Citation, DOI, disclosures and article data
At the time the article was created Yuranga Weerakkody had no recorded disclosures.View Yuranga Weerakkody's current disclosures
Round atelectasis, also known as rounded atelectasis, 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.
Round atelectasis may be associated with:
asbestos lung exposure 3: most commonly
therapeutic pneumothorax in the treatment of tuberculosis 1
Two theories have been put forward. The second theory is more favored while the multifactorial etiology 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
organization of the fibrinous exudate and fibrous contraction lead to additional lung parenchymal distortion
Schneider et al. (expanded on by Dernevik and colleagues)
There may be a predilection towards the lower lobes 4.
round or oval in shape
almost always seen adjacent to a pleural surface
comet tail sign 2: produced by the pulling of bronchovascular bundles giving the shape of a comet tail
as it represents collapsed lung, it commonly demonstrates a typical parenchymal enhancement
posterior lower lobes are most commonly involved and, sometimes, bilateral or symmetrical 14
Rounded atelectasis can occasionally increase in size on serial scans 6,7.
not metabolically active
may play a role in differentiating from malignancy when there are few or atypical features on chest radiographs and CT 9
All five of the following findings must be present to diagnose round atelectasis:
1) Adjacent pleura must be abnormal.
2) Opacity must be peripheral and in contact with the pleura.
3) Opacity must be round or elliptical.
4) Volume loss must be present in the affected lobe.
5) Pulmonary vessels and bronchi leading into the opacity must be curved — this is the comet tail sign15.
History and etymology
It was first described by Loeschke in 1928 6.