Lobar lung collapse

Changed by Craig Hacking, 12 Feb 2019

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Lobar collapse refers to the collapse of an entire lobe of the lung. As such it is a subtype of atelectasis (although collapse is not entirely synonymous is atelectasis), which is a more generic term for 'incomplete expansion'. Individual lobes of the lung may collapse due to obstruction of the supplying bronchus.

Pathology

Aetiology

luminal
- aspirated foreign material
- mucous plugging
mural
- bronchogenic carcinoma
extrinsic
- compression by adjacent mass

Radiographic features

Plain radiograph

~~The~~Generally there is pulmonary opacification but the appearance on chest x-ray varies according to the lobe involved and are discussed separately:

Some features, however, are generic markers of volume loss and are helpful in directing ones attention to the collapse, as well as enabling distinction from opacification of the lobe without collapse (e(i.e. consolidation e.g. lobar pneumonia). These features include ^{5, 9}:

direct signs
- displacement of fissures
- crowding of pulmonary vessels
indirect signs
- elevation of the ipsilateral hemidiaphragm
- crowding of the ipsilateral ribs
- shift of the mediastinum towards the side of atelectasis
- ~~crowding~~compensatory hyperinflation of ~~pulmonary vessels or air bronchograms~~normal lobes
- hilar displacement towards the collapse
- shifting granuloma sign

CT

Lobar collapse is usually trivially easy to identify on CT, but identification of the cause is not always easy, as the collapsed lung can make identification of an obstructing lesion difficult.

~~-</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>The appearance on chest x-ray varies according to the lobe involved and are discussed separately: </p><ul>~~
+</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Generally there is pulmonary opacification but the appearance on chest x-ray varies according to the lobe involved and are discussed separately: </p><ul>
-</ul><p>Some features, however, are generic markers of volume loss and are helpful in directing ones attention to the collapse, as well as enabling distinction from opacification of the lobe without collapse (e.g. <a href="/articles/lobar-pneumonia">lobar pneumonia</a>). These features include <sup>5</sup>:</p><ul>
+</ul><p>Some features, however, are generic markers of volume loss and are helpful in directing ones attention to the collapse, as well as enabling distinction from opacification of the lobe without collapse (i.e. consolidation e.g. <a href="/articles/lobar-pneumonia">lobar pneumonia</a>). These features include <sup>5, 9</sup>:</p><ul>
+<li>direct signs<ul>
+<li>displacement of fissures</li>
+<li>crowding of pulmonary vessels</li>
+</ul>
+</li>
+<li>indirect signs<ul>
~~-<li>crowding of pulmonary vessels or air bronchograms</li>~~
+<li>compensatory hyperinflation of normal lobes</li>
+<li>hilar displacement towards the collapse</li>
+<li><a href="/articles/shifting-granuloma-sign">shifting granuloma sign</a></li>
+</ul>
+</li>

References changed:

9. W. Richard Webb, Charles B. Higgins. Thoracic Imaging. (2010) <a href="https://books.google.co.uk/books?vid=ISBN9781605479767">ISBN: 9781605479767</a><span class="ref_v4"></span>

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