Radiology - Lobar collapse

Question 1

In which direction does an X-Ray make the heart look enlarged?

Answer 1

Anterior posterior

Question 2

What happens to the right horizontal fissure during a right upper lobe collapse?

Answer 2

In a coronal perspective, it would move up the way.

Question 3

From which direction are radiological scans viewed in an axial plane?

Answer 3

From the bottom - like you are sitting at the feet and looking up at the section

Question 4

What does a right upper lobe collapse look like on X-Ray?

Answer 4

White area in the right upper segment of the lung

- SVC can sometimes mimic this (be careful)

Question 5

What must you look for during right upper lobe collapses that is indicated by presence of the right upper lobe bronchus?

Answer 5

Pneumonic consolidation

• alveoli are filled with water, blood, mucous, etc
• but the right upper lobe isn’t, and that’s why is it visible

Question 6

Why do the fissures move when there is right upper lobe collapse?

Answer 6

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

Question 7

Which way does a right upper lobe lung collapse in an axial plane?

Answer 7

Medially - squashed into the mediastinum

Question 8

What is the possible cause of lack of bronchogram on an axial right upper lobe collapse CT?

Answer 8

Tumour - obstructing the bronchus

Question 9

What is the coronal radiological difference between right upper and middle lobe collapse?

Answer 9

Right upper lobe - opaque section at the apices

Right middle lobe - hazy opacification at the base of the lung, smudging the heart border

Question 10

Why is a right middle lobe collapse less opaque than a right upper lobe collapse?
- on coronal X-Ray

Answer 10

Because the opaque middle lobe lies in front of the lower lobe, which is still more lucent.
- opaque mixed with lucent = hazy

Question 11

In which plane an a right middle lobe collapse be seen most easily?

Answer 11

Saggittal - can see the triangular shaped opacity in the anterior area of the lung

Question 12

Which fissure moves during right middle lobe collapse?

Answer 12

Horizontal - lobe collapses towards the heart

Question 13

Why is the heart border lost on right middle lobe collapse?

Answer 13

As the lobe collapses towards the heart, the lobe becomes a similar density to the heart, and the silhouette sign is lost

Question 14

How is right middle lobe collapse differentiated from right lower lobe collapse?
- coronal view

Answer 14

Middle lobe - loss of the heart border

Lower lobe - loss of the diaphragmatic silhouette

Question 15

Which direction does the right lower lobe collapse?

Answer 15

Inferiorly and medially

Question 16

Why is a haze seen on a lateral X-Ray during right lower lobe collapse?

Answer 16

Opacification of the lower right lobe combined with lucency of the leftlower lobe

Question 17

What does the left lung have instead of a middle lobe?

Answer 17

A lingula - part of the left upper lobe

Question 18

Which direction does the left upper lobe collapse, and why?

Answer 18

It collapses forward because it is heavier/bigger than the right upper lobe (which collapses upwards)

Question 19

What sign can you see on X-Ray which suggests left upper lobe collapse?

Answer 19

Luftsichel sign - the aorta becomes highlighted as it is surrounded by air (from the left lower lung when it moves forwards)

Question 20

On coronal X-Ray view, why is left upper lobe collapse hazy?

Answer 20

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

Question 21

What three features are important in identifying a left upper lobe collapse?

Answer 21

Hazy lobe
Loss of cardiac borders - opaque upper lobe moves anterior (same place as the heart)
Ascending aorta easily seen

Question 22

What is the difference between right and left lower lobe collapse?

Answer 22

Nothing - they are the same

Question 23

How can you identify complete complete collapse of the lung?

Answer 23

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

Question 24

How can you identify a pneumonectomy?

Answer 24

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

Question 25

Where/why would you hear stony dull percussion?

Answer 25

A large pleural effusion will sink to the bottom of the lung when someone is sitting up
- dullness will be heard at lung bases