CTICasesHepatic Hydrothorax evolving into Rounded Atelectasis
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Imaging findings
Serial CT scans in a patient with chronic liver disease demonstrate a large right-sided pleural effusion (hepatic hydrothorax) that gradually decreases, leaving behind a classic rounded atelectasis. The collapsed lung forms a rounded, pleural-based mass in the right lower lobe, associated with a "comet tail" sign of bronchovascular bundles curving into the lesion and displacement of the adjacent major fissure.
Key takeaways
Rounded atelectasis is a benign form of lung collapse that occurs when chronic pleural fluid or pleural thickening causes the underlying lung to fold and roll up. On CT, it is characterized by a round or oval pleural-based mass, the comet tail sign, and signs of volume loss in the affected lobe. Recognizing this benign evolution from prior hepatic hydrothorax is crucial to avoid misinterpreting it as a neoplastic mass.
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