Types of atelectasis occupational lung disease-comet tail sign
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Transcript of Types of atelectasis occupational lung disease-comet tail sign
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
1. Types of Atelectasis
2. Occupational lung disease
3. Comet tail sign
2
Topic Outline
1. Types of Atelectasis2. Occupational lung disease3. Comet tail sign
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Types of Atelectasis
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Definition of Atelectasis
• The loss of air in the alveoli• Alveoli devoid of air (not
replaced)
Muller, NL, Fraser, RS, Colman, NC, et al. Radiologic diagnosis of diseases of the chest. Saunders, Philadelphia, 2001.
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Types of Atelectasis
Obstructive
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Types of Atelectasis
Obstructive
No obstructive
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Obstructive Atelectasis
Atelectasis Right Upper Lobe
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Types of Atelectasis
Obstructive
No obstructive
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No obstructive
Relaxation
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Relaxation Atelectasis / Mechanical Atelectasis
Massive right pneumothorax
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No obstructive
Relaxation
Compressive
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Compressive Atelectasis
Chest wall masses
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Compressive Atelectasis
Chest wall masses
Pleural masses
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Compressive Atelectasis
Chest wall masses
Pleural masses
Loculated collections of pleural fluid
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Compressive Atelectasis
Chest wall masses
Pleural masses
Loculated collections of pleural fluid
Intraparenchymal masses
Lead to a diminution in lung volume below the usual resting volume
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Compressive Atelectasis
Posterior
Loculated
collections
of pleural fluid
Courtesy of Paul Stark, MD.
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Compressive Atelectasis
Posterior
Loculated
collections
of pleural fluid
Compressed
right lowe
r lobe
Courtesy of Paul Stark, MD.
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No obstructive
Relaxation
Compressive
Adhesive
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Qualitative or
quantitative
surfactant
abnormalities
Adhesive Atelectasis
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Qualitative or
quantitative
surfactant
abnormalities
Alveolar
collapse
Adhesive Atelectasis
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Qualitative
or quantitative surfactant
abnormaliti
es
Alveolar collaps
e
Reduce
the ventilation
-perfusion ratio
Adhesive Atelectasis
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Adhesive AtelectasisARDS is an example of diffuse
alveolar atelectasis
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No obstructiveRelaxation
Compressive
Adhesive
Replacement
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Replacement Atelectasis
• Occurs when the alveoli of an entire lobe are filled by tumor
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Replacement AtelectasisBronchioloalveolar Cell
Carcinoma
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No obstructive
Relaxation
Compressive
Adhesive
Replacement
Cicatrization
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Cicatrization Atelectasis
• Results from diminution of volume as a sequel of severe parenchymal scarring
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Granulomatous disease
TB Sarcoidosis
Necrotizing pneumonia Radiation
Cicatrization Atelectasis
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Cicatrization Atelectasis
Silicosis
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Cicatrization Atelectasis
Silicosis
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No obstructive
Relaxation
Compressive
Adhesive
Replacement
Cicatrization
Rounded
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Types of Atelectasis
Obstructive
No obstructive
Relaxation
Compressive
Adhesive
Replacement
Cicatrization
Rounded
Occupational lung disease
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Occupational lung disease
Inhalation or Ingestion
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Occupational lung disease
Inhalation or Ingestion
• Dust particles• Noxious chemicals
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• Pneumoconiosis• Chemical pneumonitis• Occupational infection• Hypersensitivity pneumonitis• Organic dust toxic syndrome
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PneumoconiosisSilicosis
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PneumoconiosisSilicosis
Asbestosis
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PneumoconiosisSilicosis
Asbestosis
Berylliosis
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PneumoconiosisSilicosis
Asbestosis
Berylliosis
Foreign body granulomatosisTalc
Cellulose and starch
Cotton-wool fibers
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Chemical pneumonitis
• The term chemical pneumonitis refers to the aspiration of substances that are toxic to the lower airways, independent of bacterial infection.
• Mendelson's syndrome.
Mendelson, CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52:191.
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Occupational infection
• Viral and Bacterial infections at health workers
• Parasitic infections : Echinococcus disease
Comet tail sign
Comets
Comets are made up of ice and dust
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Comets
• The center of a comet is called a nucleus and is the only part that is solid.
• It is made from ice, rock and dust
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Comets
• Usually a comet has 2 tails, a white or yellow dust tail and a blue gas tail.
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Rounded Atelectasis
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Rounded Atelectasis
Historically called
folded lung syndrome
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Rounded Atelectasis
Historically called
folded lung syndrome
helical atelectasis
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Rounded Atelectasis
Historically called
folded lung syndrome
helical atelectasis
Blesovsky syndrome
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Rounded Atelectasis
Historically called
folded lung syndrome
helical atelectasis
Blesovsky syndrome
pleural pseudotumor
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Rounded Atelectasis
Historically called
folded lung syndrome
helical atelectasis
Blesovsky syndrome
pleural pseudotumor
Pleuroma
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Rounded Atelectasis
Usually located inPosterior and lower
zonesLingula
Right middle
lobe
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Rounded Atelectasis
• It presents as a subpleural mass
• Segmental or subsegmental atelectasis
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Rounded Atelectasis
Generally in association with pleural disease :
1. pleural plaque2. pleural
thickening 3. Or a currently
present or resolving pleural effusion.
Comet tail
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Staples CA. Computed tomography in the evaluation of benign asbestos-related disorders. Radiol Clin North Am 1992; 30:1191-1207 / Lynch DA, Gamsu G, Ray CS, Aberle DR. Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans.Radiology 1988; 169:603-607.
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Comet tail
Bronchovascular bundles (Bronchi and
blood vessels)
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Comet tail
Bronchovascular bundles (Bronchi and
blood vessels) as they enter
the atelectatic
lung parenchyma
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Comet tail
Bronchovascular bundles (Bronchi and
blood vessels ) as they enter
the atelectatic
lung parenchyma that extend
from the lower border of the mass to the hilum
Rounded Atelectasis
• All rounded atelectasis is actually round.
60Lynch DA, Gamsu G, Ray CS, Aberle DR. Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans.Radiology 1988; 169:603-607.
Rounded Atelectasis / Atypical features
Wedge-shapedLentiformOr (less often) irregular opacities or
attenuation
61Batra P, Brown K, Hayashi K, Mori M. Rounded atelectasis. J Thorac Imaging 1996; 11:187-197.
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Rounded Atelectasis
• Volume loss of the affected lobe is uniformly present
• Often with hyperlucency of the adjacent lung.• Serial examination usually shows a stable
appearance
Batra P, Brown K, Hayashi K, Mori M. Rounded atelectasis. J Thorac Imaging 1996; 11:187-197.
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Approximately 70 % of cases are associated with:
Previous Asbestos exposure
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Approximately 70 % of cases are associated with:
Previous Asbestos exposure
Pleural Tuberculosis
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Can
Persist for years
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Can
Persist for years
Clear spontaneously
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Can
Persist for years
Clear spontaneously
Grow rarely
Rounded atelectasis in the right lung
A nodular mass in the right mid-lung (long arrow).
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Rounded atelectasis in the right lung
A tail-like connection is seen between the mass and the hilum (short arrow).
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CT scan of rounded atelectasis in the right lower lobe
A subpleural mass in the right lower lobe with tentacle-like extensions towards the hilum (arrow)
Comet tail signBronchovascular bundles (Red arrows)
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What is your diagnosis ?
Klebsiella pneumonia74
• Sequential 2-mm, nonenhanced CT scans
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• Bronchovascular bundles (solid
arrow) appear to be pulled into the mass in a curvilinear fashion
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• Pleural thickening (arrowhead) is present
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• The major fissure (open arrow) is displaced posteriorly owing to the volume loss in the right lower lobe
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CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner).
Transverse CT scans obtained with 10-mm collimation.http://radiology.rsna.org/content/236/2/685/F8.expansion.html
80
CT scans and autopsy findings in an 86-year-old man with silicosis (former metal ore miner).
Lung window scan shows a rounded opacity in the right lower lobe. http://radiology.rsna.org/content/236/2/685/F8.expansion.html
81
CT scans and autopsy findings in an 86-year-old man with silicosis (former metal
ore miner).
Lung volume is reduced
http://radiology.rsna.org/content/236/2/685/F8.expansion.html
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CT scans and autopsy findings in an 86-year-old man with silicosis (former metal
ore miner)
The major fissure is displaced (arrows)http://radiology.rsna.org/content/236/2/685/F8.expansion.html
Mediastinal window scan at the same level as in a shows a thickened band (arrow) that connects Progressive Massive Fibrosis (PMF) with the thickened pleura.
http://radiology.rsna.org/content/236/2/685/F9.expansion.html
There is a small amount of ipsilateral pleural effusion and multiple calcifications in the PMF
http://radiology.rsna.org/content/236/2/685/F9.expansion.html
Rounded Atelectasis / Silicosis
• Gross lung specimen from a coronal section shows diffuse pleural thickening in the right lung base and invagination (arrow) into the mass
http://radiology.rsna.org/content/236/2/685/F10.expansion.html
Elastic-Goldner stain, original size / Silicosis
• Silicotic nodules forming the mass (Blue color)
• Interstitial fibrosis and atelectasis (Black color)
• Thickened pleura (arrows) (Blue color)
http://radiology.rsna.org/content/236/2/685/F11.expansion.html
A 50-year-old man with asbestos exposure from working in a brake lining production plant
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Asbestosis
• Chest radiograph shows:• Diffuse thickening of
the left pleura• Curvilinear band
opacities in the left lower lung zone
88http://radiographics.rsna.org/content/21/6/1371/F16.expansion.html
High-resolution CT scan (mediastinal windowing) /Asbestosis
• pleural plaques on the right side (small white arrows)
89http://radiographics.rsna.org/content/21/6/1371/F17.expansion.html
High-resolution CT scan (mediastinal windowing) /Asbestosis
• Rounded atelectas on the left side (large white arrow)
90http://radiographics.rsna.org/content/21/6/1371/F17.expansion.html
High-resolution CT scan (mediastinal windowing) /Asbestosis
• Diffuse pleural thickening (black
arrows) on the left side.
91http://radiographics.rsna.org/content/21/6/1371/F17.expansion.html
High-resolution CT scan (mediastinal windowing) /Asbestosis
• Pleural plaques along the diaphragmatic contour (black arrows)
92http://radiographics.rsna.org/content/21/6/1371/F18.expansion.html
High-resolution CT scan (mediastinal windowing) /Asbestosis
• An irregular attenuation pattern, which is typical in rounded atelectasis (white
arrows).
http://radiographics.rsna.org/content/21/6/1371/F18.expansion.html
High-resolution CT scan (lung windowing) obtained at the level of the liver dome /Asbestosis
• A visceral pleural plaque in the right major fissure (arrow)
http://radiographics.rsna.org/content/21/6/1371/F19.expansion.html
High-resolution CT scan (lung windowing) obtained at the level of the liver dome /Asbestosis
• Curvilinear bands of hyperattenuation in the posterior subpleural area
http://radiographics.rsna.org/content/21/6/1371/F19.expansion.html
High-resolution CT scan (lung windowing) obtained at the level of the liver dome /Asbestosis
• Rounded atelectasis + posterior displacement of the left major fissure.
http://radiographics.rsna.org/content/21/6/1371/F19.expansion.html
High-resolution CT scan (lung windowing) obtained at the level of the liver dome /Asbestosis
• The diagnosis of asbestosis was proved at open lung biopsy
http://radiographics.rsna.org/content/21/6/1371/F19.expansion.html