Lung collapse (Fig.

2a)
- The lack of air within collapsed
right upper lobe accounts for the
increase in radiographic density.
The well-demarcated lateral border
represents the elevated horizontal
fi ssure.
- The focal bulge at the apex of the
collapsed right upper lobe
corresponds to the centrally
located bronchogenic carcinoma
causing the lobar collapse. The
combined radiologic appearance on
frontal radiograph is known as
Golden S sign.
- The hyperinfl ation and elevated
right hemidiaphragm are due to
volume loss.
Discussion
- Other radiologic features of right
upper lobe collapse not seen on
this chest radiograph include:
1. Crowding of ribs in right upper
chest wall due to underlying
lung volume loss
2. Tracheal deviation to the right
due to traction from the
collapsed lung
- Lobar collapse in different lobes
gives characteristic radiographic
appearances on frontal and lateral
radiographs (Fig. 2b, c, d).
- In general, lobar collapse represents
obstruction to the corresponding
lobar bronchus. The underlying
etiology may be classifi ed as:
1. Intraluminal obstruction
(e.g. mucus plug / foreign body)
2. Intramural obstruction
(e.g. bronchogenic carcinoma)
3. Extramural obstruction
(e.g. extrinsic compression by
enlarged hilar lymph nodes)
- Recognition of lobar collapse is
important, especially in elderly
patients, as this may be the only
radiologic feature of primary lung
carcinoma. Further evaluation by
sputum cytology, bronchoscopy or
CT scan is necessary.