CTICasesCombined Right Upper and Middle Lobe Collapse
Imaging findings
Chest radiograph shows a large, flappy, right-sided opacity (elephant ear sign) and a juxtaphrenic peak. CT chest shows a squamous cell carcinoma mass obstructing both the right upper and middle lobe bronchi, sparing the bronchus intermedius.
Key takeaways
Combined right upper and middle lobe collapse is known as the 'double lesion sign' (Felson). Because the upper and middle lobes have separate bronchial origins, a single mass must be large enough to obstruct both orifices simultaneously while sparing the bronchus intermedius, which is highly characteristic of central bronchogenic carcinoma.
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