Right upper lobe collapse

Case contributed by Dr Ian Bickle

Presentation

Chronic cough and exertional dyspnea. Chest x-ray performed.

Patient Data

Age: 55 years
Gender: Female

Linear density medially in the right upper lobe.

Volume loss in the right hemithorax.

Relative translucency of the right hemithorax.

Elevated right hilum.

A normal female chest x-ray for comparison with the first film.

Case Discussion

Benjamin Felson was the doyan of chest radiology and his description of the silhouette sign remains a core radiological plain film lesson.

The collapse or consolidation of the various lobes of the lung illustrates classical appearances - one of these being the right upper lobe.  

The right upper lobe will collapse medially effacing the upper mediastinum.  

This film has a number of accompanying features:

a. The transradiancy of the right lung ( compared to the left ) is greater - it reflects the hemithorax now being only occupied by the middle and lower lobes.

b. Reduction in the hemithorax volume

c. Elevation of the right hilum ( it is usually 1.5cm lower than the left, but in this case at the same level as it is 'pulled up' )

The features are even better appreciated if compared with the normal chest x-ray which is shown above.

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