RadloGraphics

index
Chest radiology
Cumulative
Index
Lung, surgery
Lung, collapse
Lung, anatomy

terms:

The postlobectomy

terms:

Anatomic

considerations

J. Michael

M.D.*

Herman

M.D.*

Clifton

Marvin

chest:

Holbert,
H. Chasen,

I. Libshilz,

M.D.*

F. Mountain,

M.D.t

The authors present a systematic

review of the changes
that occur in pulmonary
and extrapulmonary
anatomy
as
the result of lobar collapse
or resection.
Differences
In the
changes
produced
by lobectomy
and lobar collapse
are
noted.

Introduction
This study

incorporates

chest

radiographs

THIS EXHIBIT WAS DISPLAYED AT THE

72ND SCIENTIFIC ASSEMBLY AND ANNUAL MEETING OF THE RADIOLOGI-

right sided lobectomy,

by the orientation
anatomic
analysis
forms the foundation

CAL SOCIEIY OF NORTH AMERICA

postlobectomy

NOVEMBER
30-DECEMBER
5, 1986,
CHICAGO,
ILLINOIS. IT WAS RECOMMENDED BY THE CHEST RADIOLOGY
PANEL AND WAS ACCEPTED
FOR
PUBLICATION
AFTER PEER REVIEW
AND REVISION ON MARCH 3. 1987.

One

Diagnostic

Department
Surgery(t).

Radiology(4)

and

Holbert,

Diagnostic
ment

M.D.,

Imaging,

of Diagnostic

M.D. Anderson
Tumor
Institute,

Box 57, Houston,

Division

hundred

Methods

chest

together

The following
of possible

and

Nomenclature

detailed

,.
.

..

of

Depart-

in each case was given an intravenous

drip infusion
(4 mI/kg). From these cases, we have selected
5 for

presentation.

representations
abbreviations

CT scans

with corresponding

slices; the patient

of 30% diatrizoate

of Thoracic
M.D. Anderson

Hospital and Tumor Institute,

Houston.
Address reprint requests to
J.M.

.
.

of

of a neofissure.
for the evaluation

of 56 postlobectomy
patients were
chest radiographs.
The CT
examinations
had been performed
from Iwo weeks to five years postoperatively,
with GE 8800, GE 98002, Siemens Somatom
2, or Siemens
DR3 CT3 scanners. The CT studies consisted
of 8-10 mm contiguous

Department

tomo-

pathology.

Material,

reviewed

the

computed

grams for a systematic

review of anatomic
changes
resulting from
lobectomy.
The alterations
in pulmonary
and extrapulmonary
anatomy
after lobectomy
resemble,
but are distinct from, those seen in severe
Iobar coIIapse.
The reorientation
of the lung after left sided lobectomy
is reflected
by a pleuromediastinal
interface,
and after each type of

From

and

We used

our total

of neofissures resulting
used are as follows:

experience

to derive

from right sided

graphic

Iobectomy.

LUL = left upper lobe

LLL= left lower lobe
RUL = right upper lobe

LULL = left upper

(lobe) lobectomy
LLLL = left lower (lobe) lobectomy
RULL = right upper
(lobe) Iobectomy

RML = right middle

lobe
RLL = right lower lobe

RMLL = right middle

(lobe) lobectomy
RLLL = right lower (lobe) lobectomy

Radiology,
Hospital
and
1515 Holcombe,

1The term
necessarily

TX 77030.

2General

Electric

3Siemens

Medical

Volume

collapse
complete,

7, Number

is used throughout
loss of volume

Medical

Group.

Systems,

Iselin,

Milwaukee,

to indicate

very marked,

but not

WI

NJ.

September,

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this article

1987

#{149}

RadloGraphics

889

The

The postlobectomy

Hoiborf

chest

Comparison

of Lobecfomy

Changes from volume loss are broadly simibr for lobar collapse
and lobectomy;
the radiographic findings after lobectomy
strongly resemble those seen in lobar collapse
(Figure 1). The
radiographic
differentiation
of postlobectomy
changes
from those of lobar collapse
is made
difficult
by Iwo factors: I. Mediastinal
structures
in the

postlobectomy

patient

may

mimic

with

Lobar

Collapse

pearance

of a collapsed lobe shifting into the

postlobectomy
space4. 2. In many postlobectomy patients, a pleural effusion or fibrothorax
forms in the postlobectomy
space that causes a
radiographic,

and

remarkably

similar

sometimes

the ap-

lB

Figure 1
Left upper lobe collapse vs, left upper lobectomy

PA (A) and lateral (B)

chest radiographs demonstrate the classical findings of LUL collapse. The

left hilum is elevated. The left lung is oligemic. The superior mediastinum is
shifted to the left. The lateral radiograph shows the interface (arrowheads)
of the hyperexpanded
LLL with the anterior mediastinum and the collapsed
LUL. PA (C) and lateral (D) chest radiographs after LULL mimic LUL collapse.
The lateral radiograph shows the interface (arrowheads) between the
LLL and the mediastinum.

(E&F) Magnified

images

show

metallic suture material (arrows) in the left lung secondary to the lobectomy.
The most obvious distinctions between lobectomy and lobar collapse are
postthoracotomy
changes in the ribs and the presence of postsurgical
foreign

material.

Surgical

sutures may be difficultto

detect

unless one looks

for them specifically, however, and in some cases metallic clips are not used.
Sometimes postthoracotomy
changes are difficult to detect, and occasionally, lobar collapse after a failed attempt at tumor resection may resemble
Iobectomy.
4The usually

890

transitory,

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intraplural

space

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created

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by the

resection

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of a lobe

7, Number

of a lung.

a CT, appearance

to that of a collapsed

(See Figure 10.)

IA

hyperexpanded

of al.

lobe

Holbort

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1

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3
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ID

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IF

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The postlobectomy

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chest

of al

U)

a.
a
0

0
a
.a
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U)

U)

A collapsed
idual

lobe

volume

must

made

up

retain

of

a minimal

pulmonary

res-

the lateral

chyma,
vessels, and bronchi.
Lobectomy
removes
even this minimal
volume
of lung tissue.
The difficulty
in distinguishing
collapse
from

lobectomy

is seen

collapsed
plain

lobe

chest

in Figure

may

not

radiograph,

1. The opacity

be
but

the

Tethering

on a

identification

mediastinum

lapse

and

upper

Because
lung

volume

ponding

of upper

lobe

lobectomy

results in greater
collapse

lobe,

col-

lobectomy

lobectomy.

than

does

signs

commonly

of the
seen

loss of

the

additional

rotation

may

between

mediastinal

combine

shift

to produce

the LUL and the lower

and

an

cardiac

interface

mediastinum

and

to the hilum,

and

on

the anterior

2B

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after

collapsed

lower

in the

course

of middle

(12,13).

of the

In lobar

collapse,

bronchus

and

lobar

veins

the

artery

to the atrium

exert additional
tethering
effects that are not
present after lobectomy.
These tethering
effects
help to determine
the configuration
of lobar collapse (Figure 3A).

right chest and the RLL occupies the posterior right chest.
A new fissure created by the contact of the RML with the
RLL (arrowheads) is seen. After LULL, there is no major fissure; the LLL expands to fill the left chest. (Compare with
Figure 2A.)

RadioGraphics

Also,

lung

Upper lobe collapse vs upper lobectomy (A) Differences between RUL collapse and LUL collapse on CT
scans are illustrated schematically. (Mediastinal shifts are
not shown.) In collapse, displacement
of the RUL is predominantly medial; displacement
of the collapsed LUL is
anterior. The superior segment of the RLL may be interposed between the collapsed upper lobe and the mediastinum, deviating the major fissure. The minor fissure, laterally, is seen to be displaced from the horizontal into a
parasagittal plane (arrow). The major fissure on the left is 2A
V shaped. The LUL bronchus tethers the LUL more effectively than the RUL bronchus tethers the RUL because it is
longer, more posterior, and fixed at the hilum by the left
pulmonary artery. (Modified from Khoury et al. (5) with
permission of the author and publisher.) (B) Differences
between RULL and LULL are illustrated. (Mediastinal shifts

892

the

of the lobar

Figure 2

are not shown.) After RULL, the RML occupies

causes

space.

remaining

attachments

col-

lapse, such as the upper triangle

sign (7,8), the
flat waist sign, and other signs of cardiac
rotation (9,10), are accentuated
after lobectomy.
In
LLLL, the

3).
are not present

or upper lobectomy,
the inferior pulmonary
Iigament is usually cut to allow better distribution
of

corres-

in lobar

is not commonly

lobe to flatten against the posteroinferior

aspect
of the mediastinum
(11). After lower lobectomy,
the residual lung is not influenced
by the tethering effect of the inferior pulmonary
ligament.
It,
therefore,
reorients more freely to fill the post-

of

this opacity
makes
it possible
to differentiate
lobar collapse
from a postlobectomy
chest with
CT. Characteristic
CT appearances
of lobar collapse have been described
(1-6). Figure 2 con-

trasts the CT appearances

forces,

that
(Figure
which

lobectomy,
limit the redistribution
of lung in lobar
collapse.
In lower lobe collapse, the inferior pulmonary ligament
tethers the lower lobe to the

of a

recognizable

radiograph

seen in LLL collapse

paren-

7, Number

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a0
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3
C

3A

Figure 3
Left lower lobectomy vs left lower lobe collapse

(A) An
interface (arrowheads) between the LUL and the lower
mediastinum is present in this lateral view after LLLL. (B) is
the corresponding
PA radiograph. No evidence of col-

Volume

7, Number

lapsed lung is seen through the heart shadow. (C) There

is no comparable
interface in the lateral view in LLL
collapse. (D) is the PA radiograph corresponding to (C). A
triangular opacity representing the collapsed lower lobe
is seen through the heart shadow.

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The post/obectomy

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chest

The Postlobecfomy

of al.

Appearance

After lobectomy,
changes
in the remaining
pulmonary
and extrapulmonary
structures
follow
a
generally
predictable
pattern.
Variations
in the
normal
anatomy
of the bronchi,
vessels, and fissures can alter these patterns,
however.
In addition, preexisting
disease
(e.g., pleural
adhesions);

Iobectomy
space decreases
in size
and fills in with fluid and fibrothorax
few cases, the pleural space persists
expanded
with gas, fluid or thickened
These patients, who may have fever

postoperative

pleural fistula (14).

The following
sections present common
patterns encountered
in the postlobectomy
state.
They are based on a detailed
analysis of the CT
scans and radiographs
of the 56 postlobectomy
patients in the study group.

of the

factors

postlobectomy

(e.g., variations
space,

gas, fluid, or fibrothorax

the

cytosis,

in the size

presence

of

in the postlobectomy

space,
etc.); and changes
the expected
appearance
tomy chest.
In uncomplicated

with time can vary

of the postlobeccases, the post-

LOBECTOMY
Radiographic

usually

have

empyema

over time
(14-16).

In a

or is even
pleura.
or leuko-

or a broncho-

ON THE LEFT
Appearances

Figure4A
Left upper lobectomy

The PA radiograph after LULL shows postFigure 4B

thoracotomy
rib distortion and several surgical clips. The anterior
A
slightly rotated lateral projection demonstrates
mediastinum is shifted to the left. This sign has been described as the
the anterior interface of the LLL with the mediasupper triangle sign in lower lobe collapse (8). In LUL collapse, coltinum. The anterior mediastinal interface (arrowlapsed lung next to the anterior mediastinum prevents radiographic
heads) correlates,with
the lateral position of the
detection of this shift. In LULL, the interface between the lung and the
interface
seen
on
the
PA
view. This interface should
shifted anterior mediastinum (arrows) can be seen. Thus, the upper
not
be
confused
with
a
displaced
left major fissure.
triangle sign does not imply mediastinal widening, and should not be
confused with adenopathy. A juxtaphrenic peak is seen at the left lung After LULL, there is no major fissure.
base.

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Holborf

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I-

Figure 4C
A scan at the level of the aortic arch
with settings to optimize mediastinal
detail demonstrates anterior mediastinal contents displaced to the left (asterisk). This helps to fill the space left
by removal of the LUL. The right lung
extends across the midline anteriorly
(arrow). Mild clockwise rotation of the
aorta is present. More marked clockwise rotation of the aorta has been
reported after left sided pneumonectomy (17).

\\.

Figure 4D
At the aortic root, the degree of rotation of the heart upward and to the
left is well demonstrated
by the hori
zontal position of the left anterior descending coronary artery (arrows).

Figure 4E
A CT scan with window settings to optimize bronchial detail shows shifts in
bronchial anatomy after LULL. Two
centimeters caudal to the carina, the
LLL bronchus (arrowhead) and the
horizontally oriented LLL basilar segmental bronchi are visible. Note the
more than normally horizontal orientation of the vessels and bronchi in the
right lung as part of the response to
LULL. Lung from the anteromedial,
lateral and posterior basilar segments of
the LLL occupies the anterior and lateral aspects of the left chest at this
level.

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5A

Figure 5A&B
Left lower lobectomy

(A) A PA radiograph after LLLLdemonstrates relative

hyperlucency of the left hemithorax. After LLLL,the LUL expands to fill most of
the left chest. Displacement of anterior mediastinal contents to the left is
discernible (black arrowheads). The pleuromediastinal
interface between
the lung and the anterior mediastinum (white arrowheads) is an expected
finding and should not be confused with adenopathy; it is a left sided upper
triangle sign. After LLLL,the left hilum appears small and the remaining pulmonary arteries are displaced caudally. (B) A lateral chest radiograph after
LLLL demonstrates a pleuromediastinal
interface (arrowheads) of the LUL
with the mediastinum. A left major fissure no longer exists. The left hemidiaphragm is elevated.

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U-

2
U-

I
5D

Figures 5C,D&E
(C) A CT scan made with mediastinal window
settings at the level of the aortic arch demonstrates anterior mediastinum (asterisk) shifted to
the left. The right lung (arrow) extends across
the midline. The aorta is rotated slightly
clockwise. (D) This CT scan is at the level of the
carina. The anterior mediastinum is displaced
to the left and is rotated clockwise. The right
lung extends to the left. The left main pulmonary artery (arrowheads) and the left main
bronchus (arrows) are displaced posteriorly. (E)
In this more caudal CT scan, displacement
of
the diaphragm and mediastinum to the left is
apparent from the orientation of the diaphragrn
matic attachments to the sternum (arrowheads).
The heart is slightly rotated.

5E

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5G

5F

Figures 5F,G&H
(F) In this CT scan just below the level of the carina, the
junction of the anterior segmental bronchus (arrow) and
the apical posterior segmental bronchus (arrowhead) is
seen. These bronchi are inferiorly and posteriorly displaced.

(G) The upper division bronchus of the LUL(arrowhead)

branches vertically from the left main bronchus (arrow).
These structures are posteriorly and inferiorly displaced.
(H) The lingular bronchus (arrow) is posteriorly and inferiorly displaced. The lingula occupies most of the left
lower chest after LLLL.

5H

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The postlobectomy

LOBECTOMY

chest

ON THE RIGHT
Analysis

of Neo fissures

Medial
One of the better
signs
volume
loss is displacement

of the interlobar

of

fissures. After

right sided
lobectomy,
the remaining
lobes meet along
newly formed
fissures. These
neofissures
are fairly constant
in position,
but may vary be-

cause of preoperative
or postoperative
pleural or parenchymal
disease.
They may
difficult
to see on conventional
radiographs,
because
they are usually not parallel
the axis of the x-ray beam.

Tracings
veloped

6A

to

of CT scans were deinto topographic

rep-

resentations

Lateral

be

of the

expected

appearance

of the neofissure

after each
lobectomy
topographic

type of right sided

(Figure 6). These
representations

served as a basis for the three

dimensional
illustrations
of the
postoperative
appearance
of
each type of right sided
lobectomy

(Figure

Figure 6
Topographic drawings

7).

(A) A rep-

resentation of the orientation of a

neofissure formed after each type of
right sided lobectomy was developed
by review of the literature on the postlobectomy chest and by review of the
radiographs and CT scans of the patients in our study. A series of tracings
from CT scans was compiled into
topographic
form. (B) From topographic drawings, three dimensional
illustrations were drawn. Minor modifications were made to fit our clinical
experience.

6B

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U)
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Figure 7
Right sided neofissures

pected changes in the anatomy of the fissures on the

right after PULL. The RML and RLL create a new fissure by
swinging upward to contact each other near the apex of
the right chest cavity. The RML and RLL are contiguous
along the lower part of the major fissure as they were
before PULL, but the lower part of the major fissure is
shifted anteriorly. (B) After RMLL, the PUL and PLL expand
to contact each other along a curved surface that resembles that seen in PML collapse. A new fissure is
created between the RUL and RLL in the anteroinferior
aspect of the right chest. The fissure between the PUL and
RLL in the posterosuperior
right chest (upper part of the
major fissure) often moves caudad. (C) After RLLL,the PML
expands to occupy most of the right lower chest. The right
major fissure no longer exists. The PUL expands posteriorly
and inferiorly to contact the PML near the posterior costophrenic sulcus. A new fissure is formed; it arches inferiorly and posteriorly from the former minor fissure. A
common variation is lateral depression of this fissure.

0
U)
U)
>1

(A) This illustration depicts ex-

nor
7A

Right
Middle
Lobectomy

Right
Lower
Lobectomy

,1
nor

Posterior

7c

7B

900

4iiterior

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Radiographic

chest

Appearances

I
Figures 8A&B
Right upper lobectomy

(A) After
PULL, there is a slight shift of the
trachea and anterior mediastinum to
the right. The PLL hyperinflates to occupy the major portion of the right
chest. The proximal right interlobar
pulmonary artery (arrows) is superiorly
and laterally displaced. The right cardiophrenic sulcus is blunted, a sign of
volume loss described in patients after
radiation therapy (18). The right
hemidiaphragm
is elevated. There is
a scar at the lateral right lung base.
(B) After PULL, the PML expands to
meet the superior segmeht of the PLL
near the apex of the right chest. The
superior aspect of the neofissure
(arrowheads) can be seen on the lateralradiograph.

8A

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Figures 8C-E

(C) A CT scan with window settings to

optimize mediastinal detail demonstrates slight shift to the right and
counterclockwise
rotation of the antenor mediastinum (asterisk). This oc-

.2

:g.
:

curs to a lesser extent than the rotation and shift that occur after right
sided pneumonectomy
(17). The left
lung extends anteriorly across the midline (arrow). The right hemithoracic
volume is decreased. (D) CT scan at
the level of the right pulmonary artery
demonstrates elevation of the proximal right interlobar pulmonary artery
(arrow). There are surgical sutures in
the lung near the right hilum. (E) A CT
scan through the level of the heart at
the top of the elevated right hemidiaphragm demonstrates fat in the right
anterior cardiophrenic
sulcus partially
compensating
for volume loss secondary to PULL. This fat causes the blunted
right cardiophrenic
sulcus seen in Figure 8A. Very little lower mediastinal
shift is present.

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-uw-

Figures 8F-H

(F) After RULL, a new fissure (arrowheads) extends from the apex of the
right chest to the hemidiaphragm.
This
neofissure is formed by the pleural surfaces of the PML (curved arrow) and
the PLL (open arrow). This fissure does
not fit the classical description of the
major fissure because it is formed
along its entire surface by contact of
the PML with PLL. (G) A CT scan with
window settings to optimize bronchial

8F

detail shows the cranially displaced

PLL superior segmental bronchus (thin
arrow) in cross section. The bronchus
intermedius (black arrowhead) is obliquely oriented because it is elevated
and anteriorly displaced. The anterior
mediastinum is displaced to the right.
The neofissure (white arrowheads) between the PML (curved arrow) and the
PLL (open arrow) is seen as a curved
line. The right sided anterior mediastinal tenting seen in this section represents a scar. (H) At the level of the right
pulmonary artery, the division of the
now horizontally oriented basilar segmental bronchi arising from the PLL
bronchus (black arrow) can be seen.
The proximal segment ofthe elevated
and laterally displaced PML bronchus
(black arrowhead) is visible. The fissure

8G

between the PMLand PLLis seen as a

curved white line (white arrowheads).
Surgical sutures cause the increased
opacity in the PML.

8H

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9A

Figures 9A&B
Right middle lobectomy

(A) A PA chest radiograph after PMLLdemon-

strates blunting of the right cardiophrenic

sulcus (asterisk), but no other apparent mediastinal change. There is volume loss in the right chest, but only
slight pulmonary movement
The RUL and PLL have moved to contact each
other. This area of contact causes an opacity (black arrowheads) that resembles a collapsed RML. The area of contact is thick and irregular owing to
postoperative pleural thickening. The superolateral aspect ofthis fissure can
also be seen as a faint interface (white arrowheads). (B) The lateral view
provides another look at the neofissure (arrowheads). The right hemidiaphragm is elevated anteriorly.
.

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Figure 9C
A right posterior oblique
heads) after PMLL.

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Figures 9D-F
(D) In a CT section made with window
settings to optimize lung detail, the
obliquely oriented neofissure is seen.
It begins posteriorly as a broad band
(black arrowheads). (E) This fissure is
vertically oriented (and hence is sharply defined) in its inferior aspect (arrows). (F) CT scan at the level of the
inferior pulmonary veins was made
with settings to optimize mediastinal
detail. It demonstrates blunting of the
right cardiophrenic
angle from
changes in heart orientation and
pericardial fat distribution (arrow).

9D

:1
,d
9E

9F

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Figures 10 A&B
Right lower lobectomy

(A) A PA
radiograph demonstrates marked volume loss in the right chest. After PLLL,
the mediastinum shifts to the right. The
upper triangle sign (arrowheads) is
the same after PLLL and PLL collapse.
The right hilum is small and the right
hemidiaphragm
is elevated. A triangular opacity (arrow) representing postoperative fibrothorax strongly resembles PLL collapse. The pulmonary and
extrapulmonary
shifts also mimic PLL
collapse. Surgical clips imply that the
changes are postoperative.
(B) On the
lateral radiograph, a portion of the
neofissure (arrowheads), that separates the PML in the anterior lung base
from the PUL in the posterior lung
base, can be seen.

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Figures 10 C&D
(C) CT scan through the superior
mediastinum shows its slight counterclockwise rotation and shift to the
right after PLLL. The findings are less
marked than those seen after right
pneumonectomy
(17). The anterior
mediastinum has shifted to the right
creating the CT equivalent of the
upper triangle sign. Note the hyperexpanded lung extending across the
midline anteriorly. (D) This CT scan
shows surgical clips at the site of resection of the PLL pulmonary veins
(arrows). The esophagus (black arrow)
is shifted to the right. A postoperative
fibrothorax (white arrowheads) closely
simulates the CT appearance
of a RLL
collapsed against the posteromedial
mediastinum (See Figure bA).

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Figures 10 E&F
(E) CT scan with settings to optimize

bronchial detail demonstrates slight

posterior and inferior displacement of
the PUL bronchus and its branches
(arrows). A branch of the truncus antenor pulmonary artery (arrowhead)
crosses over the anterior segmental
bronchus. This plane is just above the
level of the minor fissure, which is now
part of a continuous fissure between
the RUL and the RML. (F) This CT scan
3 cm caudal to (E) demonstrates the
inferiorly and laterally displaced PML
bronchus (black arrowheads). Surgical
clips are present at the PLL bronchial
stump (wavy arrow). The esophagus
(black arrow) contains air. The PML
(curved arrow) and the PUL (open
arrow) form a neofissure that is faintly
perceptible
as it curves posteriorly
and inferiorly toward the posterior
costophrenic
sulcus.

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Figure lOG

Slightly caudal to (F), the fissure between the PML ( curved arrow) and
RUL (open arrow) is again seen as a
band (white arrowheads).

Summary
Lobectomy
may be considered
the ultimate form of lobar volume
loss. After lobectomy,
the remaining
pulmonary
parenchyma,
bronchi,
and vessels reorient in characteristic
patterns, and the extrapulmonary
structures shift to help fill the space created
by the resection
of the
lobe. The left pleuromediastinal
interface
after left sided lobectomy
and the neofissures after right sided lobectomy
reflect the reorientation
of these anatomic
structures. Although
lobectomy
and lobar collapse
produce
similar radiographic
findings, there are clear radiographic
differences
between
the two entities.

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References
1. Naidich

DP, McCauley

Dl, Khouri

NF, Leitman

9. Katfan KR, Wiot JF. Cardiac rotation in left lower lobe

collapse: The flat waist sign. Radiology 1976; 118:275-276.

BS. Hulnick

DH, Slegelman 55. Computed tomography

of lobar collapse: I. Endobronchial
obstruction. J Comput Assist Tomogr

10. Proto

2. Naidich DP, McCauley Dl, Khouri NF, Leitman BS, Hulnick

DH, Siegelman 53. Computed tomography
of lobar collapse: II. Collapse
in the absence
of endobronchial
obstruction.

J Comput

Ii,

Assist Tomogr

of lobar

col-

Rabinowilz
JG, Wolf BS. Roentgen
significance
of the puPmonary
ligament.
Radiology
1966: 87:1013-1020.

Surg Tech Illustrated,

Sabiston,
DC Jr. Carcinoma
of the lung. In: Gibbons
surgery of the chest. Sabiston
DC Fr., Spencer
FC, eds.
4th ed. WB Saunders
Co.. Philadelphia
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14. Goodman
LR. Putman
CE. Intensive
care radiology:
Imaging of the critically ill. Mosby, St. Louis. 1978:29-63.
15. Malamed
M, Hipona
FA Reynes CJ, Barker WC, Paredes

S. The adult post-operative

716.

chest. Thomas, Springfield.

IL.

1977.

6. Glazer HS, Aronberg

ifestatlons

DJ, Van Dyke JA Sogel 53. CT man-

of pulmonary

collapse.

In: Computed

16. Silver AW, Espinoso EE: Byron FX. The fate of the post-resectIon
space. Ann Thorac Surg 1966; 2:311-327.
17. Biondetti PR; Fiore D, Sartori F, Colognato A, Ravasini R,

tomog-

raphy of the chest. Godwin JD, ed. JB Llppincott,

Philadelphia, 1984:81-119.
KR, Felson

B, Holder LE, et al. Superior

lobe collapse:
The upper

shift in right lower

Radiology
1975; 116:305-309.
8. Kaffan KR. Upper mediasfinal changes
lapse.

manifestations

1980; 15:117-173.

13.

chopulmonary
collapse. RadioGraphics 1984: 4:195-232.
5. Khoury MB, Godwin JD, Halvorsen
RA Jr. Putman
CE. CT
of obstructive lobar collapse. Invest Radiol 1985: 20:708-

Kattan

I. Radiologic

Roentgenol

12. Ellis FH Jr. Left upper lobectomy.

1978: 3:63-74.

1983; 7:758-767.
3. Naidich DP, Ettinger N. Leitman BS. McCauley
Dl. CT of
lobar collapse.
Semin Roentgenol
1984; 19:222-235.
4. Raasch
BN. Heitzman
ER, Carsky EW. Lane EJ, Berlow ME,
Wilwer
G. A computed
tomographic
study of bron-

7.

AV, Tocino

lapse. Semin

1983; 7:745-757.

Semin

Roentgenol

in lower
1980: 15:183-186.

The authors are grateful

Buegeler

for photography,

Romani S. Evaluation
of the posf-pneumonectomy
by computed
tomography.
J Comput
Assist

mediastinal
triangle
sign.
lobe

6(2):238-242.
18. Libshitz HI, North L. Lung. In: Diagnostic
roentgenology
of
radiotherapy
change.
Libshitz HI, ed. Williams
& Wilkins,
Baltimore.
1979:33-46.

col-

to Patricia Carlson for artwork:

and

Volume

Cynthia

space

Tomogr 1982;

Dillard

7, Number

for secretarial

Gene Szwarc
assistance.

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and

Chuck

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