collapse & consolidation made simple - chest x-rayz

LUNG COLLAPSE & CONSOLIDATION.

Dr. Nikrish S Hegde

What is collapse?

Reduction in volume of air within the lung

Asssociated with reduction in lung volume.

Atelectasis.

Mechanisms.

Passive Collapse

Cicatrisation Collapse

Adhesive Collapse

Resorption Collapse

Passive Collapse

Lung retracts towards the hilum.

Air or increased fluid in the pleural cavity

Pleural effusion / pneumothrax

Passive Collapse

Cicatrisation Collapse

Lung is abnormally stiff

Reduction in lung compliance

Resulting in collapse

Pulmonary Fibrosis.

Cicatrisation Collapse

Adhesive Collapse

Surfactant reduces the surface tension

Disturbance of this mechanism

Collapse of the alveoli

Respiratory Distress Syndrome.

Resorption Collapse

Acute bronchial obstruction .

Gases in the alveoli are taken up by the blood.

Modified by collateral air drift and infection.

Chronic Collapse

Resorption Collapse

SIGNS

DIRECT:

INDIRECT:

Displacement of interlobar fissures.

Loss Of Aeration

Crowding of vessels and bronchi.

Elevation Of Hemidiaphragm.

Mediastinal Displacement.

Hilar Displacement.

Compensatory Hyperinflation

1)ANTERIOR TO ASCENDING AORTA2)POSTERIOR TO HEART3)UNDER THE ARCH

Air Bronchogram

Almost not seen in resorption collapse

Seen in adhesive and passive collapse.

And in cicatrisation collapse with extensive fibrosis.

Pre existing Lung Diseases.

Fibrosis

Plueral Adhesions

May alter the expected anatomical displacements in collapse

Reciprocal Relationship

There exists a relationship between the compensatory signs.

Degree of diaphragmatic elevation is directly related to amount of collapse and inversely to the hilar displacement and compensatory hyperinflation.

Eg: Lower lobe collapse, if diaphragmatic elevation is marked, hilar depression is diminished.

RUL Collapse

RUL Collapse

LUL Collapse

RML Collapse

Lingular Collapse

RLL Collapse

LLL Collapse

Shifting Granuloma sign.

Luftsichel Sign:

Juxtaphrenic Peak Sign

Golden S Sign

Superior Triangle Sign

Double Lesion Sign

If collapse of multiple segments occurs in certain combination , the likelyhood of bronchogenic carcinoma is small.

Eg: RUL and RML is rarely seen in bronchogenic ca but RML and RLL is frequently seen.

Round Atelectasis

RML & RLL COLLAPSE

RLL & LLL COLLAPSE

CONSOLIDATION

Decrease in volume of air within the Lung.

Associated with normal lung volume.

Pulmonary airways 1) Conducting network

2) Acini

Replacement of air in the acini with fluid or solid material.

Causes:

Pneumonia

Cardiogenic / non cardiogenic pulmonary edema

Aspiration

Haemorrhage

Neoplasms

Air Bronchogram

Produced by the radiographic contrast between the column of air in the airway and the surrounding opaque acini.

Lobar Consolidation

Homogenous opacity

Air bronchogram

Well defined borders.

RUL

RML

RLL

LUL & Lingula

LLL

LLL Consolidation

RUZ & paracardiacconsolidation

Points to Remember

Volume of lung is not reduced.

Collapse and consolidation are often associated with one another.

When consolidation is due to fluid , its distribution is dependent on gravity.