ATELECTASIS /

COLLAPSE
Dr.Ather Farooq
M.B.B.S , M.Phil
 Collapse / Atelectasis
⦿ Defined as the collapse or closure of the lung resulting
in reduced or absent gas exchange. It may affect part or
all of one lung.
⦿ Atelectasis is the collapse or airless condition
of the lung with incomplete expansion.
Types of collapse

⦿ Obstructive

⦿ Non- Obstructive
Causes of Obstructive collapse
● Blockage of an airway…

Causes:
1. Bronchogenic carcinoma
2. Metastases to the bronchi
3. Lymphoma
4. Tuberculosis
5. Foreign body obstruction
Causes of Non-Obstructive
collapse

○ Loss of contact between the parietal and visceral

pleura,
○ Parenchymal compression,
○ Loss of surfactant,
○ Replacement of lung tissue by scarring or
infiltrative disease.
 Types of
Atelectasis

Obstructive Compressive Cicatricial Adhesive

collapse collapse collapse collapse
Mechanism of Atelectasis

● Resorption / Obstruction
● Compressive
● Cicatrization
● Adhesive
Resorption Collapse (Obstruction)

Air retained distal to occlusion is resorbed

from the non ventilated alveoli in
obstructive type of atelectasis. Over time,
affected area becomes totally airless
causing alveolar collapse.
Compressive Collapse
Contact between parietal & visceral pleurae is
eliminated.
Lung tends to retract towards its hilum when air or
fluid collects in the pleural space.
1). Pleural effusion
2). Pneumothorax
3). Hemothorax
4). Pleural masses (including metastases and
mesothelioma)
Adhesive Collapse

● Induced by surfactant dysfunction.

● Decreased production or inactivation of
surfactant leads to alveolar instability and
collapse although central airways remain
patent.
● Respiratory distress syndrome of premature
infants, ARDS, acute radiation pneumonitis and
lung contusion.
Cicatrisation Collapse
● Diminution of volume as a sequel of severe
parenchymal scarring.

Etiologies include:
○ granulomatous disease
○ necrotizing pneumonia
○ radiation
○ pneumoconiosis
○ Collagen vascular diseases (e.g. scleroderma,
rheumatoid lung)
Patterns of Lobar Collapse
Patterns of Lobar Collapse
⦿ The left lung has 2 lobes (upper, lower),
and the right lung 3 lobes (upper, middle,
and lower)
⦿ The collapse of each lobe has specific
appearances on a CXR
X Ray Chest
CXR Features of Lobar/Whole
Lung Atelectasis

⦿ Ipsilateral tracheal displacement

⦿ Increased density of collapsed lung tissue
⦿ Ipsilateral mediastinal shift
⦿ Elevation of the hemidiaphragm
⦿ Herniation of the opposite lung across the
midline
Complete left lung collapse
Complete left lung collapse
Trachea deviated to left

Opaque (white)
hemithorax, caused by
non-aerated lung

Heart shifted to left

 Right Up Lobe Collapse

Right middle and lower lobes hyperexpand superiorly and medially rather than laterally.
Right Lower Lobe Collapse
 Right Lower Lobe Collapse

The right lung has lost volume and the horizontal fissure is depressed
(red arrow)
Middle Lobe Collapse
 Middle Lobe Collapse

The right heart border is blurred.

Left Upper Lobe Collapse
Left Upper Lobe Collapse
R

Loss of volume of the left

hemithorax and generalised
increased density.
Left Lower Lobe Collapse
 Left Lower Lobe Collapse

Loss of left diaphragm contour medially, volume loss of the left hemithorax and
Increased retrocardiac opacity with obscuring of the left lower lobe vessels.
 The left lung has •1 fissure
•2 lobes

The left lung has

•1 fissure
•2 lobes
 The right lung has

The right lung has

•2 fissures
•3 lobes
Obstuctive Resorption of alveolar Bronchial
air by circulating blood. obstruction
Compressive +ve pleural pressure Pleural effusion.
Pneumothorax.
Cicatricial Pulmonary fibrosis TB
Post-irradiation
Adhesive Loss of pulmonary RDS
surfactnant
Signs Of Collapse
⦿ Lobar:
● Shift of fissures
● Crowding of vessels (increased opacity)
⦿ Extra lobar:
● Hemi diaphragm elevation.(Juxtaphrenic peak sign)
● Mediastinal shift towards side of collapse
● Compensatory contra-lateral hyperinflation
● Obscuring of structures adjacent to collapsed lung,
such as the diaphragm, heart, or pulmonary vessels.
CXR Features of Lobar/Whole
Lung Atelectasis

⦿ Ipsilateral tracheal displacement

⦿ Increased density of collapsed lung tissue
⦿ Ipsilateral mediastinal shift
⦿ Elevation of the hemidiaphragm
⦿ Herniation of the opposite lung across the
midline
⦿ (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
Transverse fissure – 6th rib
laterally Does not extend
beyond pulm artery
medially
Visible in 50%