Definition

• Bulging of the minor fissure below its normal, roughly horizontal position at the level of the 4th rib anteriorly) due to increased volume of the RUL

Etiology

• Post-Obstructive Pneumonia Associated with Bronchogenic Carcinoma (see Pneumonia):
• Bronchioloalveolar Cell Carcinoma (see Bronchioloalveolar Cell Carcinoma)
• Klebsiella pneumoniae (see Klebsiella Pneumoniae): 62% of cases
• Streptococcus pneumoniae (See Streptococcus Pneumoniae): 14% of cases
• Acinetobacter calcoaceticus var. anitratus (see Acinetobacter): occasional
• Haemophilus influenzae (see Haemophilus Influenzae): occasional
• Yersinia pestis (see Yersinia Pestis): occasional
• Tuberculosis (see Tuberculosis): occasional

Diagnosis

Prognosis

• Bulging fissures have no prognostic significance

References

• The diagnostic and prognostic significance of bulging fissures in acute lobar pneumonia. Aust NZ J Med 1988; 18:130-133
• Complications of Klebsiella pneumoniae: CT evaluation. J Comput Assist Tomogr 1995; 19:176-181
• Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163:1730-1754
• The pathophysiology and treatment of sepsis. N Engl J Med 2003; 348:138-150
• Treating patients with severe sepsis. N Engl J Med 1999; 340:207-214