Left upper lobe collapse in the exam

Last revised by Kieran Kusel on 28 Mar 2023

Citation, DOI, disclosures and article data

Citation:

Holland M, Kusel K, Teaching M, et al. Left upper lobe collapse in the exam. Reference article, Radiopaedia.org (Accessed on 18 Apr 2024) https://doi.org/10.53347/rID-22513

DOI:

https://doi.org/10.53347/rID-22513

Permalink:

https://radiopaedia.org/articles/22513

rID:

22513

Article created:

4 Apr 2013, Mark Holland

Disclosures:

At the time the article was created Mark Holland had no recorded disclosures.

View Mark Holland's current disclosures

Last revised:

28 Mar 2023, Kieran Kusel ◉

Disclosures:

At the time the article was last revised Kieran Kusel had no financial relationships to ineligible companies to disclose.

View Kieran Kusel's current disclosures

Revisions:

15 times, by 11 contributors - see full revision history and disclosures

Systems:

Chest

Sections:

Approach

Tags:

chest x-ray, cxr, refs

Getting a film with left upper lobe collapse in the exam is one of the many exam set-pieces that can be prepared for.

This frontal chest radiograph shows hazy (or veil-like*) opacification of the left hemithorax that is associated with superior displacement of the left hilum and a horizontal left mainstem bronchus. The lateral border of the aortic arch is well defined by air (Luftsichel sign) and there is tenting of the left hemidiaphragm. There is loss of the left superior mediastinal and left heart border interfaces (silhouette sign).

In my practice I would review a lateral film, which shows increased retrosternal opacification, anterior displacement of the oblique (major) fissure and hyperexpansion of the left lower lobe.

Older patient / smoker

There is an associated hilar mass which may be malignant. I would contact the GP to arrange an urgent bronchoscopic biopsy and staging CT. Look for pulmonary and bony metastases and ask for old films to demonstrate serial enlargement of the hilar mass.

* some examiners feel that "veil-like opacification" should only be used to describe a pleural effusion!