Collapsed lung

Published on 02/04/2015 by admin

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Last modified 22/04/2025

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111 Collapsed lung

Instruction

Examine this patient’s chest.

Salient features

History

• Sudden onset of breathlessness

• History of cough

• History of asthma, TB, lung cancer.

Examination

• Trachea deviated to the affected side

• Movements decreased on the affected side

• Percussion note dull on the affected side

• Breath sounds diminished on the affected side.

Proceed as follows:

• Tell the examiner that you would like to look for tar staining (tobacco smoking), clubbing and cachexia (bronchogenic carcinoma; see p. 387).

• Be prepared to discuss the patients chest radiography (Fig. 111.1).

Fig. 111.1 Collapsed lung. (A) Triangular-shaped density adjacent to the right heart border in right middle lobe collapse. (B) Superior triangle sign in right lower lobe collapse (arrow). (C) Paramediastinal lucency (Luftsichel sign; arrow) in left upper lobe collapse. (D) A small triangular density (juxtaphrenic peak sign; arrow) in left upper lobe collapse (indicates reorientation of an inferior accessory fissure). (E) Shifting granuloma sign in right lower lobe collapse.

(With permission from Adam et al. 2008.)

Diagnosis

This patient has a collapsed lung (lesion); he is breathless at rest (functional status). You would like to exclude malignancy (aetiology).

Questions

What are the causes of lung collapse?

• Bronchogenic carcinoma

• Mucus plugs (asthma, allergic bronchopulmonary aspergillosis) (BMJ 1982;285:552)

• Extrinsic compression from hilar adenopathy (e.g. primary TB)

• TB (Brock syndrome)

• Other intrabronchial tumours including bronchial adenoma

• Ventilation-induced lung injury.

What are the chest radiograph findings of collapse of the right middle lobe?

The loss of definition of the right heart border (Fig. 111.1A) reflects collapse (or consolidation) affecting the right middle lobe.

What is Brock syndrome?

It is collapse caused by compression of the right middle lobe bronchus by an enlarged lymph node.

Sir Russel C Brock (1903–1980) graduated from Guy’s Hospital and was surgeon at Guy’s and Brompton Hospitals. His interests included both thoracic and cardiac surgery. He was the President of the Royal College of Surgeons, 1963–1966.

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