CTICasesRight Upper and Middle Lobe Atelectasis
Imaging findings
Chest CT and radiographs in a trauma patient with rib fractures and subcutaneous emphysema demonstrate right upper and right middle lobe collapse (elephant ear sign) with hyper-expansion of the right lower lobe. Due to a large pneumothorax, the middle lobe flipped posteriorly and got stuck, preventing it from returning to its normal anterior position.
Key takeaways
Right upper and middle lobe atelectasis can occasionally occur in combination, particularly in the setting of trauma or mechanical ventilation with a large pneumothorax. The collapsed lobes can displace posteriorly and become trapped by the expanding lower lobe, presenting as a characteristic 'elephant ear' opacity on radiographs. Recognizing the hilar and fissural anatomy on CT is key to identifying this complex collapse.
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