TOACS FCPS Station · Chest X‑ray: Right‑sided Atelectasis

📷 Chest X‑ray (PA view)

Chest X-ray showing right-sided atelectasis with mediastinal shift toward collapse

Figure 1 · PA chest radiograph · Right‑sided Atelectasis

🔍 Key radiographic features:

✓ Volume loss – reduced lung volume on the right side
✓ Mediastinal shift to the right – trachea and heart pulled toward collapse
✓ Crowded vessels and bronchi – increased density in collapsed area
✓ Elevated right hemidiaphragm – due to volume loss
✓ Fissure displacement – horizontal fissure pulled downward

📋 Clinical scenario (examiner prompt)

A 6‑year‑old child with a history of asthma presents with persistent cough and mild dyspnoea despite bronchodilator therapy. On examination, there are decreased breath sounds on the right side with dullness to percussion. The chest X‑ray (PA view) shows volume loss in the right lung with mediastinal shift to the right.

Asthma history Mediastinal shift to right Volume loss Decreased breath sounds

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the X‑ray and clinical context.

2. Describe the X‑ray findings (volume loss, mediastinal shift to right).

3. Explain the pathophysiology (obstruction → resorption atelectasis).

4. Discuss management (treat asthma, chest physiotherapy, bronchoscopy).

⚠️ Key concept: Atelectasis (collapse of lung tissue) is characterized by mediastinal shift toward the collapsed side (unlike pneumothorax where shift is away). This occurs due to volume loss from airway obstruction or compression. In asthma, mucus plugging is the most common cause of atelectasis.

🎯 Expected answers (for examiners)

• Diagnosis: Right‑sided atelectasis (likely from mucus plug)
• X‑ray findings: Volume loss, mediastinal shift to right, crowded vessels, elevated right hemidiaphragm
• Pathophysiology: Airway obstruction → air absorption → alveolar collapse → volume loss
• Management: Bronchodilators, corticosteroids, chest physiotherapy; bronchoscopy if refractory

⚡ Quick FCPS‑style MCQ

Mediastinal shift toward the collapsed side on chest X‑ray is characteristic of:

A. Atelectasis B. Pneumothorax C. Pleural effusion D. Consolidation

📌 Topic summary ·

Definition
Collapse of lung tissue (volume loss)

Mediastinal shift
Toward the collapsed side

Common cause
Mucus plug (asthma, CF)

X‑ray findings
Crowded vessels, fissure displacement

Treatment
Treat underlying, chest PT, bronchoscopy

vs Pneumothorax
Shift away from collapse

Feature	Atelectasis	Pneumothorax
Mediastinal shift	Toward the collapse	Away from collapse
Lung volume	Decreased	Normal or increased
Vascular markings	Crowded	Absent (pleural air)
Diaphragm	Elevated on affected side	Normal or depressed

🩻 TOACS FCPS Station · Chest X‑ray: Right‑sided Atelectasis

📷 Chest X‑ray (PA view)

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary ·