Chest > Diagnosis > Overview of Chest Imaging > Atelectasis and Volume Loss

Cicatricial Atelectasis
Brett W. Carter, MD, CPPS

Selected Images Hide Images

Axial CECT shows right upper lobe PA chest radiograph of a patient
atelectasis with dense fibrosis and with healed tuberculosis
traction bronchiectasis , demonstrates a heterogeneous right
consistent with cicatricial atelectasis. upper lobe opacity with associated
Note mild superior mediastinal volume loss and hilar retraction,
displacement toward the right due intrinsic architectural distortion, and
to adjacent volume loss. traction bronchiectasis , typical
of cicatricial atelectasis.
PA chest radiograph of a patient
who had right lung radiation three
years previously shows dense right
paramediastinal opacities, volume
loss, architectural distortion, and
shift of the mediastinum to the
right.
Axial CECT of the same patient
shows dense right perihilar opacities
with intrinsic traction bronchiectasis
and architectural distortion. The
straight interface along the margin
of the consolidation is characteristic
of radiation fibrosis and represents
the boundary of a treatment port.

Additional Images

PA chest radiograph of a patient
who had radiation therapy two
years previously shows dense
bilateral paramediastinal
consolidations with associated
architectural distortion,
bronchiectasis, and volume loss.
Axial CECT of the same patient
shows dense bilateral perihilar
opacities with intrinsic traction
bronchiectasis and architectural
distortion. The straight interface
along the anterior margin of the left
consolidation is characteristic of
radiation fibrosis and correlates with
the boundary of a treatment port.
Axial CECT of a patient who had
radiation therapy for left upper lobe
lung cancer two years previously
shows a dense left upper lobe
paramediastinal opacity with subtle
internal air bronchograms .
Note anteromedial displacement of
the left major fissure.

KEY FACTS

Terminology
Synonym: Cicatrization atelectasis
Reduction in alveolar air volume in setting of pulmonary fibrosis
Imaging
Radiography
Focal or multifocal involvement
Increased opacity of affected lung
Variable volume reduction of affected lung; ± increased volume of unaffected lung, mediastinal shift
Mass-like, nodular, consolidative, or band-like opacities ± architectural distortion
Intrinsic bronchiectasis
CT
Assessment of extent of involvement
Characterization of mass-like opacity; identification of associated architectural distortion, intrinsic traction bronchiectasis
&/or bronchiolectasis
 Pathology
Pulmonary fibrosis; typically localized
Etiologies
Radiation-induced fibrosis
End-stage sarcoidosis
Sequela of infection (e.g., tuberculosis, histoplasmosis, necrotizing pneumonia)
Pneumoconiosis (e.g., progressive massive fibrosis)
Clinical Issues
Most common symptoms
Asymptomatic
Shortness of breath, dyspnea
Cough
Diagnostic Checklist
CT assessment of nodular or mass-like radiation-induced cicatricial atelectasis for signs of tumor recurrence (e.g., obliteration
of previously visualized bronchiectatic airways)

SELECTED REFERENCES

1. Shaikh F et al: Radiographic and histopathologic features in sarcoidosis: a pictorial display. Semin Respir Crit Care Med. 41(5):758-
84, 2020
2. Shao H et al: Ultra-facile and rapid colorimetric detection of Cu2+ with branched polyethylenimine in 100% aqueous solution.
Analyst. 143(2):409-14, 2018
3. Nachiappan AC et al: Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics. 37(1):52-72, 2017
4. Jun JS et al: Complications of pneumoconiosis: radiologic overview. Eur J Radiol. 82(10):1819-30, 2013
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