bài giảng giải phẫu phổi

a Posteroanterior radiograph showing markedly atelectatic right upper lobe as a band opacity at the right superior mediastinum arrows.. b CT clearly demonstrates the atelectatic right up

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• Xeïp phoåi

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Thoat vò

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Figure 1 68-year-old woman with marked right upper lobe atelectasis due to bronchial tuberculosis (a) Posteroanterior radiograph showing markedly atelectatic right upper lobe as a band opacity at the right superior mediastinum (arrows) Note the small and elevated right hilum and the decreased vascular markings in the right lung (b) CT clearly demonstrates the atelectatic right upper lobe as a band opacity

(arrows)

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• Figure 2 61-year-old man with marked left upper lobe atelectasis due to a carcinoid tumour in left upper lobe bronchus (a) Posteroanterior radiograph shows a small left perihilar opacity The left hilum is elevated and the left upper lobe pulmonary artery is invisible (b) Anteroposterior scout radiograph

on CT shows a radiolucent stripe (arrowheads) between the atelectatic left upper lobe and the aortic arch (Luftsichel sign) (c) CT shows the atelectatic left upper lobe as a triangular

opacity with its apex directed posteriorly The hyperinflated superior segment of the left lower lobe extends medially to the atelectatic lobe (arrow), producing the Luftsichel sign

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• Figure 3 20-year-old man with marked right lower lobe atelectasis due to bronchiectasis as a result of childhood pulmonary infection (a) Posteroanterior radiograph The atelectatic right lower lobe is so small that it can hardly be seen The right hilum is small, and compensatory overinflation and decreased vascular markings in the right lung are present Note that the anterior mediastinal triangle has shifted to the right (black and white arrowheads), forming the upper triangle sign (b) Lateral radiograph The atelectatic lobe cannot be identified Note that the right hemidiaphragm is seen throughout (c)

CT shows a small opacity with air bronchogram at the right paravertebral region (arrow)

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• Figure 4 74-year-old man with marked left lower lobe atelectasis due to bronchiectasis (a) Posteroanterior radiograph shows a small hilum on the left and decreased vascular markings in the left lung Lateral margin of the atelectatic left lower lobe can easily be mistaken for the descending aortic interface (arrowheads) (b) CT demonstrates a

markedly atelectatic left lower lobe as a small opacity with air bronchogram in the left paravertebral region

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• Figure 6 22-year-old man with marked right middle lobe atelectasis due to bronchiectasis (a) Posteroanterior (PA) radiograph shows obliteration of the right cardiac border, but the finding is rather subtle (b) Lateral radiograph shows a thin linear opacity (arrowheads) The diagnosis of right middle lobe atelectasis cannot be clearly made from

PA and lateral views (c) Apical lordotic radiograph demonstrates the atelectatic right middle lobe as a triangular opacity Note the air bronchogram within the atelectatic lobe, indicating non-obstructive atelectasis

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• Figure 7 46-year-old man with right upper lobe atelectasis due to adenocarcinoma arising from the right upper lobe bronchus (a) Posteroanterior radiograph shows a large opacity with a sharp lateral margin Since the trachea is slightly displaced to the left, a mediastinal mass may be considered Note elevation of the right hemidiaphragm (b) CT demonstrates the atelectatic right upper lobe adjacent to the mediastinum The right main bronchus is stenotic due to tumour invasion

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• Figure 9 61-year-old woman with combined right middle and lower lobe atelectasis due to bronchial tuberculosis (a) Posteroanterior radiograph shows

a mass-like opacity with a sharp margin lateral to the right cardiac border (arrow) The right hilum is small and inferiorly displaced (b) CT clearly demonstrates marked atelectasis of the right middle lobe (arrow) and right lower lobe (arrowhead) with dilated bronchi containing mucus

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• Figure 8 40-year-old woman with combined right middle and lower lobe atelectasis due to bronchial tuberculosis (a) Posteroanterior radiograph shows a mass-like opacity with a convex lateral margin A thymoma was suspected as the patient had been suffering from myasthenia gravis (b) CT clearly demonstrates atelectatic right middle lobe (arrow) and right lower lobe (arrowhead) with dilated bronchi containing mucus Bronchial tuberculosis was confirmed at right middle and lower lobe

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• Figure 10 70-year-old man with right upper lobe atelectasis associated with lung torsion due to squamous cell carcinoma (a) Posteroanterior radiograph shows a mass-like opacity with sharp lateral margin overlying the right hilum (b) Anterior location and sharp outer margin of the atelectatic lobe are demonstrated on the lateral radiograph (c) Note that the atelectatic lobe migrates with change in the patient's position, as seen on CT scout view (d) The atelectatic right upper lobe is located posteriorly on axial CT in the supine position (Courtesy of Yasuyuki Kurihara,

MD, St Marianna University, School of Medicine, Kawasaki-shi, Japan.)

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• Figure 10 70-year-old man with right upper lobe atelectasis associated with lung torsion due to squamous cell carcinoma (a)

Posteroanterior radiograph shows a like opacity with sharp lateral margin overlying the right hilum (b) Anterior location and sharp outer margin of the atelectatic lobe are demonstrated on the lateral radiograph (c) Note that the atelectatic lobe migrates with change in the patient's position, as seen on CT scout view (d) The atelectatic right upper lobe is located posteriorly on axial CT in the supine

mass-position (Courtesy of Yasuyuki Kurihara,

MD, St Marianna University, School of Medicine, Kawasaki

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• Figure 13 7-year-old girl with right upper lobe atelectasis associated with localized pneumothorax The patient had congenital hypertrophic cardiomyopathy

Anteroposterior radiograph shows a localized pneumothorax adjacent to the atelectatic

right upper lobe, "pneumothorax ex vacuo"

Note that the pneumothorax is bounded by the outline of the atelectatic upper lobe (arrowheads)

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