/ Passive
 Cicatricial
 Adhesive

Clinical Manifestations:
 decreased or absent breath sounds, crackles, cough, sputum production, dyspnea, tachypnea,
and/or diminished chest expansion (NCBI)

LOPEZ, MATT SAVIOR T.

1/M
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2023060426

Compared with the study dated 02/25/2023, there is increased hazy densities now seen diffusely in
both lung fields.
A recent wedge shaped homogenous opacity is seen in the right upper lung lobe.
Tracheal air column is at the midline.
The heart is not enlarged. Great vessels are within normal size.
Both hemidiaphragms and costophrenic sulci are intact.
A feeding tube is seen with its tip at the gastric shadow.
The rest of the extra-thoracic soft tissues and visualized osseous structures are unremarkable.
No other significant findings.
IMPRESSION:
> BILATERAL PNEUMONIA - PROGRESSING
> LOBAR ATELECTASIS, RIGHT
Transcribed by:
Patrick Armando R. Untalan, MD
Medical Officer III

Lobar atelectasis

 Lobar collapse refers to the collapse of an entire lobe of the lung

 Individual lobes of the lung may collapse due to obstruction of the supplying bronchus.
 Most often collapse of most or all of a lobe is secondary to bronchial obstruction causing
resorptive atelectasis. (radiopedia)
 Only direct radiographic finding: displacement of an interlobar fissure

There are several indirect findings of atelectasis, most of which reflect attempts to compensate for the
volume loss
 Increased density of in the affected portion of the lung- Due to diminished aeration
 Bronchovascular crowding- Due to diminished aeration
  Ipsilateral shift of the trachea, heart, or mediastinum and hilar structures
 Shift of the entire mediastinum is typical of collapse of an entire lung
 Compensatory hyperinflation- attempt by the remaining normal lung to partially fill the space
lost by the affected lung (usually this is due to chronic volume loss and is not seen in acute
collapse)
 In complete lung or upper lobe atelectasis, the contralateral upper lobe may herniate across the
midline, bowing the anterior junction line toward the affected side
 “shifting granuloma”- characteristic but seldom seen plain radiographic finding of compensatory
hyperinflation
 Ipsilateral small hemithorax- usually seen in the chronic atelectasis of the lung

The absence of an air bronchogram helps distinguish resorptive lobar atelectasis from lobar pneumonia
Triangular configuration with the apex at the pulmonary hilum is common to all types of lobar
atelectasis.
Complete lobar atelectasis can easily be missed on PA and lateral radiographs but is easily appreciated
on CT.

Atelectasis is usually a clinical diagnosis in a patient with known risk factors. If imaging is warranted, a
chest X-ray, chest CT, and/or thoracic ultrasonography are useful in the diagnosis of atelectasis. A chest
x-ray will reveal platelike, horizontal lines in the area of atelectatic lung tissue. Atelectasis is not typically
evident on convention chest radiographs until it is significant. 
Resorptive/ Obstructive Atelectasis

 secondary to complete endobronchial obstruction of a lobar bronchus with resorption of gas

distally
 Incomplete bronchial obstruction: produces air trapping from a check-valve effect rather than
atelectasis since air enters but cannot exit the lung
 Complete bronchial obstruction: may not produce atelectasis if collateral airflow to the
obstructed lung (via pores of Kohn, canals of Lambert, or incomplete interlobar fissures) allows
the lung to remain inflated
 an obstructed lobe or lung containing 100% oxygen will collapse more rapidly due to rapid
absoption of oxygen into the alveolar capillaries
 Most common causes: bronchogenic carcinoma, foreign bodies, mucous plugs, and
malpositioned endotracheal tubes

Relaxation/ Passive Atelectasis

 results from the mass effect of an air or fluid collection within the pleural space on the subjacent
lung
 degree of atelectasis depends upon the size of the pleural collection and upon the compliance of
the lung and visceral pleura
 Compressive atelectasis- a form of passive atelectasis in which an intrapulmonary mass
compresses adjacent lung parenchyma; common causes include bullae, abscesses and tumors