Atelectasis (Lobar)

Case 44

Malignancy / , , , , ,

This radiograph demonstrates left upper lobe collapse. This is one of the more challenging lobar collapse patterns to recognize on AP or PA radiographs as the left upper lobe collapses anteriorly and superiorly and ends up superimposed over the inflated left lower lobe. Other than the increased opacity over the left hemithorax, other notable features present on this radiograph are a left juxtaphrenic peak sign and silhouetting of the left heart border and hilum by the collapsed left upper lobe.

When this finding is identified, the cause of the collapse should be further investigated with CT. This case was post-obstructive collapse secondary to a central obstructing mass. The mass is not well visualized on this radiograph.

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Case 21

Chronic & ILD, Lines/Tubes/Devices / , , , , , , ,

This radiograph demonstrates several findings:

First, this is a COPD patient with very few lung markings seen in the right upper lobe due to severe emphysema.

Second, this patient has undergone endobronchial valve placement leading to complete lobar atelectasis in the left upper lobe. The valves themselves are visible projecting over the left hilum. There is expected volume loss in the left hemithorax, with increased opacity in the left lung due to superimposition of the collapsed left upper lobe and aerated left lower lobe.

Third, a named sign is demonstrated: The luftsichel sign (German for “air crescent”), which is seen as a crescentic lucency in the paramedian left upper lung and indicates left upper lobe collapse. The lucency is created by a portion of the aerated left lower lobe that insinuates itself between the mediastinal wall and the collapsed upper lobe.

Fourth, there is an incidentally noted small hiatal hernia seen as a rounded opacity projecting just to the left of midline at the level of the diaphragm. Diaphragmatic eventration is also noted.

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