Discussion Author: Fred R Brandon
The right upper lobe collapses superiorly and medially producing a sharply defined triangular opacity bordered by the minor fissure laterally and the major fissure posteriorly. This may become difficult to see if it is a chronic collapse. There are both direct and indirect signs of lobar collapse. The direct signs are displacement of the fissures and opacification of the lobe. The indirect signs include elevation of the hemidiaphragm, mediastinal displacement, hilar displacement, crowded vessels in the affected lobe if the lobe is still partially aerated, and compensatory over inflation of the remaining lung. The most common cause of lobar collapse in adults is due to a bronchial obstruction, most commonly bronchogenic carcinoma. Other causes include mucus plugging extrinsic masses or inhalation of foreign bodies. In this case we see the reverse S sign of Golden which is due to a central mass obstructing the right upper lobe bronchus which displaces the minor fissure outwards around the mass. This central mass turned out to be a bronchogenic carcinoma.
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