Left upper lobe collapsed

   June 24, 2021  Posted in Chest, Tumour

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 16 years old girl, no known medical illness
  • Presented with neck swelling for 3 months
  • Associated with cough and weight loss about 6 kg
  • Noted a palpable lesion at the sternum area
Chest radiograph PA erect view

Findings of chest radiograph:

  • A veil-like opacity of the left hemithorax
  • The pulmonary markings are not obscured
  • Left mediastinum and cardiac margin are not visualized
  • Left hemidiaphragm outline is also obscured
  • No tracheal or mediastinum shift. No air bronchogram sign
  • Right hilum is normal. Left hilum is not seen.
  • No rib lesion is seen
Ultrasound of neck and sternal mass

Ultrasound findings:

  • There are multiple enlarged nodes at upper part of left cervical and supraclavicular region. The largest lesion is measuring 1.9 x 2.1 cm (AP x W).
  • Another heterogeneous lesion is detected at the left anterior chest wall measuring 1.4 x 2.8 cm (AP x W).
  • No calcification seen within these lesions.
  • No cystic lesion seen within to suggest area of necrosis.
Contrast enhanced CT scan thorax in axial lung and soft tissue windows

CT scan findings:

  • Collapsed consolidation of left upper lobe (red arrows). Multiple hypodense lesions are seen within the collapsed left lung.
  • Multiple lung nodules are seen scattered throughout both lungs.
  • Associated left pleural effusion is also seen.
  • There is enlarged lobulated enhancing lesion is seen at left supraclavicular region measuring 4.1 x 5.9 x 5.7 cm (AP x W x CC). Central hypodensity is observed in keeping with central necrosis. The lesion is seen displaced the left thyroid lobe medially. No clear margin observed with the surrounding neck muscles.
  • Multiple enlarged cervical nodes also seen

Progress of patient:

  • Biopsy done under ultrasound guidance shows Hodgkin lumphoma
  • CT scan shows Stage IVb Hodgkin lymphoma
  • On chemotherapy

Discussion:

  • Left upper lobe collapse can present with a ‘veil-like’ opacity of the left lung field.
  • This is because the left upper lobe collapses anteriorly becoming a sheet of tissue apposed to the anterior chest wall and appears as a hazy or veiling opacity extending out from the left hilum and fading out inferiorly.
  • Part of the cardiac and mediastinal outline can be obscured if lingular segments are involved. Part of the aortic arch are also often obscured.
  • Other signs of left upper lobe collapsed include:
    • elevation of the hemidiaphragm
    • ‘peaked’ or ‘tented’ hemidiaphragm
    • crowding of the left ribs
    • shift of the mediastinum to the left
    • posterior and left lateral rotation of the heart
Author: radhianahassan