What are the imaging features of right upper lobe (RUL) collapse in patients with atelectasis?

Updated: Oct 22, 2020
  • Author: Tarun Madappa, MD, MPH; Chief Editor: Nader Kamangar, MD, FACP, FCCP, FCCM  more...
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Answer

With right upper lobe (RUL) collapse, the collapsed RUL shifts medially and superiorly, resulting in elevation of the right hilum and the minor fissure. Rarely, the RUL may collapse laterally, producing a masslike opacity that may look like a loculated pleural effusion. The minor fissure in RUL collapse is usually convex superiorly but may appear concave because of an underlying mass lesion. This is called the sign of Golden S. It is so named because this sign resembles a reverse S shape. It is created by a central mass obstructing the RUL bronchus and should raise suspicion for primary bronchogenic carcinoma, enlarged lymph nodes, or metastatic disease. Tenting of the diaphragmatic pleura juxtaphrenic peak is another helpful sign of RUL atelectasis. [9] Upon CT scanning, RUL collapse appears as a right paratracheal opacity, and the minor fissure appears concave laterally. Note the images below.

Atelectasis. Left upper lobe collapse showing opac Atelectasis. Left upper lobe collapse showing opacity contiguous to the aortic knob, a smaller left hemithorax, and a mediastinal shift.
Atelectasis. Right upper lobe collapse and consoli Atelectasis. Right upper lobe collapse and consolidation.
Atelectasis. Right upper lobe collapse. Atelectasis. Right upper lobe collapse.
Atelectasis. Chest posteroanterior radiograph demo Atelectasis. Chest posteroanterior radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
Atelectasis. Chest lateral radiograph demonstrates Atelectasis. Chest lateral radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
Atelectasis. CT scan of the chest shows tumor enca Atelectasis. CT scan of the chest shows tumor encasing and occluding the right upper lobe bronchus and collapse of the right upper lobe, with superior and medial displacement of the minor fissure.

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