Emphysema – ChestDB.com

Case 51

This radiograph demonstrates the expected postoperative appearance of a pleural tent following lung volume reduction surgery in the right upper lobe (note the visible staple line), though this can be done after upper lobectomies for any cause. The anatomy of upper lobectomies in particular is unfavorable for post-operative pleura-pleura apposition, increasing the risk for air leaks from the staple line. In this procedure, the visceral pleura is peeled from the chest wall and draped over the staple line. This promotes apposition and decreases the chance of an air leak. A chest tube is placed under the tent intraoperatively, as seen here, and will eventually be removed. The cavity will eventually fill with fluid, just like a pneumonectomy cavity.

There is marked emphysema in the left lung. Incidentally, this patient also has a small left effusion which is chronic and unrelated to the procedure.

Case 21

Chronic & ILD, Lines/Tubes/Devices / Age >61, Atelectasis (Lobar), COPD, Emphysema, Endobronchial Valve, Eventration, Hiatal Hernia, Luftsichel Sign

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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