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Volume Loss

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Abstract

This chapter describes the spectrum of appearances of volume loss, ranging from streaks of atelectasis to collapse of a lobe or an entire lung, and the characteristic pattern of collapse for each lobe. It also addresses the differentiation between total lung collapse and pleural effusion, based on whether there is shift of the mediastinum and the fallen lung sign.

Keywords

  • Platelike atelectasis
  • Obstructive atelectasis
  • Round atelectasis
  • Right upper lobe collapse
  • Left upper lobe collapse
  • Right middle lobe collapse
  • Lower lobe collapse
  • Golden S sign
  • Round atelectasis
  • Mediastinal shift
  • Fallen lung sign

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References

  1. Nemec SF, Bankier AA, Eisenberg RL. Lower lobe-predominant diseases of the lung. AJR. 2013;200:712–28.

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  2. Eisenberg RL. Clinical Imaging: An Atlas of Differential Diagnosis. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.

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Fig. e5.1

Round atelectasis. (a) Enhancing mass (arrow) in the right lower lobe with pleural adhesion (TIF 1143 kb)

Fig. e5.1

Round atelectasis. (b) Bronchovascular structures (white arrow) extend into the mass (black arrow) [1] (TIF 1140 kb)

Fig. e5.2

Round atelectasis. (a, b) Large area of involvement in the right lower lung (arrow) [2] (TIF 977 kb)

Fig. e5.3

Right upper lobe collapse. (a) Initial radiograph demonstrates the collapsed right upper lobe, which appears as a homogeneous soft tissue mass (arrows) in the right apex along the upper mediastinum (TIF 783 kb)

Fig. e5.3

Right upper lobe collapse. (b) As the collapsed lobe expands, the soft tissue opacification has disappeared and the minor fissure (arrow) has reappeared [2] (TIF 775 kb)

Fig. e5.4

Endobronchial hamartoma. Mass (black arrows) of mixed fat (white arrow) and soft tissue attenuation involves the right middle lobe bronchus, resulting in post-obstructive atelectasis of the right middle lobe [1] (TIF 2193 kb)

Fig. e5.5

Right middle lobe and lingula collapse. (a) Silhouetting of both the right and left borders of the heart (TIF 565 kb)

Fig. e5.5

Right middle lobe and lingula collapse. (b) Lateral view confirms collapse of both the right middle lobe and lingula (arrows) [2] (TIF 805 kb)

Fig. e5.6

Right lower lobe collapse. (a) Right lower lung opacity with preservation of the right heart border. There is silhouetting of the medial part of the right hemidiaphragm (TIF 936 kb)

Fig. e5.6

Right lower lobe collapse. (b) Lateral view confirms the presence of right lower lobe collapse (due to bronchogenic carcinoma) with posterior displacement of the major fissure (1). The elevated right hemidiaphragm (2) is obliterated posteriorly by the airless right lower lobe, and the anterior third of the left hemidiaphragm (3) is obscured by the bottom of the heart. The overlapping shadows of the back of the heart (4), which lies in the left hemithorax, and the right hemidiaphragm simulate interlobar effusion [1] (TIF 1136 kb)

Fig. e5.7

Combined right middle and lower lobe collapse. (a) Opacification of the lower lung with no air bronchograms, silhouetting of the right heart border and right hemidiaphragm, and mediastinal shift to the right (TIF 712 kb)

Fig. e5.7

Combined right middle and lower lobe collapse. (b) Following bronchoscopic removal of a mucous plug from the bronchus intermedius, there has been complete re-expansion of the collapsed lobes. Note that the right heart border and right hemidiaphragm are now sharply seen and there is no longer any shift of the mediastinum (TIF 754 kb)

Fig. e5.8

Left lower lobe collapse. (a) Obliteration of the descending thoracic aorta and obscuration of much of the left hemidiaphragm (TIF 618 kb)

Fig. e5.8

Left lower lobe collapse. (b) Lateral view confirms the posterior position of the collapsed left lower lobe [2] (TIF 937 kb)

Fig. e5.9

Partial left upper lobe collapse. (a) Generalized increase in the opacity of much of the left hemithorax, but without silhouetting of the aortic knob or proximal descending aorta. Note the elevation of the left hemidiaphragmatic contour (TIF 1687 kb)

Fig. e5.9

Partial left upper lobe collapse. (b) Lateral view confirms the anterior position of the collapsed portion of the left upper lobe (arrows) (TIF 2500 kb)

Fig. e5.10

Total collapse of the left lung (mucous plug). (a) Complete opacification of the left hemithorax with shift of mediastinal structures toward the affected side (TIF 1463 kb)

Fig. e5.10

Total collapse of the left lung (mucous plug). (b) Examination taken four days previously was entirely normal with no mediastinal shift (TIF 1524 kb)

Fig. e5.11

Pleural effusion with shift of the mediastinum away from affected side. (Courtesy of Jennifer Ni Mhuircheartaigh, MD, Boston) (TIF 1553 kb)

Fig. e5.12

Tension pneumothorax. Complete collapse of the left lung (arrow) and shift of the mediastinum to the contralateral side (TIF 1988 kb)

Fig. e5.13

(a) Malignant pleural effusion filling the right hemithorax but not causing mediastinal shift (TIF 1409 kb)

Fig. e5.13

(b) CT image shows the large fluid-density attenuation of the effusion and the slightly higher attenuation of underlying collapsed lung (arrows). The combination of these processes explains why there is no mediastinal shift to the contralateral side (TIF 651 kb)

Fig. e5.14

Substantial left pleural effusion but no mediastinal shift. This indicates that there has been substantial compensatory collapse of the left lower lobe and lingula (TIF 1760 kb)

Fig. e5.15

Fallen lung sign. Following traumatic fracture of the bronchus intermedius, the affected collapsed lung (arrow) has moved inferiorly and laterally away from the hilum. Note the large right pneumothorax (TIF 559 kb)

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Eisenberg, R.L. (2020). Volume Loss. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_5

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  • DOI: https://doi.org/10.1007/978-3-030-16826-1_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16825-4

  • Online ISBN: 978-3-030-16826-1

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