Journal reading

Signs in chest imaging

Oktay Algin, Gkhan Gkalp, Uur Topal
Department of Radiology, Uluda University School of Medicine, Bursa, Turkey
Oleh: Arum Sekar Negari

Pembimbing: dr. Freddy Sp.Rad

Abstract
Radiological sign

Signs for Plain film

The air bronchogram sign

Silhouette sign Deep sulcus sign Golden S sign cervicothoracic sign Luftsichel sign scimitar sign doughnut sign Hampton hump sign Westermark sign
juxtaphrenic peak sign Continuous diaphragm sign Air crescent (meniscus) 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

particular object or pattern

suggestive of a group of similar pathologies

reversed halo sign

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

Deep sulcus sign & Continuous diaphragm sign

Deep sulcus sign indicating possible pneumothorax in chest xrays 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 Its 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 Its 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

Its 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