CTICasesCombined Right Upper and Lower Lobe Collapse Sparing the Middle Lobe
Imaging findings
An initial radiograph shows a patient intubated with right lower lobe and possible left lower lobe atelectasis. The next day, there's a unique appearance to the right hemithorax with a visible right heart border, complete right lower lobe atelectasis, and right upper lobe collapse, creating a reverse S sign without a mass. This indicates combined right upper and lower lobe collapse, sparing the right middle lobe. A subsequent study shows reopening of the right upper and lower lobes, but now a portion of the right middle lobe is collapsed. CT shows discrete centrilobular findings in the right lower lobe, and earlier aspiration or pathology in the right middle lobe.
Key takeaways
This case illustrates an unusual combination of right upper and lower lobe collapse sparing the right middle lobe, serving as an excellent teaching example for residents in pattern recognition. The "elephant's ear sign" refers to atelectasis of the right upper and right middle lobes, which can simulate left upper lobe collapse.
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