Multi-lobar Collapse

Introduction

Multilobar collapse can produce confusing patterns on chest X-ray images. This page considers patterns of multilobar collapse.

Combined RML and RLL collapse

source: Paul Stark (MD)

This uncommon combination can produce a confusing plain film appearance. The cause of the collapse often involves tumour compression of the bronchus intermedius. Loss of visualisation of the right hemidiaphragm and right heart border requires consideration of a combined RML and RLL collapse. There is loss of visualisation of the right hemidiaphragm and right heart border suggestion RLL and RML disease respectively. The oblique fissure is demonstrated in a collapsed position (black arrow) and the horizontal fissure as similarly seen in a collapsed position (white arrow)

Case 1

This is an AP erect bedside chest X-ray image. There is right basal pathology. Is this a raised right hemidiaphragm? This appearance is typical of combined RML and RLL collapse. There is loss of visualisation of the right heart border and right hemidiaphragm. What might be mistaken for the right hemidiaphragm is the superior aspect of the oblique fissure. Combined RML and RLL collapse is associated with bronchial obstruction by tumour. This is consistent with the patients known history of disseminated cancer.

Previous chest X-ray image demonstrates normal right heart border and right hemidiaphragm.

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