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Round atelectasis

Dr Craig Hacking ◉ ◈ and Dr Yuranga Weerakkody ◉ et al.

Round atelectasis, also known as rounded atelectasis, folded lung or Blesovsky syndrome, is an unusual type of lung atelectasis where there is infolding of a redundant pleura. The way the lung collapses can at times give a false mass-like appearance.

On this page:

Article:

Pathology
Radiographic features
History and etymology
See also
Related articles
References

Images:

Cases and figures

Pathology

Two theories have been put forward. The second theory is more favored while the multi-factorial etiology suggests both mechanisms probably operate in different patients:

Hanke and Kretzschmar
- underlying pleural effusion causes local atelectasis in the adjacent lung
- a cleft or infolding of the visceral pleura will then form if the rate of pleural fluid formation exceeds alveolar air absorption
- this then causes the lung to tilt on the cleft
- the lung then curls on itself in a concentric fashion
- fibrous adhesions suspending the atelectatic segment (and usually tilt the lung cranially) develop
- as the effusion resorbs, the aerated lung fills in the space between the area of round atelectasis
- organization of the fibrinous exudate and fibrous contraction lead to additional lung parenchymal distortion
Schneider et al. (expanded on by Dernevik and colleagues)
- a local pleuritis caused by irritants such as asbestos
- in the event of a benign asbestos-related pleural effusion, the pleura contracts and thickens with shrinkage of the underlying lung, and atelectasis develops in a round configuration

Etiology

exposure to mineral dust: asbestosis, pneumoconiosis ¹³
exudative pleuritis: tuberculosis, hemothorax¹³
less commonly seen in histoplasmosis, legionella, end-stage renal disease¹³
sarcoidosis¹³

Associations

It can be associated with:

asbestos lung exposure ³: most commonly
therapeutic pneumothorax in the treatment of tuberculosis ¹
congestive heart failure ²
pulmonary infarction ²
parapneumonic effusion

Location

There may be a predilection towards the lower lobes ⁴.

Radiographic features

CT

almost always seen adjacent to a pleural surface
there is associated adjacent pleural abnormality, e.g. pleural thickening or pleural effusion
comet tail sign ²: produced by the pulling of bronchovascular bundles giving the shape of a comet tail
crow feet sign
as it represents collapsed lung, it commonly demonstrates a typical parenchymal enhancement

Rounded atelectasis can occasionally increase in size on serial scans ^6,7.

Nuclear medicine

FDG-PET:

not metabolically active
may play a role in differentiating from malignancy when there are few or atypical features on chest radiographs and CT ⁹

History and etymology

It was first described by Loeschke in 1928 ⁶.

See also

References

Airspace opacification

Article information

rID: 10354

System: Chest

Section: Gamuts

Synonyms or Alternate Spellings:

Folded lung
Blesovsky syndrome
Rounded atelectasis
Rounded lung collapse
Round atelectatic change
Rounded atelectatic change

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Cases and figures

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