A 50-year-old male smoker presented with three episodes of hemoptysis over one day, expelling 100-150 mL of blood-stained sputum each time. On examination, his left lung fields were dull to percussion and breath sounds were diminished. A chest x-ray showed a homogeneous opacity in the left upper, middle, and lower lung zones, with the left diaphragm and heart border not visible. Differential diagnoses included left lung collapse or fibrosis. A chest physician suspected central bronchogenic carcinoma as the cause of the collapse.

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WEEK
BY PROF.P.VIJAYARAGHAVAN’S UNIT
ELAVAZHAGAN.B PG

2.  50 yr male old came with c/o
 Hemoptysis three episodes over 1 day
◦ Around 100-150 ml per episode
 Blood stained sputum since morning
 No h/o breathlessness.
 Past h/o : not a known DM/HT/BA/PT
 Personal h/o: known smoker 15 yrs
 Contact h/o : no contact with TB

3.  O/E conscious ,afebrile
no pallor/icterus/cyanosis/clubbing/LN/PE
 VITALS - stable
 RS: Tracheal shift to left
apical impulse at 5 ICS lat to mid
clavicular line.
 VF,VR diminished Lt side lung fields
 Dullness in same side on percussion
 Lt side BS absent
 Rt side NVBS heard.

5.  Chest x ray PA view
 In full inspiration
 Properly positioned
 Adequate penetration
 Soft tissue shadow normal

6.  Trachea shifted to left
 Homogenous opacity seen in lt upper/ mid/lower
lung zones
 Lt diaphragm silhouetted
 Lt heart border couldn’t be made out.
 Lt side crowding of ribs+
 Rt side hyperinflation+

7.  CAUSES OF OPAQUE HEMITHORAX
 Rotation,scoliosis
 Large pleural effusion,pleural
thickening,mesothelioma.
 Collapse,consolidation,fibrosis.
 Pulmonary agenesis,gross cardiomegaly,tumor
 Pneumectomy,thoracoplasty.

8. Differential diagnosis
Left lung COLLAPSE
Left lung FIBROSIS

9. CHEST PHYSICIAN OPINION
 Collapse left lung
 ? Central type bronchgenic carcinoma

12.  CAUSES OF CENTRAL OBSTRUCTION
 In children:
mucous plug,foreign body
 <40 YRS :
mucous plug,F.body,endo broncial
tumour[lowgrade]
 >40YRS:
bronchogenic ca.

13.  Collapse reversed in 3 days.
 Probably a mucous block which has been
coughed out.
 CT shows bronchiectactic changes in left
lower zone.
 FOB: no mass or block detected.

14.  COLLAPSE[complete atelectasis]
 resorption atelectasis
 relaxation atelectasis
 adhesive atelectasis
 cicatrization atelectasis
 round atelectasis
 Basal atelectasis due to hypo ventilation.

15. RADIOLAGICAL SIGNS: DIRECT
displacement of inter lobar fissures
crowding of vessels& bronchi
crowded air bronchograms.

16.  INDIRECT SIGNS:
 local opacity
 diphragmatic elevation
 mediastinal shift
 Approximation of ribs
 overinflation of remainder lung
 displacement of hila
 absence of visibility of inter lobar A.

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