Left upper lobe collapse in the exam

Getting a film with left upper lobe collapse in the exam is one of the many exam set-pieces that can be prepared for.

This frontal chest radiograph shows a hazy (or veil-like*) opacification of the left hemithorax that is associated with superior displacement left hilum and horizontal left mainstem bronchus. The lateral border of the aortic arch is well defined by air (Luftsichel sign) and there is tenting of the hemidiaphragm. There is loss of the left superior mediastinal and left heart border interfaces (silhouette sign).

In my practice I always perform a lateral film, which shows increased retrosternal opacification, anterior displacement of the oblique (major) fissure anteriorly and the left lower lobe is hyperexpanded.

There is an associated hilar mass which may be malignant. I would contact the GP to arrange an urgent bronchoscopic biopsy and staging CT. Look for pulmonary and bony metastases and ask for old films to demonstrate serial enlargement of the hilar mass.

* some examiners feel that "veil-like opacification" should only be used to describe a pleural effusion!

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Article information

rID: 22513
System: Chest
Section: Approach
Synonyms or Alternate Spellings:

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