Left upper lobe collapse

Case contributed by Dr Son Do

Presentation

Worsening shortness of breath despite bronchodilators.

Patient Data

Age: 70 years
Gender: Male
X-ray

Increased opacity over the left hemithorax with obliteration of the left heart border.

Presence of hyperlucent shadow around aortic knuckle consistent with Luftsichel sign.

Loss of volume within the left hemithorax with elevation of the left hemidiaphragm.

Small left sided pleural effusion.

CT

Left upper lobe collapse with truncation of the left upper lobe bronchus.

A left superior hilar soft tissue mass is demonstrated surrounding the left main bronchus extending into the mediastinum to the carina, tracking along the left main pulmonary artery and the left superior pulmonary vein.

Associated moderate sized left pleural effusion with associated compressive atelectasis.

Case Discussion

This was a case of first presentation with lung cancer. The patient had a significant smoking history and a recent chest infection which improved on oral antibiotics. Frontal x-ray shows Luftsichel sign, a hyperlucent shadow due to hyperinflation of the superior segment of the left lower lobe between the aorta and collapsed lung. CT scan is important for further evaluation of upper lobe collapse and in this case confirmed the diagnosis.

The patient was sent for bronchoscopy under the respiratory team. Histology: small cell carcinoma

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