Left lower lobe collapse
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Left lower lobe collapse has distinctive features, and can be readily identified on frontal chest radiographs, provided attention is paid to the normal cardiomediastinal contours. However, the shadow cast by the heart does make it more difficult to see than the right lower lobe collapse.
FindingsSome of the findings of right lower lobe collapse can be grouped together as they are almost identical on both sides.
For a general discussion please refer to the article on lobar collapse.
Radiographic features
Chest radiograph
Left lower lobe collapse is readily identified on a well-penetrated radiograph of a patient with a normal sized heart but can be challenging in the typical patient with collapse, namely unwell patients, with portable (AP) often under-penetrated films, or with concomitant cardiomegaly. Features include 1-3:
- triangular opacity in the posteromedial aspect of the left lung (retrocardiac sail sign)
- right lower zone opacification (usually medially) with the apex pointing towards the left hilum
- edge of the collapsed lung may create a 'double cardiac contour'
- inferior displacement of the left hilum
- flat waist sign: flattening of the left heart border
- obscuration of the left hemidiaphragm
- obscuration of the descending aorta
- preservation of a clear left heart border, which is contacted by the lingular segments of the right upper
lobelobe (c.f. obscuration seen LUL consolidation) - inferior displacement of the horizontal fissure
- descending interlobar pulmonary artery is not visible
Non-specific signs found in left-sided atelectasis are usually also present including:
- elevation of the hemidiaphragm
- crowding of the left ribs
- shift of the mediastinum to the left
On the lateral projection the findings are usually obvious:
- triangular opacification in the lower posterior chest
- left hemidiaphragm is obscured posteriorly and the lower thoracic vertebrae appear denser than normal (they are usually more radiolucent than the upper vertebrae) 3.
- oblique fissure displaced posteroinferiorly but may be invisible with a severe collapse of the RLL as it fissure rotates posteromedially becoming non-tangental to the X-ray beam 2
- inferior displacement of the left hilum
CT2
- triangular opacification in axial images, thinner at the hilum, against the posterior mediastinum and medial hemidiaphragm2
- oblique fissure rotates posteromedially or posteriorly2
- compensatory hyperinflation of the LUL2
Differential diagnosis
The characteristic shape associated with volume loss usually does not allow for any significant differential diagnosis. As always one should consider:
- left lower lobe consolidation (of the medial basal segment)
- pulmonary or posterior mediastinal mass
Related articles
-<p><strong>Left lower lobe collapse</strong> has distinctive features, and can be readily identified on frontal chest radiographs, provided attention is paid to the <a href="/articles/normal-contours-of-the-cardiomediastinum-on-chest-radiography">normal cardiomediastinal contours</a>. However, the shadow cast by the heart does make it more difficult to see than the right lower lobe collapse.</p><p>Findings of lower lobe collapse can be grouped together as they are almost identical on both sides.</p><p>For a general discussion please refer to the article on <a href="/articles/lobar-lung-collapse">lobar collapse</a>.</p><h4>Radiographic features</h4><h5>Chest radiograph</h5><p>Left lower lobe collapse is readily identified on a well-penetrated radiograph of a patient with a normal sized heart but can be challenging in the typical patient with collapse, namely unwell patients, with portable (AP) often under-penetrated films, or with concomitant <a href="/articles/cardiomegaly">cardiomegaly</a>. Features include <sup>1-3</sup>:</p><ul>- +<p><strong>Left lower lobe collapse</strong> has distinctive features, and can be readily identified on frontal chest radiographs, provided attention is paid to the <a href="/articles/normal-contours-of-the-cardiomediastinum-on-chest-radiography">normal cardiomediastinal contours</a>. However, the shadow cast by the heart does make it more difficult to see than the right lower lobe collapse.</p><p>Some of the findings of <a title="Right lower lobe collapse" href="/articles/right-lower-lobe-collapse">right lower lobe collapse</a> can be grouped together as they are almost identical on both sides.</p><p>For a general discussion please refer to the article on <a href="/articles/lobar-lung-collapse">lobar collapse</a>.</p><h4>Radiographic features</h4><h5>Chest radiograph</h5><p>Left lower lobe collapse is readily identified on a well-penetrated radiograph of a patient with a normal sized heart but can be challenging in the typical patient with collapse, namely unwell patients, with portable (AP) often under-penetrated films, or with concomitant <a href="/articles/cardiomegaly">cardiomegaly</a>. Features include <sup>1-3</sup>:</p><ul>
-<li>edge of collapsed lung may create a 'double cardiac contour'</li>- +<li>edge of the collapsed lung may create a 'double cardiac contour'</li>
-<li>preservation of a clear left heart border, which is contacted by the lingular segments of the right upper lobe lobe (c.f. obscuration seen <a href="/articles/left-upper-lobe-consolidation">LUL consolidation</a>)</li>- +<li>preservation of a clear left heart border, which is contacted by the lingular segments of the right upper lobe (c.f. obscuration seen <a href="/articles/left-upper-lobe-consolidation">LUL consolidation</a>)</li>
-<a href="/articles/oblique-fissure">oblique fissure</a> displaced posteroinferiorly but may be invisible with severe collapse of the RLL as it fissure rotates posteromedially becoming non-tangental to the X-ray beam <sup>2</sup>- +<a href="/articles/oblique-fissure">oblique fissure</a> displaced posteroinferiorly but may be invisible with a severe collapse of the RLL as it fissure rotates posteromedially becoming non-tangental to the X-ray beam <sup>2</sup>
-</ul><h5>CT <sup>2</sup>-</h5><ul>-<li>triangular opacification in axial images, thinner at the hilum, against the posterior mediastinum and medial hemidiaphragm</li>-<li>oblique fissure rotates posteromedially or posteriorly</li>-<li>compensatory hyperinflation of the LUL</li>- +</ul><h5>CT</h5><ul>
- +<li>triangular opacification in axial images, thinner at the hilum, against the posterior mediastinum and medial hemidiaphragm <sup>2</sup>
- +</li>
- +<li>oblique fissure rotates posteromedially or posteriorly <sup>2</sup>
- +</li>
- +<li>compensatory hyperinflation of the LUL <sup>2</sup>
- +</li>
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