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Deep sulcus signFallen Lung SignCT angiogram signFlat-waist sign
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
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Topic Outline
1. Deep sulcus sign2. Fallen Lung Sign3. CT angiogram sign4. Flat-waist sign
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Deep sulcus sign
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Deep sulcus sign
• Refers to a deep lateral costophrenic angle on a supine CXR.
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What is your diagnosis?
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Deep sulcus sign
• Representing gas collection in a subpulmonary location due to pneumothorax and may be the only sign of it
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Deep Sulcus SignAP position
• Bilateral pneumothorax
• Lucency of the left lateral costophrenic angle
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Supine chest radiograph of a neonate
Deep sulcus sign with abnormal deepening and lucency of the left lateral costophrenic angle ( )∗
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ARDS
• Deep sulcus sign • Right pneumothorax
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Deep Sulcus Sign
Left pneumothorax
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Conclusion
• Deep sulcus sign on a supine radiograph - indicates pneumothorax
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Fallen Lung Sign
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Fallen lung sign
• This sign refers to the appearance of the collapsed lung occurring with a fractured bronchus
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The bronchial fracture
Results in the lung to fall
away from the hilum
Either inferiorly and laterally in an
upright patient
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The bronchial fracture
Results in the lung to fall away from the
hilum
Either inferiorly
and laterally in an upright
patient
Or posteriorly, as seen on
CT in a supine patient
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Fallen lung sign
• Either inferiorly and laterally in an upright patient
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Fallen lung sign
• Or posteriorly, as seen on CT in a supine patient
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Conclusion
• fallen lung sign - indicates a fractured bronchus
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CT Angiogram Sign
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Terminology
• Gray• Low
Attenuation• Radiolucent• Skin and
Muscles
• White• High
Attenuation
• Radiopaque
• Fingres
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The criteria to define the CT angiogram sign are:
1. Pulmonary vessels extending 3 cm or more along a single channel
2. Diffuse homogeneous low attenuation of the consolidated lung parenchyma compared with the attenuation of the chest wall musculature.
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The criteria to define the CT angiogram sign
• Attenuation of Lung consolidation less than Attenuation of chest wall musculature
• 28 HU LC < 74 HU CWM
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The CT angiogram sign is seen on contrast material–enhanced scans
• Results from the normally enhancing pulmonary vessels
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The CT angiogram sign is seen on contrast material–enhanced scans
• Within the low-attenuating consolidated lung parenchyma relative to the chest wall musculature.
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CT Angiogram Sign
• The vessels are prominently seen against a background of low-attenuation material.
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CT Angiogram sign
The CT angiogram sign was initially described as a specific sign of lobar bronchoalveolar cell carcinoma
Specificity can be as high as 92.3%
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CT Angiogram sign
1. Pneumonia2. Pulmonary edema3. Obstructive
pneumonitis due to central lung tumors
4. Lymphoma5. Metastasis from
gastrointestinal carcinomas
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Conclusion: CT angiogram sign
• Enhancing pulmonary vessels against a background of low attenuation material in the lung
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Flat-waist sign المسطح الوسط عالمة
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Flat-waist sign
A symmetrical frontal
CXR
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Flat-waist sign
Refers to the loss of
concavity of the left
heart border
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Flat-waist sign
Due to slight anterior oblique rotation of the heart seen.
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Flat-waist sign
Due in some cases of left lower lobe collapse.
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Flat waist Sign
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Flat waist Sign
Atelectasis LLL
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Conclusion
• Flat waist sign- indicates left lower lobe collapse
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REFERENCES
• 1. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW.
Signs in thoracic imaging. J.Thorac.Imaging 2006;21:76-90
• 2. Webb WR. Thin-section CT of the secondary pulmonary
lobule: anatomy and the image—the 2004 Fleischner
lecture.Radiology. 2006 May;239(2):322-38
• 3. Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich
DP, Remy-Jardin M, Webb WR, Zerhouni EA. Glossary of
terms for CT of the lungs: recommendations of the
Nomenclature Committee of the Fleischner Society.
Radiology 1996;200(2):327-31
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