March 29, 2013

Image of the Day 15: Total Right Lung Collapse

6 years old girl, non Malaysian, non immunized, previously healthy presented with fever with chills and rigor X 2/52, cough and fever X 2/52, and worsening of rapid breathing.


1) Outline your finding in this chest x ray
2) What is your radiological impression?
3) Differential diagnosis
4) Possible aetiologies for your diagnosis
5) What other imaging you would like to do to confirm your diagnosis
6) Outline your management.


1) Chest X Ray finding

- Right lung field homogenous opacities with obliteration of cardiophrenic and costophrenic angle
- Right trachea deviation
- Crowded right ribs
- Loss of cardiac silhouette with heart and mediastinal shifted to the right side
- Compensatory hyper inflated left lung with widening of ribs.

2) Radiological Impression
Total Right lung collapse

3) Differential diagnosis
- Massive pleural effusion with lung collapse
- History of pneumonectomy

4) Possible aetiology for (2)
-Bronchitis obliterans secondary to post lung infection
- Pulmonary tuberculosis
-Infection by Haemophilus influenza, Moraxella cattharalis, Mycoplasma pneumoniae
- Associated with Steven Johnson Syndrome
- Hypogammaglobulinemia

Other causes (uncommon in pediatric population)
- Any obstruction of main stem bronchus - carcinoma, intrabronchial blood clot secondary to pulmonary infarction and others.
- Aspergillosis
- Parasitic infection like Paragonimus westermani.
- Connective tissue disease/ collagen vascular disease
- Anthracosis, Asbestosis, Silicosis

5) Diagnostic imaging
- Bronchoscopy
- CT Thorax
 -Ventilation-perfusions scan

6) Management
- Bronchoscopy and removal of obstruction
-antibiotic therapy
- Chest physiotherapy
-Oxygen therapy

Surgical - Pneumonectomy


1. Govaere et al, "Massive lung collapse with partial resolution after several years: a case report", BMC Pediatric, 2005

2. S Aithan, J Khan & M Bazarbashi, "Total lung collapse after pulmonary infarction", Thorax. 1994 September; 49(9): 938–939.

3. "Total Collapse of lung",

4. R H Ellis, "Total Collapse of the lung in Aspergillosis", Thorax 1965

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