Chest Imaging

Cicatrization atelectasis

atelectasis caused by scarring and fibrosis resulting from long-standing inflammatory disease. Atelectasis may also be identified in a nonanatomical distribution in patients with radiation fibrosis and more diffusely in patients with interstitial pulmonary fibrosis. Cicatrization atelectasis may be distinguished from obstructive atelectasis on the basis of two major criteria:

  • no endobronchial obstruction is visible on a CT scan; and

  • inflammatory changes are depicted in the bronchi located within the affected areas. These changes include airway irregularity, narrowing or distorsion. Bronchiectasis is frequently present (Fig.1). In addition, lobar bronchi may be displaced to a far greater degree than that typically seen in patients with obstructive atelectasis, and the degree of volume loss is generally more marked. Mediastinal lymph node calcification more or less associated with punctuate parenchymal calcifications is frequently visible.

    Although usually lobar or segmental in distribution, cicatrization atelectasis may also result in the destruction and shrinkage of an entire lung.

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    Fig.1

    Post-tuberculous cicatrization atelectasis of the upper part of the left upper lobe. a. PA chest radiograph showing an elevation of the left hilum due to loss of volume of the left upper lobe. Linear opacities in the upper part of the lung suggest fibrotic scarring and bronchiectasis. b. CT scans revealing dilated bronchi that are crowded within the collapsed culmen (bronchiectasis). There are also linear scarring opacities and paraseptal emphysema.
    Cicatrization atelectasis, Fig.1 (a)
    Cicatrization atelectasis, Fig.1 (b)