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SOME RADIOLOGICAL SIGNS
ByDr Ahmed mahmoud fayed
Master degree in chest diseases and TBMansora chest hospital
July 2013
Definition: lucency of bronchus or bronchiole ( linear, tubular or branching) passing through airless lung parenchyma. Importance: indicates that opacity is pulmonary parenchyma not pleural
or mediastinal
Occure in: • Pneumonia•Alveolar He•Alveolar edema•Alveolar proteiniosis•Br.alveolar cell carcinoma•Others lymphoma
infarction non obst. atelectasis
Air Bronchogram
Silhouette sign
Definition: obliteration of the border of Diaphragm or Mediastinum
Occure in: Rt Ht border middle lobe process Lt Ht border Lingula process Diaphragm LL process
Spine sign
Definition: interruption of the progressive increase in lucency of the vertebral bodies from above downward
Occure in: LLL pneumonia
Bulging Fissure sign
Definition: consolidation spreading rapidly, causing lobar expansion and bulging of the adjacent fissure inferiorly.
Occure in: Klebsiella pneumoniae involving the right upper lobe
Deep sulcus sign
Definition: deep fingure like costophrenic angle in supine CXR
Occure in: Pneumothorax
Golden S sign
Definition: Lobe collapse around central mass (Resembles a reverse S shape also referred as
reverse S sign of Golden)
Occure in: highly suspicious of Mg
Halo sign
Definition: ground glass attenuation surround a denser nodule or area of consolidation
Occure in: 1- Hge pulmonary nodule 2- invasive BPA (specially in acute leukaemia)
Reversed halo sign focal rounded GG surrounded by ring of consolidation occure in cryptogenic organizing pneumonia and para coccidiodomycosis
Reverse Halo SignDefinition: focal rounded GG surrounded by ring of consolidation.
Also in: sarcoidosis,para coccidiodomycosisWgener’s granulomatosislymphomatoid granulomatosis
Occur in: relatively specific to a diagnosis of cryptogenic organizing pneumonia
Signet ring sign
Definition: Ring opacity(dilated Br) with adjacent nodular opacity (Pul. A)
Occure in: Bronchiectasis also in reduced pul. Flow as in ch thromb. embolism
Westermark sign
Definition: focal area of oligaemia
Occure in: Pulmonary Embolism
Humpton hump sign
Definition: area of opacity in contact with pleura
Occure in: Pulmonary infarction due to Pulmonary Embolism
Melting ice cube sign
Definition: ice cube melting peripherally to internally
Occure in: Resolving pulm. infarction
CT scan obtained 2 weeks later shows bilateral peripheral opacities (arrows), an appearance typical of resolving pulmonary infarcts. Note that the opacities are not wedge shaped or rounded, as expected with acute infarcts. Infarcts resolve from the periphery inward, like a melting ice cube
Air crecent (“meniscus”) sign
Definition: mass growing in pre excisting cavity or pneumonia undergoes necrosis and cavitation
Occure in: 1- mycetoma 2- infarction 3- others TB Cx W.G
(when occure in immunocompromized invasive BPA patient indicates recovery of the immune sysytem and response of WBCs to infection)
Finger in glove sign
Definition: impaction of the bronchi by mucus, cellular depris, esinophils or fungal hyphae
Occure in: BPA also in bronchiectasis
Continuous diaphragm sign
Definition: continuous lucency outlined Ht base
Occure in: pneumo-mediastinum
Juxta phrenic peak
Definition: triangular shadow obsecure a dome of hemidiaphragm
Occure in: UL collapse
Flat waist sign
Definition: flattening of the contour of aortic knob and main P.A due to Lt ward displacement and rotation of the Ht
Occure in: sever LLL collapse
loss of the medial contour of the left hemidiaphragm, which is known as the silhouette sign. The left lower lobe bronchus has a more vertical course than normal (arrowheads). Leftward displacement and rotation of the heart in left lower lobe collapse results in flattening of the contours of the aortic knob and adjacent main pulmonary artery (arrows),
Luftsichel sign
Definition: hyperlucent sickle surrounds aortic arch on frontal CXR
Occure in: LUL collapse “probably Cx”
German for sickle of air (luft: air sichel: crescent)
CT Angiogram
Definition: blood vessels with in portion of Airless lung on contrast enhanced CT
Occure in:•Lymphoma•Br.alveolar cell carcinoma•infectious Pneumonia
Definition: separation of the visceral and parietal pleuraOccure in: empyema
Split Pleura Sign
1-2-3 SignCharacterized by bilateral hilar and right paratracheal lymphadenopathy
Occure in: Suggestive of sarcoidosis also called Garland triad
Double Density Sign
Right side of the left atrium pushes into adjacent lung Splaying of the carina
•Superior displacement of left main stem bronchus on frontal viewPosterior displacement of left main stem bronchus on lateral view•Posterior displacement of esophagus on barium study
Indicates left atrial enlargement
Fleischner Sign
Enlargement proximal pulmonary arteries on plain film or angiography due to embolus
Commonly in the setting of massive PE
Ring Around Artery Sign
Definition: Lucency along or surrounding RPA Visualized on lateral chest radiographs
Occur in: pneumomediastinum
Occure in: Pneumomediastinum in a neonate.
Definition: normal thymus surrounded by mediastinal air.
Angel wing sign
Well-defined, black line around one or both lateral margins of the heart. This is an optical illusion resulting from overlap of superimposed normal structures
Mach effect
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