Rounded atelectasis of the lung

Our plain-English summary of Rounded atelectasis of the lung, by G.T. Stathopoulos, M.T. Karamessini, A.E. Sotiriadi, et al (Respiratory Medicine, 2005).

The study

• Authors: G.T. Stathopoulos, M.T. Karamessini, A.E. Sotiriadi, V.G. Pastromas
• Journal: Respiratory Medicine
• Published: 2005;99(5):615-23
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Rounded atelectasis of the lung (RA) is a lesion well described in the medical literature, yet often very difficult to diagnose. In recent years, the widespread use of high-resolution imaging modalities employed in the struggle against cancer, coinciding with the peak of the asbestos epidemic, have boosted the detection frequency of RA. However, its differential diagnosis still poses a challenge to the pulmonary specialist and the radiologist, as little is known about its pathogenesis. Furthermore, the multifactorial etiology of RA and its occasional coexistence with lung cancer make the task of confidently ruling out malignancy sometimes daunting. This article attempts to provide an update on RA's etiology, radiological evaluation, clinical management, and prognosis based on recent advances in broadly available diagnostic modalities and minimally invasive interventional procedures. An exemplary case of post-tuberculous RA is illustrated, as RA often presents as an unusual finding of a fairly common disease.

In plain English

This article was a narrative review of rounded atelectasis, a benign area of folded, collapsed lung against thickened pleura that can mimic a tumor. The authors reviewed published reports on its causes, features, imaging, management and outlook, and described one case of their own. In the reviewed literature, asbestos exposure was the leading cause, accounting for 29–86% of cases in various series. Pleurisy was second, at about 14–64%. The authors' case was a 30-year-old non-smoking man with no occupational history of asbestos exposure, who did not live in an area of documented environmental asbestos pollution. He had been treated for tuberculosis with a tuberculous pleural effusion. After 3 years of follow-up he had an abnormal chest X-ray, and CT findings suggested rounded atelectasis. No further diagnostic evaluation was deemed necessary; at yearly follow-up the lesion stayed stable without symptoms. Citing one earlier study of asbestos bodies in lung tissue, the authors concluded that rounded atelectasis is not itself pre-cancerous, but that certain asbestos-induced lesions occurring with it are. They called asbestos-induced rounded atelectasis a sign of exposure to a known carcinogen.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature, with one illustrative case report from the authors
• Who was studied: Review of published reports on rounded atelectasis. The illustrative case was a 30-year-old non-smoking man with a history of pulmonary tuberculosis and a tuberculous pleural effusion on the right, followed with yearly chest X-rays from 1998. He had no occupational history of asbestos exposure and did not live in an area with documented environmental asbestos pollution.
• Exposure: Causes reviewed: asbestos (occupational and environmental, including tremolite in Metsovo, Greece), silica, mixed mineral dusts, exudative pleural effusions and other conditions. The illustrative case followed a tuberculous pleural effusion, in a man with no occupational history of asbestos exposure and no residence in an area with documented environmental asbestos pollution.
• Main results:
  • In the cited literature, asbestos exposure accounted for 29–86% of cases of rounded atelectasis in various series.
  • In the cited literature, pleurisy was the second leading cause, accounting for approximately 14–64% of cases.
  • The review reported that an estimated 50% of rounded atelectasis lesions are not detected on chest X-rays.
  • In one cited study of CT criteria, the converging bronchovascular markings ('comet-tail') sign was the most reliable, with 83% sensitivity and 92% specificity.
  • In one cited study of asbestos-exposed individuals, tissue retention of asbestos bodies was statistically significantly higher in patients with rounded atelectasis plus diffuse pleural thickening and/or interstitial fibrosis than in patients with isolated pleural plaques.
  • In the authors' case, after CT findings suggested rounded atelectasis, no further diagnostic evaluation was deemed necessary and the patient returned to yearly follow-up.
  • In the authors' case, the lesion stayed stable and the patient had no symptoms during later follow-up.
• The authors' conclusion: The authors concluded that rounded atelectasis is not a pre-neoplastic lesion in itself, but that specific coexisting asbestos-induced lesions in exposed individuals are. They also stated that asbestos-induced rounded atelectasis is a sign of exposure to a known carcinogen, and they proposed small-airway (microbronchial) distortion as an additional mechanism by which it forms.
• Limitations the authors state:
  • The authors stated that much of the knowledge about rounded atelectasis was gathered non-systematically, probably because few patients present with it.

Topics

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Differential Diagnosis, Etiology, Lung Cancer, Prognosis.

Related studies

• Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases — C. Voisin, F. Fisekci, et al. (1995)
• Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis — K. Kishi, S. Homma, et al. (2005)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis due to acute exudative effusion. Spontaneous resolution — L.S. Smith, R.F. Schillaci (1984)
• Rounded atelectasis and mesothelioma — R.F. Munden, H.I. Libshitz (1998)
• An unusual case of rounded atelectasis — G. Geremia, R.A. Mintzer (1984)

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