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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