This frontal chest x-ray is from a 43 year old with exacerbation of asthma. What can you glean from the x-ray?

 

 

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The frontal chest x-ray shows a triangular opacity at the apex of the right lung, silhouetting with the medial pleura. The inferior concave margin of the opacity is formed by the displaced horizontal fissure and the trachea is deviated toward the right. These findings are consistent with right upper lobe collapse. No obvious right hilar mass is seen.

In an asthmatic, the likely cause is a mucus plug obstructing the right upper lobe bronchus. This patient did cough up a mucus plug after chest physio, with an improvement in clinical condition.

Right upper lobe collapse due to an obstruction of the right upper lobe bronchus by a right hilar mass causes a Golden S Sign and an example can be found here.

Chest x-ray signs of a lobar collapse are:

• Direct sign – displacement of interlobar fissure
• Indirect signs – increased density, bronchovascular crowding, ipsilateral tracheal shift, ipsilateral diaphragmatic elevation, compensatory hyperinflation of other lobes, ipsilateral rib space narrowing.

Reference: Fundamentals of Diagnostic Radiology by Brant and Helms, 4th edition

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