Signs in chest imaging

Department of Radiology, Uludağ University School of Medicine, Bursa, Turkey

Oktay Algin, Gőkhan Gőkalp, Uğur Topal

Journal reading

Oleh:Arum Sekar Negari

Pembimbing: dr. Freddy Sp.Rad

Radiological sign

particular object or pattern

suggestive of a group of

similar pathologies

Silhouette signDeep sulcus

signGolden S sign

cervicothoracic sign

Luftsichel sign

scimitar sign

doughnut signHampton hump

signWestermark signjuxtaphrenic peak sign

Signs for CT

the gloved finger sign

CT halo sign

signet ring sign

comet tail sign

CT angiogram sign

crazy paving pattern

tree-in-bud sign

feeding vessel sign

split pleura sign

reversed halo sign

The air bronchogram sign

Continuous diaphragm sign

Air crescent (“meniscus”) sign

Signs for Plain film

Abstract

Signs for Plain Film

Air bronchogram sign

• Frequently encountered in pneumonia and pulmonary edema

• It shows that the central bronchi are not obstructed or half obstruction Bronchioalveolar Ca, Lymphoma, Interstitial fibrosis, Alveolar hemorhage, fibrosis due to radiation & sarcoidosis

Silhouette sign- Important sign indicating the localization of a lesion

“Hilum overlay sign”

Pericardial cyst

Deep sulcus sign & Continuous diaphragm sign

• Deep sulcus sign indicating possible pneumothorax in chest x-rays obtained in supine position

• Continuous diaphragm sign occurs as a result of continuation of mediastinal air accumulated at the lower border of the heart with both hemidiaphragms

Air crescent (“meniscus”) sign

• As the result of air accumulation between a mass or nodule and normal lung parenchyma

• Most frequently encountered in invasive aspergillosis• Other causes intracavitary fungus ball (mycetoma), hydatid

cyst with bronchial involvement, hematoma, abscess, necrotizing pneumonia, cystic bronchiectasis filled with mucus plugs and papillomatosis

Golden S sign

• Encountered when there is right upper lobe atelectasis due to a centrally located mass

• It’s an important clue indicating a central mass obstructing the bronchus

Cervicothoracic sign

• This sign is used to describe the location of a lesion at the inlet of the thoracic cavity

• Frontal radiograph of the chest demonstrating a mass with a distinct cranial border projecting above the level of the clavicles, supporting a posterior mediastinal location

Luftsichel sign

•A patient with a centrally located mass at the left lung. Frontal chest radiograph demonstrates volume loss due to left upper lobe atelectasis

•The crescent-shaped radiolucency around the aortic arch is called the luftsichel sign

Scimitar sign

• Frontal radiograph of a patient with hypogenetic lung syndrome. The abnormal inferior pulmonary vein is seen as a tubular opacity parallelling the right border of the heart

Doughnut sign

•Occurs when mediastinal lymphadenomegaly oocurs behind the bronchus intermedius in subcarinal region.

Hampton hump sign

•Wedge-shaped, pleura based consolidation with a rounded convex apex directed toward the hilus

•Usually encountered at the lower lobes & heals with scar formation

Westermark sign

• Describes a decrease vascularization at the periphery of the lungs due to mechanical obstruction or reflex vasoconstriction in pulmonary embolism (oligemia)

Juxtaphrenic peak sign

• Occurs in upper lobe atelectasis triangular opacity projecting superiorly at the medial half of the diapraghm

Signs for CT scan

CT Halo sign

•Represents an area of ground-glass attenuation surrounding a pulmonary nodule or mass on CT images

•Most commonly in the early stage of invasive aspergillosis in immunocompromised patients

The gloved finger sign

•Characterized by branching tubular or finger-like soft tissue densities

•This appearance is formed by dilated bronchi filled with mucus (mucoid impaction)

Signet ring sign

• Occurs when the bronchoarterial ratio is increased (>1)

• Usually seen in patients with bronchiectasis or irreversible abnormal bronchial dilatation

Comet tail sign

•Characteristic features of round atelectasis•It’s refers to Curvilinear opacities that

extend from a subpleural “mass” toward the hilum

CT angiogram sign• It consists of

enhancing pulmonary vessels in a homogenous low attenuating consolidation of lung parenchyma relative to the chest wall musculature at the mediastinal window

Crazy paving pattern• Patient with situs

inversus and kartagener syndrome showing diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines in both lungs.

• The cause of diffuse parenchymal disease in this patient was alveolar proteinosis

Tree-in-bud sign• Initially, this sign was described in cases with transbronchial

spread of Mycobacterium tuberculosis• The tree-in-bud pattern is characterized by small

centrilobular nodules connected to multipe branching linear structures of similar caliber originating from a single stalk

Feeding vessel sign•It consists of a

distinct vessel leading directly to a nodule or a mass

•Patient with bronchial Ca pulmonary artery leading directly to the mass

Split pleura sign

•It’s characterized by thickened pleural layers separated by fluid

•This sign is found primarily in empyema but also frequently seen in hemothorax and talc pleurodesis

Reversed halo sign

• Lung window CT image of a patient with invasive pulmonary fungal infection shows reversed halo sign (central ground-glass opacity & surrounding air-space consolidation of crescent and ring shapes)

Sekian & Terima Kasih