collapse & consolidation made simple - chest x-rayz
TRANSCRIPT
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.