Atelectasis

Presenter: Dr.Morice N Radiology resident year 3

Facilitator: Dr.Lilian Radiologist-Lecturer
Participants: Undergraduate Radiography students(Semister4)
Outlines

Definition
Anatomy of the lung
Causes
Types of atelectasis
Plain radiographic features
Definition
The term atelectasis means "incomplete stretching" in Greek. It is used to
indicate loss of volume of lung tissue associated with a decrease in the
amount of air it contains.
Types and causes
There four types
1.Resorption (obstructive) atelectasis
Caused by airway obstruction and resorption of alveolar gas .Occurs
within 24 hours More rapid when breathing oxygen ,may result in
drowned lung with little volume loss. Collateral ventilation may prevent
collapse with large airway obstruction, air bronchograms are often absent
Cont..
2 Relaxation (passive) atelectasis
Atelectasis due to pleural effusion, pneumothorax, or mass. Lung
density need not be increased
3.Adhesive atelectasis
Caused by loss of lung surfactant. Typical of respiratory distress
syndrome of the newbom, acute respiratory distress syndrome,
radiation pneumonitis
4.Cicatricial atelectasis
Caused by lung fibrosis
Lung anatomy

(1) aortic arch

(2) pulmonary trunk
(3) left atrial appendage
(4) left ventricle
(5) right atrium
(6) superior vena cava
(7 & 8) diaphragm
(9) transverse fissure
Cont..
Cont..

(1) oblique fissure

(2) transverse fissure
(3) retrocardiac space
(4) retrosternal space
Silhouette sign
 If two soft tissue densities lie in
apposition, then they will not
be visible separately

 If they are separated by air, the

boundaries of both will be seen
Uses of silhouette sign
• Localisation without a lateral view
• Loss of clarity of a structure suggests there is adjacent soft tissue
shadowing even when the abnormality itself is not clearly visualised.
This is particularly valuable in some cases of lobar collapse.
Cont..
Signs of lobar collapse
• Lobar
• Shift of fissures
• Crowding of vessels (increased opacity)
• Extra lobar
• Hemi diaphragm elevation
• Mediastinal shift towards side of collapse
• Hilar shift and distortion
• Compensatory hyperinflation
• Rib approximation
• Shift of other structures e.g. granuloma
Right upper lobe collapse

Minor fissure pivots and bows

Right hilar elevation
May simulate mediastinal widening
Deviation of trachea
Both fissures concave superiorly
Cont..
Golden sign
Cont..
Right lower lobe collapse

• Posterior and medial collapse

• Obliteration of the right hemi diaphragm
• Heart border clearly seen
• Transverse fissure pulled inferiorly
Right lower lobe collapse
Right middle lobe collapse
Cont..
Left lower lobe collapse

• Posterior and medial collapse

• triangular opacity – sail sign
• hemidiaphragm may be obscured
Cont..
Left upper lobe collapse

 veil like opacity

 aortic knuckle, left hilum, and left-heart border initially ill defined but may pro-
gress to become sharp
 almost vertical oblique fissure
Cont..
Upper lobe collapse with Luftsichel sign
Complete collapse lung
References
• Core radiology second edition
• https://radiopaedia.org/articles/lobar-lung-collapse
• Diagnostic imaging by Putman 2nd edition
• www.radiographic.org
• Thoracic imaging, Pulmonary and cardiovascular Radiology. Second ed
ition by Richard Webb, MD