Round atelectasis

Case contributed by Dr Matthew Lukies

Presentation

Follow-up imaging for a patient with a recent past history of hydropneumothorax and chronic liver disease.

Patient Data

Age: 60
Gender: Female
Modality: X-ray
  • Right-sided pleural fluid collection with fluid tracking into the oblique fissure
  • Round area of opacity adjacent to the pleura in the right lower zone

CT of the chest was recommended to further characterise the round opacity.

Modality: CT
  • Right-sided pleural fluid collection
  • Round soft-tissue density in the right lower lobe adjacent to the pleura with curvilinear extensions (comet tail sign)

The location of the round density adjacent to the pleura and comet tail sign are characteristic of round atelectasis.

Case Discussion

Although the CT features were characteristic of round atelectasis, the area of hyperdensity was biopsied in this case. This is not typical, since cases with the characteristic CT features of round atelectasis are generally not biopsied and managed conservatively with follow up imaging 1,2. A biopsy of round atelectasis will inevitably contain scant lung parenchymal tissue and may lead to clinician uncertainty and repeated unnecessary invasive procedures. As such, biopsy should only be performed where imaging findings are indeterminate 1,2.

The histopathology report in this case described limited tissue containing pneumocytes with patchy mild interstitial chronic inflammation, and no features of malignancy.

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Case Information

rID: 45643
Case created: 2nd Jun 2016
Last edited: 10th Jan 2017
System: Chest
Inclusion in quiz mode: Included

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