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Causative factors, imaging findings, and CT course of round atelectasis

      Highlights

      • Round atelectasis displays converging bronchovascular markings and lobar volume loss in the setting of pleural abnormality.
      • In the modern era, nearly 75% of cases of round atelectasis may be due to etiologies other than asbestos exposure.
      • Round atelectasis will most often remain stable or decrease in size over serial CT examinations.

      Abstract

      Objective

      To assess causative factors, associated imaging findings, and CT course of round atelectasis (RA).

      Materials and methods

      We retrospectively reviewed CT reports for “round” or “rounded atelectasis” over a 5-year time frame. Patients with at least 2 CT scans a minimum of 6 months apart were included. Electronic medical records and clinical and imaging follow-up was reviewed for all cases.

      Results

      Study population included 50 individuals with mean age of 63 years, and 59 unique instances of RA. The most commonly associated etiologies were hepatic hydrothorax (26%, n = 13) and asbestos exposure (26%), followed by post-infectious pleural inflammation (22%), congestive heart failure (12%), and end stage renal disease (8%). RA was found in the right lower lobe in over half of cases (n = 30). Association with one or more pleural abnormality was identified in all cases, including thickening (88%), fluid (60%), or calcification (40%). Nearly one third (n = 19) demonstrated intra-lesional calcification. In those who underwent PET/CT (20%), lesions demonstrated an average SUV of 2.2 (range 0–7.8). CT course over mean follow up of 32 months (range 6–126 months), demonstrated RA to remain stable (n = 26) or decrease (n = 26) in size in the majority (88%) of cases.

      Conclusion

      Round atelectasis may arise from diverse etiologies beyond asbestos, and will most often decrease or remain stable in size over serial exams. Accurate identification may obviate the need for added diagnostic interventions.

      Graphical abstract

      Keywords

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      References

        • Blesovsky A.
        The folded lung.
        Br J Dis Chest. 1966; 60: 19-22
        • Kretzschmar R.
        Über atelektatische Pseudotumoren der Lunge. RöFo - Fortschritte Auf Dem Gebiet Der Röntgenstrahlen Und Der Bildgeb Verfahren.
        122. 1975: 19-29https://doi.org/10.1055/s-0029-1230015
        • Tylén U.
        • Nilsson U.
        Computed tomography in pulmonary pseudotumors and their relation to asbestos exposure.
        J Comput Assist Tomogr. 1982; 6: 229-237
        • Stark P.
        Round atelectasis: another pulmonary pseudotumor.
        Am Rev Respir Dis. 1982; 125: 248-250https://doi.org/10.1164/arrd.1982.125.2.248
        • Sinner W.
        Pleurom - Ein atelektatischer Pseudotumor der Lunge mit krebszellenähnlichem Zellaufbau. RöFo - Fortschritte Auf Dem Gebiet Der Röntgenstrahlen Und Der Bildgeb Verfahren.
        133. 1980: 578-585https://doi.org/10.1055/s-2008-1056795
        • Sinner W.N.
        Computed tomography of “pleuroma”—a cancer mimicking atelectatic pseudotumor of the lung.
        Eur J Radiol. 1981; 1: 266-269
        • Dernevik L.
        • Gatzinsky P.
        • Hultman E.
        • Selin K.
        • William-Olsson G.
        • Zettergren L.
        Shrinking pleuritis with atelectasis.
        Thorax. 1982; 37: 252-258
        • Homolka J.
        • Bohut V.
        • Voslárová Z.
        Rounded atelectasis—the Blesovsky syndrome.
        Cas Lek Cesk. 1986; 125: 715-717
        • Hanke R.
        Round atelectasis (spherical and cylindrical atelectasis). Contribution to the differential diagnosis of intrapulmonal round foci.
        Fortschr Geb Rontgenstr Nuklearmed. 1971; 114: 164-183
        • Hanke R.
        • Kretzschmar R.
        Round atelectasis.
        Semin Roentgenol. 1980; 15: 174-182https://doi.org/10.1016/0037-198X(80)90005-X
        • Schneider H.
        • Felson B.
        • Gonzalez L.
        Rounded atelectasis.
        Am J Roentgenol. 1980; 134: 225-232https://doi.org/10.2214/ajr.134.2.225
        • Hillerdal G.
        Rounded atelectasis. Clinical experience with 74 patients.
        Chest. 1989; 95: 836-841
        • Mintzer R.A.
        • Cugell D.W.
        The association of asbestos-induced pleural disease and rounded atelectasis.
        Chest. 1982; 81: 457-460https://doi.org/10.1378/chest.81.4.457
        • Kakkar C.
        • Koteshwara P.
        • Kadavigere R.
        Round atelectasis.
        Lung India. 2015; 32: 646-647https://doi.org/10.4103/0970-2113.168105
        • Stathopoulos G.T.
        • Karamessini M.T.
        • Sotiriadi A.E.
        • Pastromas V.G.
        Rounded atelectasis of the lung.
        Respir Med. 2005; 99: 615-623https://doi.org/10.1016/j.rmed.2004.10.003
        • Stancato-Pasik A.
        • Mendelson D.S.
        • Marom Z.
        Rounded atelectasis caused by histoplasmosis.
        AJR Am J Roentgenol. 1990; 155: 275-276https://doi.org/10.2214/ajr.155.2.2115250
        • Kuno R.
        • Bower D.J.
        • Aguayo S.M.
        Round atelectasis as a complication of Legionnella pneumonia.
        Chest. 1994; 106: 607-608https://doi.org/10.1378/chest.106.2.607
        • Weyeneth M.
        • Deruaz J.P.
        • Perentes E.
        • Leuenberger P.
        Rounded atelectasis and persistent pleural effusion on top of fibrothorax. Report of a case.
        Schweiz Med Wochenschr. 1985; 115: 166-171
        • Cohen A.M.
        • Crass J.R.
        • Chung-Park M.
        • Tomashefski J.F.
        Rounded atelectasis and fibrotic pleural disease: the pathologic continuum.
        J Thorac Imaging. 1993; 8: 309-312
        • Tetikkurt C.
        • Tetikkurt S.
        • Ozdemir I.
        • Bayar N.
        Round atelectasis in sarcoidosis.
        Multidiscip Respir Med. 2011; 6: 180https://doi.org/10.1186/2049-6958-6-3-180
        • Kishi K.
        • Homma S.
        • Miyamoto A.
        • Kurosaki A.
        • Motoi N.
        • Kohno T.
        • et al.
        Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis.
        Intern Med. 2005; 44: 625-627
        • Srinivasan A.K.
        • Holemans J.A.
        • Page R.D.
        Two cases of rounded atelectasis presenting after coronary artery surgery.
        Ann Thorac Surg. 2004; 77: 2190-2192https://doi.org/10.1016/S0003-4975(03)01431-0
        • Oxnard G.R.
        • Zhao B.
        • Sima C.S.
        • Ginsberg M.S.
        • James L.P.
        • Lefkowitz R.A.
        • et al.
        Variability of lung tumor measurements on repeat computed tomography scans taken within 15 minutes.
        J Clin Oncol. 2011; 29: 3114-3119https://doi.org/10.1200/JCO.2010.33.7071
        • Sobocińska M.
        • Sobociński B.
        • Jarzemska A.
        • Serafin Z.
        Rounded atelectasis of the lung: a pictorial review.
        Pol J Radiol. 2014; 79: 203-209https://doi.org/10.12659/PJR.889983
        • Jarno F.
        • Bazot M.
        • Korzec J.
        • Milleron B.
        • Carette M.F.
        Computerized tomography imaging of round atelectasis. Study of a series of 21 patients.
        Rev Pneumol Clin. 1999; 55: 211-218
        • McHugh K.
        • Blaquiere R.M.
        CT features of rounded atelectasis.
        AJR Am J Roentgenol. 1989; 153: 257-260https://doi.org/10.2214/ajr.153.2.257
        • Voisin C.
        • Fisekci F.
        • Voisin-Saltiel S.
        • Ameille J.
        • Brochard P.
        • Pairon J.-C.
        Asbestos-related rounded atelectasis: radiologic and mineralogic data in 23 cases.
        Chest. 1995; 107: 477-481https://doi.org/10.1378/chest.107.2.477
      1. McAdams HP, Erasums JJ, Patz EF, Goodman PC, Coleman RE. Evaluation of patients with round atelectasis using 2-[18F]-fluoro-2-deoxy-d-glucose PET. J Comput Assist Tomogr n.d.;22:601–4.

        • O'Donovan P.B.
        • Schenk M.
        • Lim K.
        • Obuchowski N.
        • Stoller J.K.
        Evaluation of the reliability of computed tomographic criteria used in the diagnosis of round atelectasis.
        J Thorac Imaging. 1997; 12: 54-58
        • Carvalho P.M.
        • Carr D.H.
        Computed tomography of folded lung.
        Clin Radiol. 1990; 41: 86-91
        • Bayeux M.C.
        • Letourneux M.
        • Brochard P.
        • Raffaelli C.
        • Pairon J.C.
        • Iwatsubo Y.
        • et al.
        Rolled atelectasis and asbestosis. Apropos of 26 patients.
        Rev Mal Respir. 1998; 15: 281-286
        • Payne C.R.
        • Jaques P.
        • Kerr I.H.
        Lung folding simulating peripheral pulmonary neoplasm (Blesovsky's syndrome).
        Thorax. 1980; 35: 936-940
        • Dernevik L.
        • Gatzinsky P.
        Pathogenesis of shrinking pleuritis with atelectasis—“rounded atelectasis”.
        Eur J Respir Dis. 1987; 71: 244-249
        • Menzies R.
        • Fraser R.
        Round atelectasis. Pathologic and pathogenetic features.
        Am J Surg Pathol. 1987; 11: 674-681
        • Woodring J.H.
        Pleural effusion is a cause of round atelectasis of the lung.
        J Ky Med Assoc. 2000; 98: 527-532
        • Egashira R.
        • Jacob J.
        • Kokosi M.A.
        • Brun A.-L.
        • Rice A.
        • Nicholson A.G.
        • et al.
        Diffuse pulmonary ossification in fibrosing interstitial lung diseases: prevalence and associations.
        Radiology. 2017; 284: 255-263https://doi.org/10.1148/radiol.2017152419
        • Papiris S.A.
        • Maniati M.A.
        • Sakellariou K.
        • Gosios C.
        • Kontogiannis D.
        • Constantopoulos S.H.
        Round atelectasis and Metsovo lung.
        Chest. 1993; 103: 1759-1762
        • Munden R.F.
        • Libshitz H.I.
        Rounded atelectasis and mesothelioma.
        Am J Roentgenol. 1998; 170: 1519-1522https://doi.org/10.2214/ajr.170.6.9609165
        • Nakazono T.
        • Nakamura Y.
        • Satoh T.
        • Sakuragi T.
        • Sakao Y.
        • Kudo S.
        Squamous cell carcinoma coexisting in rounded atelectasis: diagnostic pitfalls.
        Am J Roentgenol. 2004; 182: 79-80https://doi.org/10.2214/ajr.182.1.1820079
      2. Dalli A, Selimoglu Sen H, Coskunsel M, Komek H, Abakay O, Sergi C, et al. Diagnostic value of PET/CT in differentiating benign from malignant solitary pulmonary nodules. J BUON n.d.;18:935–41.

        • Sim Y.T.
        • Goh Y.G.
        • Dempsey M.F.
        • Han S.
        • Poon F.W.
        PET–CT evaluation of solitary pulmonary nodules: correlation with maximum standardized uptake value and pathology.
        Lung. 2013; 191: 625-632https://doi.org/10.1007/s00408-013-9500-6
        • Doyle T.
        • Lawler G.
        CT features of rounded atelectasis of the lung.
        Am J Roentgenol. 1984; 143: 225-228https://doi.org/10.2214/ajr.143.2.225
        • Hakomäki J.
        • Keski-Nisula L.
        • Paakkala T.
        Contrast enhancement of round atelectases.
        Acta Radiol. 2002; 43: 376-379
        • Batra P.
        • Brown K.
        • Hayashi K.
        • Mori M.
        Rounded atelectasis.
        J Thorac Imaging. 1996; 11: 187-197
        • Horn M.
        • Oechsner M.
        • Gardarsdottir M.
        • Köstler H.
        • Müller M.F.
        Dynamic contrast-enhanced MR imaging for differentiation of rounded atelectasis from neoplasm.
        J Magn Reson Imaging. 2010; 31: 1364-1370https://doi.org/10.1002/jmri.22176
        • Shen G.
        • Ma H.
        • Liu B.
        • Ren P.
        • Kuang A.
        Diagnostic performance of DWI with multiple parameters for assessment and characterization of pulmonary lesions: a meta-analysis.
        Am J Roentgenol. 2017; : 1-10https://doi.org/10.2214/AJR.17.18257
        • Mori T.
        • Nomori H.
        • Ikeda K.
        • Kawanaka K.
        • Shiraishi S.
        • Katahira K.
        • et al.
        Diffusion-weighted magnetic resonance imaging for diagnosing malignant pulmonary nodules/masses: comparison with positron emission tomography.
        J Thorac Oncol. 2008; 3: 358-364https://doi.org/10.1097/JTO.0b013e318168d9ed
        • Smith L.S.
        • Schillaci R.F.
        Rounded atelectasis due to acute exudative effusion.
        Chest. 1984; 85: 830-832https://doi.org/10.1378/chest.85.6.830
        • Geremia G.
        • Mintzer R.A.
        An unusual case of rounded atelectasis.
        Chest. 1984; 86: 485-486https://doi.org/10.1378/chest.86.3.485