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Collapse and Consolidation Pathology and radiology
- 1. COLLAPSE AND CONSOLIDATION OF LUNGS PRESENTER: Dr. Shobhit Garg MODERATOR: Dr. Mamta Goyal(PROFESSOR RADIODIAGNOSIS)
- 2. OVERVIEW COLLAPSE • DIRECT AND INDIRECT SIGNS OF COLLAPSE • MECHANISMS OF COLLAPSE • LOBAR COLLAPSES AND VARIOUS RADIOLOGICAL SIGNS • ROUNDED ATELECTASIS CONSOLIDATION • DEFINITION • DIFFERENTIAL DIAGNOSIS • LOBAR CONSOLIDATION • DIFFUSE CONSOLIDATION • MULTIFOCAL CONSOLIDATION
- 3. COLLAPSE Collapse is diminished volume of air in the lung with associated reduction of lung volume.
- 4. RADIOLOGICAL SIGNS OF COLLAPSE Direct signs of collapse 1. Opacity of the affected lobe. 2. Displacement or bowing of fissure. 3. Crowding of the vessels and bronchi within the collapsed area.
- 5. INDIRECT SIGNS OF COLLAPSE 1. Elevation of hemidiaphragm. 2. Displacement of hilum. 3. Displacement of the mediastinal structures toward the affected side 4. Compensatory hyperinflation of the normal lung or lobes resulting in an increase in transradiancy with separation of the vascular marking. 5. Crowding of the ribs on the affected side, particularly common in children.
- 10. ADHESIVE COLLAPSE DIFFUSE ALVEOLAR COLLAPSE • WHITE OUT LUNGS • SMALL LUNGS
- 11. PLATE LIKE COLLAPSE • PULMONARY EMBOLISM • POST-OP HYPOVENTILATION
- 12. PATTERNS OF LUNG COLLAPSE 1)Complete collapse of a lung 2)Lobar collapse
- 13. 1)COMPLETE COLLAPSE • Causes opaque hemithorax with displacement of mediastinum to the affected side with compensatory hyperinflation of opposite lung often with herniation across midline. • Herniation mostly occurs in retrosternal space but may occur posterior to heart or under aortic arch
- 15. RIGHT UPPER LOBE COLLAPSE
- 17. GOLDEN S SIGN
- 19. RIGHT MIDDLE LOBE COLLAPSE • Horizontal fissure and oblique fissure move towards one another • Obscuration of right heart border • Lordotic AP projection best for middle lobe collapse • Volume of this lobe is small so indirect signs rarely present.
- 20. RIGHT MIDDLE LOBE COLLAPSE
- 22. RIGHT LOWER LOBE COLLAPSE •Depression of horizontal fissure •Increase opacity of collapse lower lobe •In case of complete collapse of lower lobe it may be so small that it merges with mediastinum and produce a thin wedge shape shadow. •Mediastinal parts and adjacent diaphragm obscured •Hila depressed and rotated medially. •Diaphragm elevation is not usual
- 23. RIGHT LOWER LOBE COLLAPSE
- 25. LEFT UPPER LOBE COLLAPSE • Anterior displacement of entire oblique fissure • Ill defined hazy opacity in upper, mid and sometimes lower zone • Hila elevated • Aortic knuckle obscured.
- 26. • With increasing collapse upper lobe retracts posteriorly and loses contact with anterior chest wall. • The space between the collapsed lung and sternum is occupied by either hyperinflated left lower lobe or herniated right upper lobe. • When complete collapse occurs LUL lose contact with chest wall and diaphragm and retract medially against the mediastinum
- 27. Left upper lobe collapse
- 29. LUFTSICHEL SIGN
- 30. LEFT LOWER LOBE COLLAPSE
- 31. LEFT LOWER LOBE COLLAPSE • Oblique fissure moves posteriorly • Thus the shadow may be obscured by the heart and a penetrated view with the grid may be required for its visualisation. • Complete left lower lobe collapse, if in doubt would require a right oblique film and will demonstrate wedge of a tissue in between diaphragm and spine.
- 33. ROUNDED COLLAPSE
- 34. COLLAPSE ON USG
- 35. CONSOLIDATION • Replacement of air in one or more acini by fluid or solid material • Smallest unit of consolidated lung is acinus casts 4-8mm diameter shadow Diminished volume of air in the lung not assosciated with the diminished volume of lung.
- 37. Key x-ray findings are • Ill defined homogeneous or inhomogeneous opacity obscuring vessels • Silhoutte sign: loss of lung and soft tissue interface. • Air bronchogram • No volume loss
- 38. When consolidation is assosciated with patent airways, Air bronchogram is seen.
- 39. Consolidation without air bronchogram seen in diseases like pulmonary infarction and bronchopneumonia
- 40. LOBAR CONSOLIDATION • RESULT OF THE DISEASE THAT STARTS IN THE PERIPHERY AND SPREADS FROM ONE ALVEOLUS TO ANOTHER THROUGH PORES OF KOHN . • CONSOLIDATION WILL NOT CROSS A FISSURE.
- 41. RIGHT UPPER LOBE CONSOLIDATION • Confined by horizontal fissure inferiorly and upper half of oblique fissure posteriorly ,may obscure right upper mediastinum
- 42. RIGHT MIDDLE LOBE CONSOLIDATION • limited by horizontal fissure above and lower half of obliue fissure posteriorly ,may obscure right heart border
- 43. LOWER LOBE CONSOLIDATION It is limited by oblique fissure anteriorly and may obscure diaphragm
- 44. RIGHT LOWER LOBE CONSOLIDATION
- 45. LEFT LOWER LOBE CONSOLIDATION
- 46. LUL AND LINGULA CONSOLIDATION • These are limited by oblique fissure posteriorly • lingular consolidation may obscure left heart border, • consolidation of upper lobe may obscure aortic knuckle.
- 47. LEFT UPPER LOBE CONSOLIDATION
- 49. DIFFUSE CONSOLIDATION BATWING DISTRIBUTIO N PULMONARY EDEMA VIRAL PNEUMONIA BRONCHOPNEUMONI A REVERSE BATWING DISTRIBUTION BRONCHOALVEOLAR CARCINOMA ORGANIZING PNEUMONIA EOSINOPHILIC PNEUMONIA
- 51. REVERSE BATWING
- 52. MULTIFOCAL CONSOLIDATION • BRONCHOPNEUMONIA • ALVEOLAR FORM OF SARCOIDOSIS • WEGENER’S GRANULOMATOSIS
- 55. CONCLUSION Both collapse and consolidation show opacities in the chest radiograph. Collapse implies diminished volume of air in the lung associated with reduction in lung volume without air bronchograms. Consolidation implies diminished volume of air in lung associated with normal lung volume and most often show air bronchograms.
- 56. QUIZ????