A Case Record from Chulalongkorn University

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A Case Record from Chulalongkorn University

• Nitra Piyavisetpat

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(No Transcript)
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What is the diagnosis?

• Sweyer-James syndrome
• Right upper lobe atelectasis
• Mediastinal mass with phrenic nerve paralysis
• Eventration of right hemidiaphragm
• Massive right pulmonary thromboembolism

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Answer

• b Right upper lobe (RUL) atelectasis

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Findings

• Small volume of right hemithorax
• Widening of superior mediastinum
• Shifting of mediastinum toward the right.
• Note this patient is in good position suggested
  by equal distance of the spinous process to each
  head of clavicle

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Findings

• Upward displacement of right hilum which located
  in the same level of the left hilum (arrowhead)
• Increased lucency of right lung
• Splaying of right pulmonary arteries decreased
  right pulmonary vascularity
• Elevation tenting of right hemidiaphragm (white
  arrow)

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• Despite there is no direct sign of
  atelectasis, i.e., upward displacement of minor
  fissure and crowding of vessels, but the presence
  of upward displacement of right hilum is the most
  important clue in diagnosis of RUL atelectasis in
  this patient.
• Other findings are also indirect signs of
  atelectasis, however, they are not specific for
  diagnosis of atelectasis.

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• In this case, marked collapse of the RUL results
  in collapse lung blending with the right superior
  mediastinum (double black arrow) so that it is
  easily overlooked.
• In some patients, the collapse RUL may mimic
  mediastinal mass.

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• NECT reveals collapsed right upper lobe against
  the mediastinum (arrows).
• Severe stenosis of the RUL bronchus, narrowing
  of the lower thoracic trachea right main
  bronchus as a result of tuberculosis also noted.

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