ATELECTASIS

PRESENTATION BY – Jossileen C Jose

 WHAT IS ATELECTASIS ?
 Atelectasis is the collapse or closure of a lung resulting in reduced or absent
gas exchange. It is usually unilateral, affecting part or all of one lung.
 It is a condition where the alveoli are deflated down to little or no volume, as
distinct from pulmonary consolidation, in which they are filled with liquid. It
is often called a collapsed lung, although that term may also refer to 
pneumothorax.
 It may be caused by normal exhalation or by various medical conditions.
 The most common cause is post-surgical atelectasis, causing restricted
breathing after abdominal surgery.
 Another cause is poor surfactant spreading during inspiration, causing the 
surface tension to be at its highest which tends to collapse smaller alveoli.
DIAGNOSIS & FINDINGS
 Atelectasis is generally visible on chest X-ray.
 Chest CT or bronchoscopy may be necessary if the cause of atelectasis
is not clinically apparent.
 Direct signs of atelectasis include displacement of interlobar fissures
and mobile structures within the thorax.
 Patients may present with indirect signs and symptoms such as
elevation of the diaphragm, shifting of the trachea, heart and
mediastinum; displacement of the hilus and shifting granulomas.

Atelectasis of a person's right lung

Atelectasis of the middle lobe on Atelectasis of the right lower Computed tomography (CT) scan
a sagittal CT reconstruction. lobe seen on chest X-ray. revealing atelectasis of the right lower

Key findings on X-ray are:

• Sharply defined opacity of vessels
• Volume loss resulting in displacement of diaphragm ,fissures, or
mediastinum.
Right upper lobe atelectasis findings:
1.triangular density
2.elevated right hilus
3.obliteration of the retrosternal clear space (arrow)

On the PET-CT a lungneoplasm is seen with subsequent

atelectasis of the right upper lobe due to obstruction of
the upper lobe bronchus.

A common finding in atelectasis of the right upper lobe

is 'tenting' of the diaphragm (blue arrow).
This patient had a centrally located lungcarcinoma with
metastases in both lungs (red arrows).
The findings are:
•Large density on the left with loss of cardiac silhouette.
•High position left diaphragm with tenting.
•Low position minor fissure
•Low position right hilum
These findings indicate a total atelectasis of the left upper lobe
and possibly also partial atelectasis on the right.
Since the silhouette of the right heart border is still visible, there is
probably partial atelectasis of the lower lobe and not of the middle
lobe.

Notice the bulging of the fissure on the lateral view.

This is comparable to the golden-S sign in right upper
lobe atelectasis and is suspective of a centrally
obstructing mass.
Luft sichel means a sickle of air (blue arrow).
ACUTE & CHRONIC ATELECTASIS
 Atelectasis may be an acute or chronic condition.
 In acute atelectasis, the lung has recently collapsed and is primarily notable
only for airlessness.
 In chronic atelectasis, the affected area is often characterized by a complex
mixture of airlessness, infection, widening of the bronchi (bronchiectasis),
destruction, and scarring (fibrosis).
 TYPES OF ATELECTASIS
 Absorption (resorption) atelectasis
 Stems from complete obstruction of an airway. Over time, air is
reabsorbed from the dependent alveoli,which collapse. Since lung volume
is diminished ,the mediastinum shifts toward the atelectatic lung.
 Compression (relaxation) atelectasis
 Results whenever significant volumes of fluid (transudate ,exudate or
blood),tumor, or air (pneumothorax) accumulate within the pleural
cavity . With compression atelectasis, the mediastinum shifts away from
the affected lung.
 Cicatrization (contraction) atelectasis
 Occurs when focal or generalized pulmonary or pleural fibrosis prevents full lung
expansion.

Notice the increased density of the lung

tissue and the volume loss.
 Rounded atelectasis
 In rounded atelectasis (folded lung or Blesovsky syndrome), an outer portion of the lung slowly collapses as a
result of scarring and shrinkage of the membrane layers covering the lungs (pleura), which would show as
visceral pleural thickening and entrapment of lung tissue.
 This produces a rounded appearance on X-ray that doctors may mistake for a tumor. Rounded atelectasis is
usually a complication of asbestos-induced disease of the pleura, but it may also result from other types of
chronic scarring and thickening of the pleura.
 The typical findings of rounded atelectasis on CT are pleural thickening, pleural-based mass and comet tail sign.

On the lateral view there is a mass-like lesion that is pleural-based.

The first impresson is, that this is a pleural lesion.

The CT shows a lesion that originates in the lung.

There is also some pleural thickening (red arrow) and
vessels seem to swirl around the mass (blue arrows).
This is also described as the comet tail sign.
 Plate-like atelectasis

Plate-like atelectasis is a common finding on chest x-rays and detected

almost every day. They are characterized by linear shadows of
increased density at the lung bases.They are usually horizontal,
measure 1-3 mm in thickness and are only a few cm long.
In most cases these findings have no clinical significance and are seen
in smokers and elderly. They are seen in patients, that are in a poor
condition and who breathe superficially, for instance after abdominal
surgery.
Plate-like atelectasis due to poor inspiration in a patient who had abdominal
surgery(figure).

Plate-like atelectasis is frequently seen in patients

in the ICU due to poor ventilation.
Platelike atelectasis is also frequently seen in
pulmonary embolism.
Plate-like atelectasis in a patient with pulmonary embolism (figure)
REFERENCES

 The Radiology Assistant : Chest X-Ray - Lung disease

 Robbins Basic Pathology - 10th Edition - Elsevier
THANKYOU!