CTICasesComplete Left Upper Lobe Atelectasis Due to Endobronchial Valves for Emphysema
Imaging findings
Radiograph shows discrepancy in volume of the left versus the right hemithorax; the left hemithorax looks a little more lucent with vessels spaced further apart. A vague band of opacity is seen medially, and an abnormal line on the lateral view, pointing to subtle left upper lobe atelectasis. Post-placement radiograph and preoperative CT show endobronchial valves in different segmental bronchi, including the lingula, resulting in collapse of the left upper lobe in a patient with severe underlying emphysema. Airways on CT appear on-lad and flat, suggestive of expiratory airway collapse, possibly contributing to symptoms.
Key takeaways
Endobronchial valves are used in minimally invasive volume reduction surgery for emphysema, intentionally causing lobar collapse. Radiographic findings can be subtle; the valves are often hidden. The desired outcome is complete lobar atelectasis, which can be seen on follow-up imaging. Consideration should be given to underlying airway dynamics (e.g., expiratory collapse) in conjunction with the intervention.
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