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IRIA Kerala in association with IRIA Thiruvalla presents- Chest X-ray- Lobar Collapse

May 23 | 2:00 PM

IRIA Kerala-Thiruvalla City Chapter brings to you a very interesting session on Chest X-ray- Lobar Collapse. Dr. Sarath will be talking about how to identify collapse on a chest X-ray and the signs of the collapse of a particular lobe with the help of some case presentations. Let us brush up on some fantastic concepts and discover some new ones. Join now!

[Music] so a good evening everyone i am dr tanvi and i welcome you all on the behalf of netflix team today we are gathered here for a very interesting session by iria kerala sitting chapter thiruvala and to introduce the session in the speaker i invite dr rashford to take over and take it forward so dr ashwin please go ahead thank you thank you it's always a great pleasure to introduce her for a speech and a speaker who you know for more than a decade so it's a great privilege to introduce dr babu he has been my undergraduate classmate um you know and then we have had the pleasure to be introduced again as a radiologist both together and even in the same hometown uh so dr sharat has his alma mater from moac medical college and his diploma in bethel mana and he has been working in his hospital for the past seven years and currently he's serving as the hod of his radiology unit so without much further ado dr shah would you like to start your presentation [Music] hey good evening i'm dr sarah and today i'm covering these parliamentary global collapse okay um the word collapse and atelectasis are used as synonymously um collapse is used mainly in the uk and i collect words like this is used in the usa the word catholic thesis comes from the great word where the atlas means incomplete and ecstasys means expansion so the word meaning of catalyticism is incomplete expansion collapse is the loss of air in a part of lung leading to organ loss coming to the causes uh eclectuses can be divided based on the extras extend into sub segmental subglobal there are mainly three causes of athletic diseases they are the compressive or passive obstructive or esophageal and secretization of fibrosis and there is also fourth diet which is known as the rdc types of metallic basis which is uh cnunx due to suffocating deficiency the examples for compressive or passive type of catalytics are plural collection of pleural fluid pneumothorax and artisan intrapulmonary space occupying lesions the process of obstacle or resulting type of catalytic bases include tumors mucous plaques and foreign bodies then the secretization or the fibrotic type of metallic pieces seen in mainly departmental tuberculosis post radiation fiber post radiation fibrosis coming into the mechanism and causes of lower collapse the uh lava causes the causes can be an intercontinental obstruction or not an undergrounding obstruction the endocrine obstruction can be divided into intrinsic and extrinsic causes the intrinsic causes include tumors granulomatous disease miscellaneous causes like a protein body or a mucous blood the extrinsic causes include hydra or mediastinal lymphadenopathy mediastinal mass fibrosis mediastinitis and vascular compression coming to the not endobronical obstruction the causes include pleural effusion pneumothorax intrapulmonary space occupying the action and radiotherapy coming to the cardinal radiography features the collapse segment will appear as an increased opacity a residual appears as a white cloud area with a sharply defined borders and without air programs then there will be features of volume loss coming to the earlier notes there are direct signs and indirect signs the direct signs include displacement of an interlob of fissures displacement of parliamentary vessels and displacement of bronchitis these are the direct signs the indirect signs include complexity hyperinflation of the adjacent lobes the crowding of ribs mediational shift and elevation of the diaphragm coming to a little bit of anatomy the right lung has three lobes they are the right upper left right middle left and right lower low right right lung has two fissures there the horizontal fissure and the oblique fissure the horizontal pressure separates the right upper lobe from the right middle lock this is the diagrammatic representation of a horizontal pressure horizontal fissure is seen in one uh 67 percent of cases on a frontal chest sexy the horizontal features looks uh appears as a horizontal line extending from the periphery towards the hiala and this is uh seen approximately at the level of anterior aspect of right fourth rate okay a then there is a oblique feature there is a lateral diagrammatic representation this is the oblique fissure superiorly it separates the right upper lobe from the right lower low and inferiorly it separates the right middle law from the right lower law the approximate location of the horizontal pressure is on a lateral radiograph is it is um reaches almost up to the anterior aspect of costophrenic ankle coming to the left lung left lung has two lobes they are the upper and lower lobes plus lung has only one fissure oblique fissure or the major fissure it separates the left upper and lower lobes the approximate location of the oblique pressure on a lateral radiograph is it is five centimeter posterior to anterior aspect of the electric hostophrenic ankle then coming to the hila the majority of the highla is uh produced by the parliamentary vice president mainly the parliamentary arteries the um you can the the level of pulmonary arteries on both sides will appear like the little fingers you have to keep that in mind these are the level of parliamentary arteries diagrammatic representation they will look like the little fingers in case of collapse the displacement of the interlob of fissures they displace towards the collapsing block and they will appear as a triangular or pyramidal in shape with effects towards the higher coming to the displacement of vessels and bronchi there will be crowding in the first permanent vessels and cronkite collapse law alterations in the positions of the alkyla the high alarm will be elevated in case of upper lobe collage on a frontal chest x-ray the hila will be small in size in case of lower low collapse and in middle of collapse there will be no change in position of the hilar coming to the high bronchial alterations they will be horizontally oriented in case of an upper lobe collapse and they will be vertically oriented in case of level of collapse they come coming to the indirect signs the compensatory hyperinflation of the artisan lobes there will be uh the um rest of the lobes will appear um increase radial losses that is they will appear darker they will be widely separated from positive vessels within the hyperinflated block they will have divergent vascular re-intuition near the phylum and there will be displacement of the anti-rejection line posterior tension strain line i'll say the esophageal lines this is secondary to hyperinflation then there is a shifting granuloma sign that is the changing position of the lung region that was previously seen on a just x-ray this is due to the collapse the position will change then there is lubrication sign this is seen in the left upper lobe collapse i will come into the later then there will be hyperloosen ideomedia system on a lateral stress text line this is a diagrammatic representation of the right upper lobe products you can see that this is the horizontal pressure it is uh limiting the right upper lower thoracic area will be white now and there will be complexity hyperinflation of the right middle and lower low they will appear darker and on a zoomed up view there will be wide the um there will be positive results this is a uh lattice radiograph of a left upper low product this you can see the this is the oblique feature on a larger radical you can see it you can see the location of the granuloma here and the media scanner shift will be released with the middle of colors and it is created with the level of colors on upper lip colors there will be greatest increases of chronic collapse elevation of heavy diaphragm uh it will be most commonly seen in left couple of collapse than in right upper glove color and this is less uh useful sign uh then there is a dystrophic peak sign this is like just a friend sweet sign this is a candy of diaphragm seed in places of leftover colors coming to right couple of colors on a frontal chest a little radiograph you will see an increased density at the effects of the right hemithorax with the elevated horizontal pressure giving rise a concave inferior outline in very severe class this brings the horizontal pressure almost parallel to the mediastinum if the mass is at the highland you will see a golden s sign or reverse s sign of golden on a lateral radiograph you will see a horizontal and oblique pressure approximately actually approximate and displace superiorly and medially there will be a superiorly defined weight shaped density these are some of the examples there's a frontal chest area of skeleton emulsification here you can see well different radio opacity involving the right upper zone with a well-defined lower margin this is a displaced horizontal t-shirt here you can see the um highland the usually the left high alarm will be higher than the right highland this is because the um left main parliamentary artery goes above the left male crosses the right highland will be a slightly lower position than the left thylam normally what you have to remember is uh in five percent of the cases the uh left hand right hyaluron will be at the uh corresponding position but the right hand will never go above the left side here you can see this is the normal position of the left highland here you can see the right half is in a higher position and there is a opacity here this is a case of another taser right upper lip color here you can see a well different radio opacity in the right effects you can see the pulled up right highland and there is a uh there is a elevated right handed diaphragm the truck is shifted towards the right side and there is pilot elevation this is another case of right upper low collapse here you can see the elevator right thailand and this is the crown case which is appearing as a right parameter this is the golden s sign which i was talking about the mass is at the sorry this is the masses at the level of hyaluronic you can see a golden s sign and this is the lateral radiograph of a light couple of color you can see here there is a wedge-like capacity superiorly and it is seen antedidated to the oblique the collapse segment will see as a triangular density with base anteriorly against the chest wall and effects at the column next is leftover color this is extremely unique because there is um there is no horizontal pressure on the left lung they all know this mainly anteriorly and medially damped superiorly on a frontal system this will appear like a weighing like increased density of the electric hemichords it is greater than the highland and gradually equates outwards there will be no loss of normal seal out of the left heart border and there will be elevated left xylem then you can see a luxurious sign this is a crescent occlusion tree around the left side of the iot custom this is caused by the hyperinflated epical segment of the left lower lobe which is causing the neutral side it's a diagrammatic representation of the left upper lobe collapse here you can see a very light capacity involving the left lung and it has got independent heart border here you cannot see the left heart border there is a frontal radiation skeleton situation and here you can see a weight like capacity of the left lung there is observation of the left heart border and here you can see the left sorry here you can see the iot knuckle foreign of the azianine iota ct will be looks similar to right upper lower collar which will look like an angular opacity basically this is again a diagrammatic representation of the left upper here you can see the anteriorly displaced oblique pressure and there is an increased ritual looseness this is a retrospeciency on ct this will look like a triangular density as you can see in case of a right upper lobe collapse if there is a sub lobe of collapse of left appalachia which is firing of the lingual section it will make me look like a right upper low product with an interior concave outline this is the case of a typical left couple of columns here you can see an opacity involving the left upper zone and the ct will show the triangular density if there is an isolated collapse of legular segment this will mimic a right middle of collapse the frontal cystic radiograph will show loss of clarity of the left heart order this is a case of a lingula color here you can see there is a um loss of clarity of the left heart border and the left handy diaphragm is elevated this is a lot of radical here you can see a bed shaped opacity in the retrograde position coming to right middle of colors this is best seen on a lateral radiator they hear the horizontal fissures moves interiorly and medially there will be loss of seal out of the right hard water the variable increase intensity will be c if the collapse is parallel to the beam their triangular sail there is a diagrammatic representation of the right middle of collapse there will be blurring of the right heart border what you have to remember is there won't be um much shift of the high alarm the highland will be in the normal position there's a stereograph of a skeletal multiplication who has got a right middle of color here you can see this is the right uh level of permanent artery which is in the normal position here you can see an opacity which is obscuring the uh right heart border and this is the another case of the right middle of color here you can see a triangular shape opacity which is obscuring the right heart border on a lateral radiograph there will be approximation of the minor and inferior portion of the major fissure there will be a triangular density over like the heart shadow in severe cases there will be a thing with shape density with the fishes becoming almost parallel on ct you will see a triangular density adjacent to the heart border this is a diagrammatic representation of a right middle of color here you can see the approximation of the horizontal and the oblique fissures and this is the uh this is the triangular density which is overlying the part this is a case of a right middle of column lateral radiograph here you can see the triangle shape opacity which is overlapping cardiac is allowed this is a ct which is showing a right middle of color which is complicated coming to the right and left level of colors there will be poster medial displacement of the oblique fissures on a frontal radiograph this will look like a triangular density superimposed over the heart there will be observations in needle portion of the hemi diaphragm there will be non-visualizing direction superior triangle sign will be seen in cases of right level of color and plus flat waste time will be seen in cases of left level of collapse these are the diagrammatic representation of the level of columns here you can see there is a triangular density which is and which will obscure the right level of parametric artery the right and left and overlapping artists will look like a little fingers and they won't be seen in cases of level of collapse there is a diagrammatic representation of the left level of clutch here you can see the straight line capacity which is still in the retrograde position and there will be observation of the left level of parliamentary arteries here this is a case of right overload collapse here you can see a triangle shaped opacity in the right lobe zone which is overlapping the left uh sorry right hard border but you can clearly see the right hard borders and you cannot see the right level of parliamentary artery this is the left level of parliamentarity here you can clearly see the left level of permanent reaction here you cannot see the right level of parliamentary artery this is a frontal radiograph in cases of a left level of collapse here you can see the triangular density which is overlying the um cardiac margin and you cannot see the um left level of permatease here here you can see the right level of pulmonary the this is a superior triangle sign which is seen in cases of right level of collapse on a lateral radiograph there will be progressively denser vertical column interiorly will also seal out of the posterior hemi diaphragm and in severe cases this alert may reappear due to hyperinflation of the afterloads on ct this will appear as a triangular density seeing draping over the iota this is a diagrammatic representation of the left level of class there will be positively displaced obliques the increased density overlapping the vertical column and there will be losses a lot of posterior aspects of left hemisphere this is a case of a right level of collapse here you can see the increased density overlaying the lower aspect of vertical column this is the portion on its ct axis section here you can see the poster medial displacement of the public pressure in cases of combined right middle low and right level of colors there will be a triangular density which will extend to the c3 angle on a frontal structural radiograph there will be losses a lot of the hemi diaphragm and loss of cardiac border here you can see this is the frontal testosterone skeletally maturation here you can see the loss of the heart border and there is a triangular density which is obscuring the left hemi diaphragm and you cannot see the uh left sorry right level of armatary artery this is a lateral radiograph here you can see an increased density overlaying the lower lower vertebrae and also losses a lot of the right hemi diaphragm when there is a hole in color there will be complete opacification of the hemispherics there will be compensated hyperinflation of the contralateral lung there will be displacement of the mediation structures and crowding on crowding of the ribs on the upper side this is a case of complete collapse of left lane here you can see the triangle shift towards the left lung and this is the compensating hyperinflation of the right lung and on a lateral system there will be acceleration of retrospec this is the uh accentuated retrospective left total nephron collapse i coming to the end of my presentation i will show you some examples this is a case of a left couple of collapse here you can see the tractor shifted towards the left side there is a weight like opacity which is uh with the elevation of the left head highland and this there is visible visualization of the iot knuckle which is known as the loop system sign this is a case of left level of collage here you can see a neutral cardiac opacity you cannot see the left level of parliamentary artery this is a case of a right middle of collapse here you can see a triangular opacity in the right lower zone with obscuration of the right heart border this is a lateral radiograph yes you can see a triangular opacity overlapping okay this is a case of a right overlap collapse this here you can see the patient has got attractors to the cube that's got an ng tube some surgical clips here and there is an icd21 left side here you can see a triangle shaped opacity involving the right lobazone with the observation of the right hemi diaphragm you cannot see the right level of pulmonary artery here you can clearly see the right cardiac margin which is the case of right level of collapse this is a case of a right couple of collapse here you can see a well-defined radio opacity involving the right arbor zone with an well-defined inferior margin horizontal fissure the right highland is elevated you can compare it to the left side you can you can see the left highland here the right column is elevated and i have taken most of the presentation from the uh district trail server guide is a very good book if you have time please go through it thank you if you have any queries you can ask yeah dr that was a very lucid presentation uh interpreting a chess text is actually the first thing we learn in radiology but still uh it's it's i think the most difficult thing to do often we are intrigued by a chest x-ray and it's not unusual that we end in surprises so that was a very lucid presentation with very good cases i hope we get some queries from the audience so uh the uh there are no questions asked from the audience right now if you have something to ask for dr sarath you can ask yeah actually it was a she covered almost everything great then uh it was a very interesting session by dr sarah and we are thankful uh that he came uh on our platform and he talked about the chess lower x-ray and uh i thank you irie as well for this wonderful session that they have done for us and uh we are getting comments and the comments are mostly that you know the session was very knowledgeable and you know the presentation was very nice and self-explanatory so there are people on the platform that are praising the presentation as well so we thank you dr sarah on the behalf of the viewers and netflix as well

BEING ATTENDED BY

Dr. SHUJAUT FAROOQ & 475 others

SPEAKERS

dr. Ramesh Shenoy

Dr. Ramesh Shenoy

Consultant Radiologist | Kochi

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dr. Venugopal M

Dr. Venugopal M

Consultant Radiologist

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dr. Ramesh Shenoy

Dr. Ramesh Shenoy

Consultant Radiologist | Kochi

+ Details
dr. Venugopal M

Dr. Venugopal M

Consultant Radiologist

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