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:
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Failure to consider lobar or segmental collapse when a loss of volume is observed on chest radiographs
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Failure to exclude an endobronchial abnormality when evaluating a patient with lobar collapse
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Failure to recognize that the lung collapse is a medical emergency because patients may develop respiratory distress and hypoxemia
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Failure to consider bronchoscopy as a diagnostic and therapeutic procedure for patients with lung collapse
Differential Diagnoses
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Atelectasis. Left lower lobe collapse. The opacity is in the posterior inferior location.
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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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Atelectasis. Left upper lobe collapse showing opacity contiguous to the aortic knob, a smaller left hemithorax, and a mediastinal shift.
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Atelectasis. CT scan of a left upper lobe collapse with a small pleural effusion.
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Complete atelectasis of the left lung. Mediastinal displacement, opacification, and loss of volume are present in the left hemithorax.
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Atelectasis. Right lower lobe collapse.
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Atelectasis. Both right lower lobe and right middle lobe collapse. The left lung is hyperexpanded.
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Complete right lung atelectasis.
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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.
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Atelectasis. The left upper lobe collapses anteriorly on a lateral chest x-ray film.
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Atelectasis. Left upper lobe collapse. The top of the aortic knob sign is demonstrated.
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Atelectasis. Left lower lobe collapse.
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Atelectasis. Right middle lobe collapse shows obliteration of the right heart border.
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Atelectasis. The azygous lobe of the right lung may be mistaken for a collapsed right upper lobe.
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Atelectasis. Left lower lobe collapse. The sail sign is obvious.
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Atelectasis. Left upper lobe collapse. The Luft Sichel sign is demonstrated clearly in this radiograph.
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Atelectasis. Chest CT scan showing left upper lobe collapse.
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Atelectasis. The right lower lobe collapses inferiorly and posteriorly.
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Atelectasis. Right lower lobe collapse without middle lobe collapse, the right major fissure is shifted downward and is now visible.
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Atelectasis. Right middle lobe collapse showing obliteration of the right heart border.
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Atelectasis. Right middle lobe collapse on a lateral chest x-ray film.
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Atelectasis. Right upper lobe collapse and consolidation.
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Atelectasis. Right upper lobe collapse.
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Atelectasis. Left lower lobe collapse on posteroanterior view.
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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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Atelectasis. Chest posteroanterior radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
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Atelectasis. Chest lateral radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
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Atelectasis. CT scan of the chest shows tumor encasing and occluding the right upper lobe bronchus and collapse of the right upper lobe, with superior and medial displacement of the minor fissure.
