Archive of Old Cases
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- Archive of Old Cases
- 2013
Case No : 803 Date 2013-03-18
- Courtesy of Tae Eun Kim, Jeung Sook Kim / Dongguk University Ilsan Hospital
- Age/Sex 75 / M
- Chief Complaintdyspnea for 2 weeks
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Round atelectasis
- Radiologic Findings
- Chest PA shows ill-defined opacity in right mid and lower lung zone, with small amount of right pleural effusion.
Lung setting image of the chest CT shows small ovoid shaped mass in the subpleural portion of right lower lobe of the lung. Bronchovascular bundles converge into the mass in a curvilinear way, forming whirling appearance or comet tail sign. Mediastinal setting image of chest CT Fig 3) shows homogeneous enhancement of the subpleural mass. Irregular pleural thickening of right lower thorax is present with volume loss of right lower lung, including adjacent area of the mass. Follow up CT showed no difference from the initial CT.
- Brief Review
- Round atelectasis is an unusual form of lung collapse that is adjacent to the pleura. This may simulate pulmonary neoplasm and often associated with asbestosis. The mechanism of round atelectasis is controversial and two main theories are suggested; pleural thickening and pleural effusion. Pleural effusion associated with asbestosis, tuberculosis, other infection, pulmonary infarction or uremic pleuritis may cause infolding of visceral pleura and curling of the adjacent lung in concentric fashion. Fibrous adhesions suspend and lead to additional distortion of the lung parenchyma. Another theory explains that pleural thickening and contraction may lead to shrinkage of the adjacent lung and develops into a round configuration.
The radiographic features of round atelectasis are characteristic; round or oval subpleural opacity, forming acute angle with pleura and commonly found in the posterior lower lungs. Adjacent pleural thickening is essential. Usually it presents as a single lesion, however multiple lesions may occur.
CT findings of round atelectasis is similar as radiography findings; peripherally located round or oval mass with thickening of adjacent pleura. The characteristic CT feature is crowded and distorted bronchovascular bundles which converge and enter the mass, called as comet tail sign. Homogeneous enhancement is seen in contrast enhanced scans, and air-bronchogram may be seen within the mass. Overlying pleural thickening is well demonstrated.
The main differential diagnosis is bronchogenic carcinoma. The round atelectasis is usually stable, but may show very slow growing or spontaneous resolution. Confident diagnosis could be made by CT and no specific treatment is needed.
- References
- 1. Vince A. Partap. The Comet Tail Sign. Radiology 1999; 213:553-554.
2. Terence C. Doyle, Gary A. Lawler. CT Features of Rounded Atelectasis of the Lung. AJR 1984; 143:225-228. - Please refer to
- Case 38
- Keywords
- Lung, Non-infectious inflammation,
No. of Applicants : 104
- ▶ Correct Answer : 54/104, 51.9%
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- - University of British Columbia , Canada Amr Ajlan
- - McGill University Health Center , Canada Alexandre Semionov
- - Asan Medical Center , Korea (South) Hye Jeon Hwang
- - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- - TCM HOSPITAL OF ZIGONG , China CAO YOU
- - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
- - Radnet Teleradiology , Turkey Murat Ulusoy
- - Chernomorska , Bulgaria VLADISLAV RUSINOV
- - James Paget Hospital , U.K , United Kingdom nabil mahmood
- - Samsung Medical Center , Korea (South) Jihyun LEE
- - Dongtan Sacred Heart Hospital , Korea (South) Younghwan Ko
- - humiic , Korea (South) Ju Won Lee
- - Pulmonary Institute, Shaare Zedek Medical Center , Israel Abraham Bohadana
- - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- - Seoul university hospital , Korea (South) Youngjin Ryu
- - Kyoto University , Japan Akihiko Sakata
- - SKG radiology , Australia Yuranga Weerakkody
- - Korea university , Korea (South) Kun Woo Kang
- - Myongji hospital , Korea (South) Ji Ye Lee
- - Kovai Medical Centre Hospital , India Krishna Prasad Bellam
- - GHICL , France manuel toledano
- - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- - Chonnam National University Hospital , Korea (South) Jung hyun Kim
- - UWO , Canada S Lee
- - Konkuk university hospital , Korea (South) Jeong Geun Yi
- - Mashhad University of Medical Sciences , Iran Bita Abbasi
- - Fukuyama city hospital , Japan Ryotaro Kishi
- - AFCH , Korea (South) Bongwan Noh
- - Hallym University sacred heart hospital , Korea (South) HyunJung Lee
- - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
- - Hanyang University Hospital , Korea (South) Yo Won Choi
- - Osaka university , Japan Akio Tsukabe
- - MBAL Sliven , Bulgaria Zlatina Boneva
- - Myongji , Korea (South) soon-young Moon
- - Dae-jeon Bohun Veterans Hospital , Korea (South) KI-TAE HAN
- - Az Osp Santa Maria Terni , Italy angelo carloni
- - chungbuk national university hospital , Korea (South) soojung lee
- - 異⑸ , China ZHANG YING
- - Chungbuk University Hospital , Korea (South) Yunhee Jang
- - McGill university , Canada Badriya Al-Qassabi
- - CAC Rennes , France nicolas gautier
- - Kizawa Memorial Hospital , Japan Yo Kaneko
- - IRSA La Rochelle France , France Denis Chabassiere
- - Private sector , Greece Vasilios Tzilas
- - HUEC , Brazil Diogo Pinheiro
- - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
- - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- - 異⑸ , Korea (South) 諛깆泥
- - Chonnam national university hospital , Korea (South) SeungJin Lee
- - All India Institute of medical sciences , India Justin Moses
- - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- - Medicheck health care , Korea (South) Chae Lim
- ▶ Correct Answer as Differential Diagnosis : 17/104, 16.3%
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- - Seoul National University Hospital , Korea (South) Sung Ui Shin
- - Montreal , Canada Drago Le King
- - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
- - Oita University, Faculty of Medicine , Japan Fumito Okada
- - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
- - Asan medical center , Korea (South) Sang Young Oh
- - GHTM ,STANLEY MEDICAL COLLEGE,CHENNAI , India siva raja
- - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- - chp st martin , France Mariotte benoit
- - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- - Saint Malo , France jean-baptiste Noel
- - chungbuk national university hospital , Korea (South) jeehye kim
- - CBNUH , Korea (South) jihyung lee
- - Chungbuk national university hospital , Korea (South) Jisun Lee
- - Onomichi municipal hospital , Japan Hirofumi Mifune
- - Okayama university , Japan Mayu Uka
- - XiangYa hospital , China Xia Yu
- ▶ Semi-Correct Answer : 13/104, 12.5%
-
- - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
- - CHU Poitiers , France CHAN paul
- - ICD,MCH CALICUT , India rikhy krishnan
- - chungbuk uni. hospital , Korea (South) JY Ahn
- - Chonnam national university hospital , Korea (South) Wongi Jeong
- - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- - NIMS, HYDERABAD , India bhaskar kakarla
- - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- - Korea university anam hospital , Korea (South) Sung-Hye You
- - stanley medical college & GHTM , India madhan k
- - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- - CNUH , Korea (South) Kim SooHyun
- - Chonnam National University Hospital , Korea (South) Sungmin Moon
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