By Agustí A., Silvestri G.A., Albert R.K.

An important device for all physicians who deal with sufferers with breathing sickness

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When there is complete collapse of an entire lung (in the absence of an accompanying pneumothorax, large pleural effusion, or extensive consolidation), complete opacification of that hemithorax is seen, with displacement of the mediastinum to the affected side and elevation of the hemidiaphragm. Compensatory hyperinflation of the contralateral lung occurs, often with herniation across the midline. Herniation is most often in the retrosternal space, anterior to the ascending aorta, but may occur posterior to the heart (Figure 1-38).

Understanding the significance of the silhouette sign allows the observer to localize an area of consolidation or other pulmonary opacity. Only if an area of consolidation lies in direct 22 SECTION I Structure and Function FIGURE 1-31 Air bronchogram in consolidation. A, Left, upper zone tuberculosis demonstrating an air bronchogram. B, Computed tomography scan through the left lower lobe in a different patient demonstrates an area of segmental pneumonia. not (Figures 1-35 through 1-37). There are several potential causes for a falsely positive silhouette sign.

Thus, lingular consolidation is likely to obscure the heart border, but left lower lobe consolidation usually does Collapse When there is partial or complete volume loss in a lung or lobe, this is referred to as collapse or atelectasis. The terms are essentially interchangeable, and they imply a diminished volume of air in the lung with associated reduction of lung volume. Several different mechanisms result in lung or lobar collapse. Relaxation or Passive Collapse. The lung retracts toward its hilum when air or an abnormal amount of fluid accumulates in the pleural space.

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