Radiology - Lobar collapse Flashcards
In which direction does an X-Ray make the heart look enlarged?
Anterior posterior
What happens to the right horizontal fissure during a right upper lobe collapse?
In a coronal perspective, it would move up the way.
From which direction are radiological scans viewed in an axial plane?
From the bottom - like you are sitting at the feet and looking up at the section
What does a right upper lobe collapse look like on X-Ray?
White area in the right upper segment of the lung
- SVC can sometimes mimic this (be careful)
What must you look for during right upper lobe collapses that is indicated by presence of the right upper lobe bronchus?
Pneumonic consolidation
- alveoli are filled with water, blood, mucous, etc
- but the right upper lobe isn’t, and that’s why is it visible
Why do the fissures move when there is right upper lobe collapse?
Because the right upper lobe has collapsed, and the other lobes have to compensate for it.
They get bigger and move into the space that used to be occupied by the right upper lobe
Which way does a right upper lobe lung collapse in an axial plane?
Medially - squashed into the mediastinum
What is the possible cause of lack of bronchogram on an axial right upper lobe collapse CT?
Tumour - obstructing the bronchus
What is the coronal radiological difference between right upper and middle lobe collapse?
Right upper lobe - opaque section at the apices
Right middle lobe - hazy opacification at the base of the lung, smudging the heart border
Why is a right middle lobe collapse less opaque than a right upper lobe collapse?
- on coronal X-Ray
Because the opaque middle lobe lies in front of the lower lobe, which is still more lucent.
- opaque mixed with lucent = hazy
In which plane an a right middle lobe collapse be seen most easily?
Saggittal - can see the triangular shaped opacity in the anterior area of the lung
Which fissure moves during right middle lobe collapse?
Horizontal - lobe collapses towards the heart
Why is the heart border lost on right middle lobe collapse?
As the lobe collapses towards the heart, the lobe becomes a similar density to the heart, and the silhouette sign is lost
How is right middle lobe collapse differentiated from right lower lobe collapse?
- coronal view
Middle lobe - loss of the heart border
Lower lobe - loss of the diaphragmatic silhouette
Which direction does the right lower lobe collapse?
Inferiorly and medially
Why is a haze seen on a lateral X-Ray during right lower lobe collapse?
Opacification of the lower right lobe combined with lucency of the leftlower lobe
What does the left lung have instead of a middle lobe?
A lingula - part of the left upper lobe
Which direction does the left upper lobe collapse, and why?
It collapses forward because it is heavier/bigger than the right upper lobe (which collapses upwards)
What sign can you see on X-Ray which suggests left upper lobe collapse?
Luftsichel sign - the aorta becomes highlighted as it is surrounded by air (from the left lower lung when it moves forwards)
On coronal X-Ray view, why is left upper lobe collapse hazy?
Because the lobe has collapsed forwards, and the healthy, lucent lower lobe has moved up behind it.
Opaque upper lobe combined with lucent lower lobe = hazy patch
What three features are important in identifying a left upper lobe collapse?
Hazy lobe
Loss of cardiac borders - opaque upper lobe moves anterior (same place as the heart)
Ascending aorta easily seen
What is the difference between right and left lower lobe collapse?
Nothing - they are the same
How can you identify complete complete collapse of the lung?
Complete collapse
- heart is no longer visible on the clear side as the heart moves into the areas of the collapsed lungs
- compensating lung pushes the heart over to the other side as well
How can you identify a pneumonectomy?
The side of the chest the lung has been taken out of it very opaque
- although the lung is removed, the pleura is left
- the pleura have an effusion within them
- the heart and mediastinum have moved over as well
Where/why would you hear stony dull percussion?
A large pleural effusion will sink to the bottom of the lung when someone is sitting up
- dullness will be heard at lung bases
