Atelectasis Differential Diagnoses

  • Author: Tarun Madappa, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Feb 11, 2016
 
 

Diagnostic Considerations

Bronchogenic carcinoma, which may present with atelectasis, must be excluded in all patients older than 35 years.

A pneumothorax can produce patient complaints similar to atelectasis. However, on physical examination, the percussion note is hyper-resonant and the heart and mediastinum are pushed to the opposite side. Chest radiographs are diagnostic.

A massive pleural effusion may cause dyspnea, cyanosis, and weakness. On physical examination, there is typically dullness to precussion and absent breath sounds of the involved hemithorax. The heart and mediastinum may be deviated away from the involved area.

The following may be areas of medicolegal concern regarding diagnosis:

  • Failure to consider lobar or segmental collapse when a loss of volume is observed on chest radiographs
  • Failure to exclude an endobronchial abnormality when evaluating a patient with lobar collapse
  • Failure to recognize that the lung collapse is a medical emergency because patients may develop respiratory distress and hypoxemia
  • Failure to consider bronchoscopy as a diagnostic and therapeutic procedure for patients with lung collapse

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Tarun Madappa, MD, MPH Attending Physician, Department of Pulmonary and Critical Care Medicine, Christus Spohn-Shoreline Hospital

Tarun Madappa, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Helen M Hollingsworth, MD Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center

Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, Massachusetts Medical Society

Disclosure: Nothing to disclose.

References
  1. Rosenbloom SA, Ravin CE, Putman CE, et al. Peripheral middle lobe syndrome. Radiology. 1983;. 149:17-21. [Medline]. [Full Text].

  2. Priftis KN, Mermiri D, Papadopoulou A, Anthracopoulos MB, Vaos G, Nicolaidou P. The role of timely intervention in middle lobe syndrome in children. Chest. 2005 Oct. 128(4):2504-10. [Medline].

  3. Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF. Middle lobe syndrome as the pulmonary manifestation of primary Sjogren's syndrome. Med J Aust. 2006 Mar 20. 184(6):294-5. [Medline].

  4. Reinius H, Jonsson L, Gustafsson S, et al. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology. 2009 Nov. 111(5):979-87. [Medline].

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  8. Partap VA. The comet tail sign. Radiology. 1999 Nov. 213(2):553-4. [Medline].

  9. [Urgent fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis]. Anesteziol Reanimatol. 2013 Nov-Dec. 51-4. [Medline].

  10. [Guideline] McCool FD, Rosen MJ. Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):250S-259S. [Medline].

  11. Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care. 2005 Aug. 9(4):R351-6. [Medline].

  12. Kato K, Sato N, Takeda S, et al. Marked improvement of extensive atelectasis by unilateral application of the RTX respirator in elderly patients. Intern Med. 2009. 48(16):1419-23. [Medline].

 
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Atelectasis. Loss of volume on the left side; an elevated and silhouetted left diaphragm; and an opacity behind the heart, called a sail sign, are present.
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Complete atelectasis of the left lung. Mediastinal displacement, opacification, and loss of volume are present in the left hemithorax.
Atelectasis. Right lower lobe collapse.
Atelectasis. Both right lower lobe and right middle lobe collapse. The left lung is hyperexpanded.
Complete right lung atelectasis.
Atelectasis. A lateral chest x-ray film confirms the diagnosis of right middle lobe collapse. The minor fissure moves down, and the major fissure moves up, leading to a wedge-shaped opacity.
Atelectasis. The left upper lobe collapses anteriorly on a lateral chest x-ray film.
Atelectasis. Left upper lobe collapse. The top of the aortic knob sign is demonstrated.
Atelectasis. Left lower lobe collapse.
Atelectasis. Right middle lobe collapse shows obliteration of the right heart border.
Atelectasis. The azygous lobe of the right lung may be mistaken for a collapsed right upper lobe.
Atelectasis. Left lower lobe collapse. The sail sign is obvious.
Atelectasis. Left upper lobe collapse. The Luft Sichel sign is demonstrated clearly in this radiograph.
Atelectasis. Chest CT scan showing left upper lobe collapse.
Atelectasis. The right lower lobe collapses inferiorly and posteriorly.
Atelectasis. Right lower lobe collapse without middle lobe collapse, the right major fissure is shifted downward and is now visible.
Atelectasis. Right upper lobe collapse demonstrating Golden sign of S.
Atelectasis. Right middle lobe collapse showing obliteration of the right heart border.
Atelectasis. Right middle lobe collapse on a lateral chest x-ray film.
Atelectasis. Right upper lobe collapse and consolidation.
Atelectasis. Right upper lobe collapse.
Atelectasis. Right upper lobe collapse.
Atelectasis. Left lower lobe collapse on posteroanterior view.
The left lower lobe collapses toward the posterior and inferior aspects of the thoracic cavity; the atelectatic left lower lobe is present as a sail behind the cardiac shadow.
 
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