Rounded atelactasis

Q: Rounded atelectasis usually points toward which disease?

Answer:  Previous asbestos exposure

Rounded atelectasis is seen on radiologic imagings and has been given a lot of names including folded lung, atelectatic pseudotumor, comet tail sign, and Blesovsky's syndrome. It is actually a subpleural mass with emanating swirl of vessels and bronchi that curve like a comet tail (also called vacuum cleaner effect) as they connect to the atelectatic lung parenchyma. Mostly their location is in the lower lobes, lingula, or right middle lobe. The subpleural mass of rounded atelectasis can be a pleural plaque, diffuse pleural thickening, existing or resolving pleural effusion, accompanying loss of volume in the adjacent lung, or adjacent accumulation of extrapleural fat.

Clinical significance: If the comet tail is not present with rounded atelectasis, the risk of a tumor is very high and calls for a biopsy. But if comet tail is characteristically present, the rounded atelectasis can be followed radiologically over years. They may get resolved and rarely grows.

Although asbestos exposure is most likely to be associated, rounded atelectasis can also be seen in pleural tuberculosis.


#pulmonary
#radiology


References:

1. Stark P. Round atelectasis: another pulmonary pseudotumor. Am Rev Respir Dis 1982; 125:248. Partap VA. 

2. The comet tail sign. Radiology 1999; 213:553. 

3. Hanke R, Kretzschmar R. Round atelectasis. Semin Roentgenol 1980; 15:174. 

4.  Stathopoulos GT, Karamessini MT, Sotiriadi AE, Pastromas VG. Rounded atelectasis of the lung. Respir Med 2005; 99:615.