Round atelectasis

Round atelectasis, also known as folded lung or Blesovsky syndrome, is an unusual type of lung atelectasis where there is infolding of a redundant pleura. The way the lung collapses can at times give a false mass-like appearance.

Two theories have been put forward. The second theory is more favoured while the multi-factorial aetiology suggests both mechanisms probably operate in different patients:

  • Hanke and Kretzschmar
    • underlying pleural effusion causes local atelectasis in the adjacent lung
    • a cleft or infolding of the visceral pleura will then form if the rate of pleural fluid formation exceeds alveolar air absorption
    • this then causes the lung to tilt on the cleft
    • the lung then curls on itself in a concentric fashion
    • fibrous adhesions suspending the atelectatic segment (and usually tilt the lung cranially) develop
    • as the effusion resorbs, the aerated lung fills in the space between the area of round atelectasis
    • organisation of the fibrinous exudate and fibrous contraction lead to additional lung parenchymal distortion
  • Schneider et al (expanded on by Dernevik and colleagues)
    • a local pleuritis caused by irritants such as asbestos
    • in the event of a benign asbestos-related pleural effusion, the pleura contracts and thickens with shrinkage of the underlying lung, and atelectasis develops in a round configuration
Associations

It can be associated with:

Location: distribution

There may be a predilection towards the lower lobes 4.

CT - HRCT chest
  • almost always seen adjacent to a pleural surface
  • there is associated adjacent pleural thickening
  • comet tail sign 2: produced by the pulling of bronchovascular bundles giving the shape of a comet tail

Rounded atelectasis can occasionally increase in size on serial scans 6,7.

FDG-PET
  • not metabolically active
  • may play a role in differentiating from malignancy when there are few or atypical features on chest radiographs and CT 9

It was first described by Loeschke in 1928 6.

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Article Information

rID: 10354
System: Chest
Section: Pathology
Synonyms or Alternate Spellings:
  • Folded lung
  • Blesovsky syndrome
  • Rounded atelectasis
  • Rounded lung collapse
  • Round atelectatic change
  • Rounded atelectatic change

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