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Age: 64

Sex: Male

Indication: Shortness of breath

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Case #1


Findings

  • Increased opacification and volume loss in the right upper lobe with superior displacement of the minor fissure
  • Mild rightward mediastinal shift
  • Mild patchy left lower lobe opacification
  • Right IJ approach Port-A-Cath with tip overlying the superior cavoatrial junction
  • No pleural effusion or pneumothorax
  • Normal size and configuration of the cardiopericardial silhouette


Diagnosis

  • Right upper lobe collapse

Sample Report

Right upper lobe collapse, which raises concern for mucous plugging or a central obstructing mass. Recommend chest CT for further evaluation.

Mild patchy opacities in the left lower lobe are nonspecific and may relate to atelectasis, aspiration, or pneumonia.


Discussion

  • Right upper lobe collapse is often identified on a frontal radiograph by volume loss and opacification with upward deviation of the minor fissure
  • The Golden S sign results from the medial aspect of the minor fissure getting caught on a hilar mass while the mid and lateral portions elevate – so if you see this appearance, think about a central obstructing mass


Images

Right upper lobe collapse. The minor fissure is elevated laterally (red arrow) but not as elevated centrally (yellow arrow) raising concern for a perihilar mass. Right upper lobe collapse. Lateral view shows a paradoxical bulging appearance along the inferior margin of the collapsed lobe concerning for mass (red arrows). Subsequent CT confirmed the presence of a suprahilar mass with bronchial invasion (red arrows), though the mass is difficult to distinguish from the adjacent atelectatic lung. Right upper lobe collapse. Illustration by Valerie George, MD



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