CTICasesOccult Lower Lobe Collapse from Endobronchial Carcinoid
Imaging findings
Two chest radiographs reported as normal at the institution actually show a left lower lobe collapse that is difficult to perceive, with subtle indirect signs (downward dragging of the left main bronchus, obscuration of the descending aorta interface, and only a faint spine sign because the opacity overlaps the posterior spine). CT shows a substantial retrocardiac atelectatic opacity, and the cause is an endobronchial carcinoid partly protruding into the airway.
Key takeaways
Voluminous lower lobe collapse can paradoxically be harder to detect on radiographs the worse it is, and here an endobronchial carcinoid caused a large but easily overlooked left lower lobe collapse. This illustrates that failure to perceive such a lesion is understandable and should not be characterized as a breach of the standard of care; attention to indirect signs of lobar atelectasis (hilar depression, obscured interfaces, bronchial displacement) aids detection.
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