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Compressive Atelectasis From Pleural Effusions

Pleural Effusion
In this case there a large right sided pleural effusion (yellow) with secondary atelectasis of the right lung.  (red and green) This coronal CT of the chest at the level of the left ventricle shows a large right pleural effusion which lies between the visceral and parietal pleura. Once the effusion is large enough to weaken the capillary forces that hold the parietal and visceral pleura together, it fail, and the lung collapses which is what is noted on this image ? ie total lung collapse because of loss of cohesive adhesive forces. 
Courtesy of: Ashley Davidoff, M.D. TheCommonvein.net 42558c

Effusion without Findings of Atelectasis on CXR

CXR and Correlative CT with Bilateral Pleural Effusions and Atelectasis
92-year-old female presents with a dyspnea. CXR shows a moderate sized right effusion. CT scan shows bilateral pleural effusions. On the right there is a moderate effusion with compressive atelectasis and on the left, there is a small effusion with a minor degree of atelectasis with atelectasis of the left lung.
Ashley Davidoff MD TheCommonVein.net
Complex pleural effusion and lobar compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Complex pleural effusion and lobar compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Complex pleural effusion and lobar compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Complex pleural effusion and lobar compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Complex pleural effusion and lobar compressive atelectasis
Ashley Davidoff MD TheCommonVein.net

 

Compressive Atelectasis due to Left Pleural Effusion
58year old male presents with dyspnea. CT scan shows bilateral pleural effusions with crescentic region of compressive atelectasis in the left lower lobe
Ashley Davidoff MD TheCommonVein.net

 

Compressive Atelectasis due to Right Pleural Effusion
68year old male presents with dyspnea. Ultrasound of the right chest shows a moderate sized pleural effusion (+) with crescentic region of compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Ultrasound and Correlative CT with Left Pleural Effusion and Atelectasis
86 year-old female presents with a dyspnea. US shows a left effusion with compressive atelectasis. CT scan shows bilateral pleural effusions with atelectasis of the left lung.
Ashley Davidoff MD TheCommonVein.net
Variation of the Crescentic Shape of Passive Atelectasis
79 year-old female with bilateral simple pleural effusions and compressive atelectasis with a variation in the shape of the atelectasis in the right lower lobe.
Ashley Davidoff MD TheCommonVein.net
Compressive Atelectasis due to Bilateral Pleural Effusion
46-year-old female presents with a dyspnea and a cough. Imaging of the chest shows cardiomegaly with bilateral moderate sized pleural effusion with crescentic region of compressive atelectasis noted on the axial images at the bases and crowding of the bronchovascular bundles best evaluated on the coronal image. The 3D reconstructions show functionally ?bare? lower lobe segmental airways.
Ashley Davidoff MD TheCommonVein.net
Bilateral Pleural Effusions with Passive Compressive Atelectasis
66 year-old female with bilateral simple pleural effusions and compressive atelectasis
Ashley Davidoff MD TheCommonVein.net
Atelectasis of the Left Lung, Pleural Effusion, Pericardial Tamponade s/p AVR
60 year old male s/p AVR presents with acute respiratory distress. CT scan shows total collapse of left lung, associated with a large effusion The atelectasis is either due to the associated effusion or an obstructing mucus plug.  There is a large pericardial effusion with tamponade physiology by echo
Ashley Davidoff MD TheCommonVein.netHyperemia and Atelectasis
70-year old female with mild bilateral hyperemic atelectasis The left sided atelectasis may in part be compressive. The absence of a compressive element on the right side raises the possibility of acute aspiration with acute inflammation causing hyperemia
Ashley Davidoff MD TheCommonVein.net

White Out – Large Pleural Effusion and 

Total Collapse of the left Lung 

White Out of the CXR with Passive Compressive Atelectasis of the Left Lung
48 year-old male presents with a dyspnea. CXR shows a total white out of the left chest with pulmonary congestion. CT scan shows a large left pleural effusion with total atelectasis of the left lung. Incidental note is made of premature calcific coronary artery disease.
Ashley Davidoff MD TheCommonVein.net
80-year-old male presents with a dyspnea. Imaging of the chest using CT shows moderate sized pleural effusion on the right with focus of fixation (black arrow b) In addition the shape of the effusion reflects restriction to follow the normal shape of a gravitational dependent effusion. On the left side the effusion is simple characterised by a crescentic shape of the atelectasis (white arrow c) and a shape of the effusion conforming to the expected shape of a simple effusion.
Ashley Davidoff MD TheCommonVein.net

 

3D CT scans Normal vs Lobar Atelectasis
3D reconstruction of a normal patient (above) and of a patient with compressive atelectasis (below) The image below is from an 88 year old male with bilateral complex effusions with compressive atelectasis of the lower lobe and portion of the lingula
Ashley Davidoff MD TheCommonVein.net
Compressive Atelectasis
88 year old male with bilateral effusions shown on the CXR. Axial CT shows thickened pleura on the left with compressive atelectasis of the lower lobe and a smaller region of crescentic compressive atelectasis on the right. 3D reconstruction shows atelectasis of the left lower lobe and portion of the lingula.  The left effusion is complex.
Ashley Davidoff MD TheCommonVein.net
Tension Hydrothorax
Lung Cancer, Tension Hydrothorax, and Atelectasis
85-year-old female with a history of lung cancer, presents with a dyspnea and hypotension. CT scan shows a large right pleural effusion under pressure, with mediastinal shift to the right. In addition, there is compression of the heart with back up of venous return due the pressure effect on the heart and vascular structures. Among the structures showing venous distension are the SVC (blue arrowhead,a) right sided upper limb veins (blue arrowhead b) and the left upper pulmonary veins (red arrowhead, b. The effusion in the right pleural cavity with atelectatic lung herniates into the left hemithorax, (white arrowhead, c). There is a dense sediment in the pleural fluid (red arrowhead, d) suggesting blood in the pleural cavity. The left atrium is compressed (maroon arrowhead, d)
Ashley Davidoff MD TheCommonVein.net106Lu 118467c
Pneumothorax
large Pneumothorax with Compressive Atelectasis
Ashley Davidoff MD TheCommonVein.net
77949

Spontaneous Tension Pneumothorax
49 year old male with a cough presents for a Chest Xray which showed a tension pneumothorax. Chest tube was placed emergently in the radiology department.
Ashley Davidoff MD TheCommonVein.net
117300c

Compressive Atelectasis Alongside the Aorta

Compressive Atelectasis Alongside the Aorta
68 year old male with a cough.
CT shows Compressive Atelectasis alongside the pulsating aorta
Ashley Davidoff MD TheCommonVein.net
37493

Compressive Atelectasis by Tortuous Aorta

Compressive atelectasis and bronchiectasis caused by tortuous aorta
Ashley Davidoff MD TheCommonVein.net
01 CT 58F

Mesothelioma

CXR of an 81 year old shipbuilder shows dense pleural surrounds of a known mesothelioma with decrease in size of the left hemithorax.  There is dense multicentric consolidation noted on the lateral CXR CT scan (lower row) confirms the presence of a dense fibrosis surrounding the left lung, dominant in the lung base with compression  of the left lower lobe
Ashley Davidoff MD  TheCommonVein.net 
pleura mesothelioma 0060c
CTscan in the coronal and axial planes in this 81 year old previous shipbuilder with mesothelioma  shows dense pleural surrounding the right hemithorax, with decrease in size of the right hemithorax (top row) compressive atelectasis of the lower lobe and probable invasion into the pericardium and pericardial fat (top row) and compression of the lower lobe by thickened malignant pleura (lower row) .  
Ashley Davidoff MD  TheCommonVein.net 
 pleura mesothelioma 0100c
CXR shows dense pleural surrounds of a known mesothelioma with decrease in size of the right hemithorax.  There are also bands of increase density in the right lower lung zone and shadowing of the right heart boarder indicates involvement of the middle lobe. CTscan confirms the presence of a dense fibrosis surrounding the right lung and compression and atelectasis of the middle lobe
Ashley Davidoff MD  TheCommonVein.net 
pleura mesothelioma 0028c
CTscan in the coronal and axial planes in this patient with mesothelioma  shows dense pleural surrounding the right hemithorax, with decrease in size of the right hemithorax (top row) compressive atelectasis of the middle lobe, (middle row) invasion into the pericardium and pericardial fat and small complex effusion with split pleura sign and thickened pleura (lower row) .  
Ashley Davidoff MD  TheCommonVein.net 
pleura mesothelioma 0028c01