Right upper lobe collapse

Last revised by Craig Hacking on 4 Nov 2021

Right upper lobe collapse has distinctive features, and is usually easily identified on frontal chest radiographs; much more so than left upper lobe collapse.

For a general discussion please refer to the article on lobar collapse.

Collapse of the right upper lobe is usually relatively easy to identify on frontal radiographs. Features consist of 1-3:

  • increased density in the upper medial aspect of the right hemithorax
  • elevation and/or superior bowing of the horizontal fissure
  • loss of the normal right medial cardiomediastinal contour
  • elevation of the right hilum
  • rotation of the bronchus intermedius laterally, appearing more horizontal than usual
  • hyperinflation of the right middle and lower lobe result in increased translucency of the mid and lower parts of the right lung
  • right juxtaphrenic peak (Kattan sign)

A common cause of lobar collapse is a hilar mass. When a right hilar mass is combined with collapse of the right upper lobe, the result is an S shape to elevated horizontal fissure. This is known as Golden S sign 1-3.

Non-specific signs indicating right sided atelectasis are also usually present including:

  • elevation of the hemidiaphragm
  • crowding of the right sided ribs
  • shift of the mediastinum and trachea to the right

On the lateral projection it is harder to identify as the soft tissues of the shoulders usually obscure the upper zones, and the collapse is mostly medial. There is wedge shaped opacification in the upper anterior chest. Elevation of the horizontal fissure and anterior bowing upper part of the oblique fissure may be visible 3.

  • triangular opacification in axial images, thinner at the right hilum
  • horizontal fissure rotates anteromedially
  • oblique fissure bows anteriorly

The differential diagnosis of collapse of the right upper lobe includes:

  • right upper lobe consolidation with absence of signs of volume loss
  • a mass in the medial aspect of the right upper lobe
  • a mass in on the right side of the superior mediastinum

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Cases and figures

  • Figure 1: position of RUL
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  • Figure 2: position of RUL
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  • Case 1
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  • Case 3
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