Chest > Diagnosis > Overview of Chest Imaging > Atelectasis and Volume Loss
Rounded Atelectasis
Selected Images
Graphic shows the morphologic
features of rounded atelectasis
characterized by focal subpleural
mass-like volume loss that
exhibits the comet tail sign and
occurs adjacent to pleural thickening
. right pleural effusion and pleural
Additional Images
Lateral chest radiograph of a patient
with rounded atelectasis
demonstrates an opacity
projecting over the lower thoracic
spine in the posterior aspect of a
lower lobe.
Frontal chest radiograph shows
bilateral low lung volume and a right
infrahilar mass . Note bilateral
basilar pleural calcifications
likely related to asbestos-related
pleural disease.
Fused axial FDG PET/CT of a patient
with a longstanding right pleural
effusion demonstrates a mass-like
opacity in the right lower lobe
that is not FDG-avid and represents
rounded atelectasis. Note adjacent
thickening . pleural disease and pleural effusion.
Axial NECT of the same patient
shows a rounded peripheral mass-
like opacity in the posterior
subpleural right lower lobe. Note
surrounding lung hyperlucency and
thickening of the adjacent pleura
. Rounded atelectasis is often
incidentally discovered on chest CT.
Axial NECT of the same patient
shows convergence of
bronchovascular structures
toward the right lower lobe lesion,
consistent with the comet tail sign of
rounded atelectasis. Note partially
calcified pleural plaques . calcification
Axial CECT (lung window) shows a
rounded peripheral mass-like lesion
in the posterior subpleural
left lower lobe that exhibits the
comet tail sign . Rounded
atelectasis is often incidentally
discovered on chest CT.
Axial NECT of a patient with rounded
atelectasis shows a rounded opacity
in the posterior subpleural right
lower lobe. Distortion, displacement,
and convergence of vessels into
the lesion represent the comet tail
sign of rounded atelectasis.
Axial NECT of the same patient
shows whorled calcification within
the rounded atelectasis , air
bronchograms in the hilar aspect of
the lesion , and adjacent right
basilar pleural thickening with
.
Brett W. Carter, MD, CPPS
Hide Images
Axial CECT (soft tissue window) of
the same patient demonstrates
thickening and high attenuation of
the adjacent pleura , the latter
secondary to prior talc pleurodesis.
Common causes of rounded
atelectasis include asbestos-related
Axial NECT of the same patient
demonstrates thickening of the
adjacent pleura . The most
common causes of rounded
atelectasis include asbestos
exposure, pleural effusion (including
that related to prior surgery), and
infection.
 KEY FACTS

Terminology
Localized typically subpleural lung volume loss
Synonyms: Folded lung, atelectatic pseudotumor, Blesovsky syndrome
Imaging
Radiography
Subpleural mass-like opacity
Bronchovascular structures converge to lesion
Pleural thickening &/or calcification
± blunt costophrenic angles
CT
Wedge-shaped or rounded peripheral subpleural opacity; lower lobe predominant; may be multifocal
Adjacent pleural thickening ± calcification
Comet tail sign: Convergence of bronchovascular structures to lesion
Volume loss in affected lobe; hyperlucency of nonatelectatic lobe
Air bronchogram in hilar aspect of peripheral opacity
FDG PET/CT: No FDG avidity
Top Differential Diagnoses
Lung cancer
Pulmonary infarct
Localized fibrous tumor of pleura
Pathology
Pleural plaques, pleural fibrosis; asbestos-related pleural disease
Pleural effusions
Clinical Issues
Typically asymptomatic: Incidental finding on imaging
M>F
Age range 59-65 years
Diagnostic Checklist
Consider rounded atelectasis in asymptomatic patient with lower lobe peripheral mass-like opacity with the comet tail sign
adjacent to pleural thickening ± calcification

DIFFERENTIAL DIAGNOSIS

SELECTED REFERENCES

1. Azour L et al: Causative factors, imaging findings, and CT course of round atelectasis. Clin Imaging. 50:250-7, 2018
2. Gorospe L et al: Round atelectasis: PET/CT findings. Intern Emerg Med. 13(7):1127-8, 2018
3. Riley JY et al: Imaging assessment of rounded atelectasis: a pictorial essay. J Med Imaging Radiat Oncol. 62(2):211-6, 2018
4. Sobocińska M et al: Rounded atelectasis of the lung: a pictorial review. Pol J Radiol. 79:203-9, 2014
5. Stathopoulos GT et al: Rounded atelectasis of the lung. Respir Med. 99(5):615-23, 2005
6. Hakomäki J et al: Contrast enhancement of round atelectases. Acta Radiol. 43(4):376-9, 2002
7. Roach HD et al: Asbestos: when the dust settles an imaging review of asbestos-related disease. Radiographics. 22 Spec No:S167-
84, 2002
8. McAdams HP et al: Evaluation of patients with round atelectasis using 2-[18F]-fluoro-2-deoxy-D-glucose PET. J Comput Assist
Tomogr. 22(4):601-4, 1998
9. O'Donovan PB et al: Evaluation of the reliability of computed tomographic criteria used in the diagnosis of round atelectasis. J
Thorac Imaging. 12(1):54-8, 1997
10. Yamaguchi T et al: Magnetic resonance imaging of rounded atelectasis. J Thorac Imaging. 12(3):188-94, 1997
11. Woodring JH et al: Types and mechanisms of pulmonary atelectasis. J Thorac Imaging. 11(2):92-108, 1996
12. Doyle TC et al: CT features of rounded atelectasis of the lung. AJR Am J Roentgenol. 143(2):225-8, 1984
13. Schneider HJ et al: Rounded atelectasis. AJR Am J Roentgenol. 134(2):225-32, 1980
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