SHËNJAT RADIOLOGJIKE PULMONARE

7/27/2019 SHNJAT RADIOLOGJIKE PULMONARE

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Sllavko K. Kallfa

SHNJAT

RADIOLOGJIKE

PULMONARE(Prmbledhje Artikujsh nga Radiopaedia.org)


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X-Ray Pulmonary signs

big rib sign f. 3

Chang's sign f. 4 coin lesion. f. 5

dense hilum sign f.12

double contour sign f.16

extrapleural sign f.21

hilum overlay sign f.22

hilum convergence sign f.33

holly leaf sign f.36

finger in glove sign f.41

flat waist sign f.47

Fleishner's sign f.48

ginkgo leaf sign f.50

Golden S sign f.53

incomplete border sign f.60

juxtaphrenic peak sign f.62

medial stripe sign f.66

more black sign f.69

Naclerio's V sign f.80

Shmoo sign f.81

silhouette sign f.82

o cervicothoracic sign f.84

o thoraco-abdominal sign f.85

steeple sign f.86

spinnaker sign f.90
http://radiopaedia.org/articles/big-rib-signhttp://radiopaedia.org/articles/big-rib-signhttp://radiopaedia.org/articles/changs-sign-1http://radiopaedia.org/articles/changs-sign-1http://radiopaedia.org/articles/coin-lesionhttp://radiopaedia.org/articles/coin-lesionhttp://radiopaedia.org/articles/dense-hilum-sign-2http://radiopaedia.org/articles/dense-hilum-sign-2http://radiopaedia.org/articles/double-density-sign-of-left-atrial-enlargementhttp://radiopaedia.org/articles/double-density-sign-of-left-atrial-enlargementhttp://radiopaedia.org/articles/extrapleural-sign-1http://radiopaedia.org/articles/extrapleural-sign-1http://radiopaedia.org/articles/hilum-overlay-signhttp://radiopaedia.org/articles/hilum-overlay-signhttp://radiopaedia.org/articles/hilum-convergence-signhttp://radiopaedia.org/articles/hilum-convergence-signhttp://radiopaedia.org/articles/holly-leaf-signhttp://radiopaedia.org/articles/holly-leaf-signhttp://radiopaedia.org/articles/finger-in-glove-signhttp://radiopaedia.org/articles/finger-in-glove-signhttp://radiopaedia.org/articles/flat-waist-sign-2http://radiopaedia.org/articles/flat-waist-sign-2http://radiopaedia.org/articles/fleishners-signhttp://radiopaedia.org/articles/fleishners-signhttp://radiopaedia.org/articles/ginkgo-leaf-signhttp://radiopaedia.org/articles/ginkgo-leaf-signhttp://radiopaedia.org/articles/golden-s-signhttp://radiopaedia.org/articles/golden-s-signhttp://radiopaedia.org/articles/incomplete-border-signhttp://radiopaedia.org/articles/incomplete-border-signhttp://radiopaedia.org/articles/juxtaphrenic-peak-signhttp://radiopaedia.org/articles/juxtaphrenic-peak-signhttp://radiopaedia.org/articles/medial-stripe-signhttp://radiopaedia.org/articles/medial-stripe-signhttp://radiopaedia.org/articles/more-black-signhttp://radiopaedia.org/articles/more-black-signhttp://radiopaedia.org/articles/naclerios-v-sign-2http://radiopaedia.org/articles/naclerios-v-sign-2http://radiopaedia.org/articles/shmoo-signhttp://radiopaedia.org/articles/shmoo-signhttp://radiopaedia.org/articles/cervico-thoracic-sign-1http://radiopaedia.org/articles/cervico-thoracic-sign-1http://radiopaedia.org/articles/thoracoabdominal-signhttp://radiopaedia.org/articles/thoracoabdominal-signhttp://radiopaedia.org/articles/steeple-signhttp://radiopaedia.org/articles/steeple-signhttp://radiopaedia.org/articles/spinnaker-signhttp://radiopaedia.org/articles/spinnaker-signhttp://radiopaedia.org/articles/spinnaker-signhttp://radiopaedia.org/articles/steeple-signhttp://radiopaedia.org/articles/thoracoabdominal-signhttp://radiopaedia.org/articles/cervico-thoracic-sign-1http://radiopaedia.org/articles/shmoo-signhttp://radiopaedia.org/articles/naclerios-v-sign-2http://radiopaedia.org/articles/more-black-signhttp://radiopaedia.org/articles/medial-stripe-signhttp://radiopaedia.org/articles/juxtaphrenic-peak-signhttp://radiopaedia.org/articles/incomplete-border-signhttp://radiopaedia.org/articles/golden-s-signhttp://radiopaedia.org/articles/ginkgo-leaf-signhttp://radiopaedia.org/articles/fleishners-signhttp://radiopaedia.org/articles/flat-waist-sign-2http://radiopaedia.org/articles/finger-in-glove-signhttp://radiopaedia.org/articles/holly-leaf-signhttp://radiopaedia.org/articles/hilum-convergence-signhttp://radiopaedia.org/articles/hilum-overlay-signhttp://radiopaedia.org/articles/extrapleural-sign-1http://radiopaedia.org/articles/double-density-sign-of-left-atrial-enlargementhttp://radiopaedia.org/articles/dense-hilum-sign-2http://radiopaedia.org/articles/coin-lesionhttp://radiopaedia.org/articles/changs-sign-1http://radiopaedia.org/articles/big-rib-sign


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water bottle sign f.96

wave sign f.100

Westermark's sign f.103

Big rib sign

Dr Henry KnipeandDr M Venkateshet al.

Thebig rib signis a sign to differentiate right and leftribson lateral chest radiographs.

It exploits a technique of magnification differences on lateral projections between right and left

ribs. For example, on right lateral projections the left ribs appear larger than right ribs.

This sign can be useful but may be difficult to appreciate as the difference in size between ribs is~10% and is not applicable when the posterior ribs are superimposed.

References

1. Kurihara Y, Yakushiji YK, Matsumoto J et-al. The ribs: anatomic and radiologic considerations.

Radiographics. 1999;19 (1): 105-19.Radiographics (full text)-Pubmed citation
http://radiopaedia.org/articles/water-bottle-signhttp://radiopaedia.org/articles/water-bottle-signhttp://radiopaedia.org/articles/wave-sign-2http://radiopaedia.org/articles/wave-sign-2http://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/mvenkateshhttp://radiopaedia.org/users/mvenkateshhttp://radiopaedia.org/users/mvenkateshhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=ribshttp://radiopaedia.org/articles/missing?article%5Btitle%5D=ribshttp://radiopaedia.org/articles/missing?article%5Btitle%5D=ribshttp://radiographics.rsna.org/content/19/1/105.fullhttp://radiographics.rsna.org/content/19/1/105.fullhttp://radiographics.rsna.org/content/19/1/105.fullhttp://www.ncbi.nlm.nih.gov/pubmed/9925395http://www.ncbi.nlm.nih.gov/pubmed/9925395http://www.ncbi.nlm.nih.gov/pubmed/9925395http://www.ncbi.nlm.nih.gov/pubmed/9925395http://radiographics.rsna.org/content/19/1/105.fullhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=ribshttp://radiopaedia.org/users/mvenkateshhttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/articles/wave-sign-2http://radiopaedia.org/articles/water-bottle-sign


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Chang's sign

Dr Yuranga WeerakkodyandDr Henry Knipeet al.

Changs signrefers to a dilatation and abrupt change in calibre of a mainpulmonary arteryduetopulmonary embolism

1.

References References

1. Plain Film Signs in Pulmonary Embolism (with CT correlate), Kirwadi A, Bickle IC.

http://www.eurorad.org/eurorad/case.php?id=7735Eurorad case 7735

Synonyms & Alternative Spellings

Synonyms or Alternative SpellingInclude in Listings?

Chang sign

Changs sign
http://radiopaedia.org/users/weer06http://radiopaedia.org/users/weer06http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://www.eurorad.org/eurorad/case.php?id=7735http://www.eurorad.org/eurorad/case.php?id=7735http://www.eurorad.org/eurorad/case.php?id=7735http://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/weer06


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Coin lesion

Dr Henry Knipeet al.

Coin lesionrefers to a round or oval, well-circumscribedsolitary pulmonary lesion.It istypically 1-5 cm in diameter and calcification may or may not be present

1,3. Typically but not

always the patient is asymptomatic1

.

Differential diagnosis

The differential diagnosis for such lesions is1-3

:

primary lung malignancy- e.g. squamous cell carcinoma

metastases

infection

o pulmonary tuberculosis;

o Streptococcus sp., Staphlycoccus sp., or Klebisialla sp.infection

o

hydatid cysto abscess

benign disease processes

o Wegener's granulomatosis

o pulmonary hamartoma

o pulmonary arteriovenous malformation

o rheumatoid nodule

o bronchogenic cyst

o bronchial adenoma

Take care not to call a "pseudo-coin lesion", which are caused byartifacts(e.g. button on

patient's clothing, unilateralnipple shadow,etc).

See also

solitary pulmonary nodule
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-manifestations-of-tuberculosishttp://radiopaedia.org/articles/pulmonary-manifestations-of-tuberculosishttp://radiopaedia.org/articles/hydatid-diseasehttp://radiopaedia.org/articles/hydatid-diseasehttp://radiopaedia.org/articles/lung-abscesshttp://radiopaedia.org/articles/lung-abscesshttp://radiopaedia.org/articles/pulmonary-manifestations-of-granulomatosis-with-polyangitis-1http://radiopaedia.org/articles/pulmonary-manifestations-of-granulomatosis-with-polyangitis-1http://radiopaedia.org/articles/pulmonary-hamartoma-1http://radiopaedia.org/articles/pulmonary-hamartoma-1http://radiopaedia.org/articles/pulmonary-arteriovenous-malformationhttp://radiopaedia.org/articles/pulmonary-arteriovenous-malformationhttp://radiopaedia.org/articles/rheumatoid-noduleshttp://radiopaedia.org/articles/rheumatoid-noduleshttp://radiopaedia.org/articles/bronchogenic-cysthttp://radiopaedia.org/articles/bronchogenic-cysthttp://radiopaedia.org/articles/bronchial-carcinoid-tumourhttp://radiopaedia.org/articles/bronchial-carcinoid-tumourhttp://radiopaedia.org/articles/x-ray-artifactshttp://radiopaedia.org/articles/x-ray-artifactshttp://radiopaedia.org/articles/x-ray-artifactshttp://radiopaedia.org/articles/nipple-shadowshttp://radiopaedia.org/articles/nipple-shadowshttp://radiopaedia.org/articles/nipple-shadowshttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/articles/nipple-shadowshttp://radiopaedia.org/articles/x-ray-artifactshttp://radiopaedia.org/articles/bronchial-carcinoid-tumourhttp://radiopaedia.org/articles/bronchogenic-cysthttp://radiopaedia.org/articles/rheumatoid-noduleshttp://radiopaedia.org/articles/pulmonary-arteriovenous-malformationhttp://radiopaedia.org/articles/pulmonary-hamartoma-1http://radiopaedia.org/articles/pulmonary-manifestations-of-granulomatosis-with-polyangitis-1http://radiopaedia.org/articles/lung-abscesshttp://radiopaedia.org/articles/hydatid-diseasehttp://radiopaedia.org/articles/pulmonary-manifestations-of-tuberculosishttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/solitary-pulmonary-noduleshttp://radiopaedia.org/users/henryknipe


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References



Coin lesions

Pulmonary coin lesion

From the case:Pulmonary coin lesion

Modality: X-ray
http://radiopaedia.org/cases/pulmonary-coin-lesionhttp://radiopaedia.org/cases/pulmonary-coin-lesionhttp://radiopaedia.org/cases/pulmonary-coin-lesionhttp://radiopaedia.org/cases/pulmonary-coin-lesion


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From the case:Coin lesion (lung adenocarcinoma)
http://radiopaedia.org/cases/coin-lesion-lung-adenocarcinomahttp://radiopaedia.org/cases/coin-lesion-lung-adenocarcinomahttp://radiopaedia.org/cases/coin-lesion-lung-adenocarcinomahttp://radiopaedia.org/cases/coin-lesion-lung-adenocarcinoma


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Modality: X-ray

From the case:Coin lesion - breast cancer metastasis

Modality: X-ray
http://radiopaedia.org/cases/coin-lesion-breast-cancer-metastasishttp://radiopaedia.org/cases/coin-lesion-breast-cancer-metastasishttp://radiopaedia.org/cases/coin-lesion-breast-cancer-metastasishttp://radiopaedia.org/cases/coin-lesion-breast-cancer-metastasis


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From the case:Coin lesion - colorectal carcinoma metastasis

Modality: X-ray
http://radiopaedia.org/cases/coin-lesion-colorectal-carcinoma-metastasishttp://radiopaedia.org/cases/coin-lesion-colorectal-carcinoma-metastasishttp://radiopaedia.org/cases/coin-lesion-colorectal-carcinoma-metastasishttp://radiopaedia.org/cases/coin-lesion-colorectal-carcinoma-metastasis


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Imaging Differential Diagnosis

From the

case:Pseudo-coin lesion due to button

Modality: X-ray
http://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-button


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From the case:Pseudo-

coin lesion due to button

Modality: X-ray
http://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-buttonhttp://radiopaedia.org/cases/pseudo-coin-lesion-due-to-button


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Dense hilum sign

Dr Henry KnipeandDr Paresh K Desai et al.

The dense hilum signsuggests a pathological process at thehilum- hilar malignancy orbronchogenic carcinomashould be suspected.

On a well-centred chest PA radiograph the density of the hilum is comparable on both sides. Inabsence of calcification oradenopathy,the hila should appear of equal density and be symmetric.

References

1. Khan MIG. On Call Cardiology: On Call Series. Saunders. ISBN:1416025375.Read it at Google

Books-Find it at Amazon

2. Armstrong P, Wilson AG, Dee P et-al. Imaging of diseases of the chest. Mosby-Year Book.

ISBN:0815100116.Read it at Google Books-Find it at Amazon

3. Desai SR, Copley SJ, Aziz ZA et-al. Thoracic Imaging (Oxford Specialist Handbooks in

Radiology). Oxford University Press, USA. ISBN:0199560471.Read it at Google Books-Find it at

Amazon
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/mailpkdhttp://radiopaedia.org/users/mailpkdhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/missing?article%5Btitle%5D=hilar-adenopathyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilar-adenopathyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilar-adenopathyhttp://books.google.com/books?vid=ISBN1416025375http://books.google.com/books?vid=ISBN1416025375http://books.google.com/books?vid=ISBN1416025375http://books.google.com/books?vid=ISBN1416025375http://www.amazon.com/gp/product/1416025375http://www.amazon.com/gp/product/1416025375http://www.amazon.com/gp/product/1416025375http://books.google.com/books?vid=ISBN0815100116http://books.google.com/books?vid=ISBN0815100116http://books.google.com/books?vid=ISBN0815100116http://www.amazon.com/gp/product/0815100116http://www.amazon.com/gp/product/0815100116http://www.amazon.com/gp/product/0815100116http://books.google.com/books?vid=ISBN0199560471http://books.google.com/books?vid=ISBN0199560471http://books.google.com/books?vid=ISBN0199560471http://www.amazon.com/gp/product/0199560471http://www.amazon.com/gp/product/0199560471http://www.amazon.com/gp/product/0199560471http://www.amazon.com/gp/product/0199560471http://www.amazon.com/gp/product/0199560471http://www.amazon.com/gp/product/0199560471http://books.google.com/books?vid=ISBN0199560471http://www.amazon.com/gp/product/0815100116http://books.google.com/books?vid=ISBN0815100116http://www.amazon.com/gp/product/1416025375http://books.google.com/books?vid=ISBN1416025375http://books.google.com/books?vid=ISBN1416025375http://radiopaedia.org/articles/missing?article%5Btitle%5D=hilar-adenopathyhttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/users/mailpkdhttp://radiopaedia.org/users/henryknipe


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Dense

right hilum

From the case:Lung carcinoma with vertebral metastasis

Modality: X-ray
http://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasishttp://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasishttp://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasishttp://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasis


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left psoas bulgeFrom the case:Lung carcinoma with vertebral metastasis

Modality: X-ray
http://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasishttp://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasishttp://radiopaedia.org/cases/lung-carcinoma-with-vertebral-metastasis


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Necrotic mass in the right

hilum


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Double density sign of left atrial enlargement

Dr Jeremy JonesandDr Frank Gaillardet al.

A double-density signis seen on frontal chest radiographs in the presence ofleft atrialenlargement,and occurs when the right side of the left atrium pushes behind the right cardiacshadow, indenting the adjacent lung and forming its own distinct silhouette

1-3.

If large enough it can actually reach beyond the border of the right atrium; this is known asatrial

escape.3 The right superior pulmonary vein can lead to a similar appearance

1

See also

double density sign of osteoid osteomas

double density sign of berry aneurysms


Synonyms

or

Alternativ

e Spelling

Include in Listings?

Doublecontour

sign

Double

contour

sign of left

atrial

enlargeme

nt
http://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/double-density-sign-of-osteoid-osteomashttp://radiopaedia.org/articles/double-density-sign-of-osteoid-osteomashttp://radiopaedia.org/articles/double-density-sign-of-berry-aneurysmshttp://radiopaedia.org/articles/double-density-sign-of-berry-aneurysmshttp://radiopaedia.org/articles/double-density-sign-of-berry-aneurysmshttp://radiopaedia.org/articles/double-density-sign-of-osteoid-osteomashttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/atrial-escapehttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/articles/left-atrial-enlargementhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/drjermy


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Synonyms

or

Alternativ

e Spelling

Include in Listings?

Right

retrocardia

c double

density

From the case:Left atrial enlargement
http://radiopaedia.org/cases/left-atrial-enlargement-5http://radiopaedia.org/cases/left-atrial-enlargement-5http://radiopaedia.org/cases/left-atrial-enlargement-5http://radiopaedia.org/cases/left-atrial-enlargement-5


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Modality: X-ray


Modality: Annotated imag


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Modality: Annotated imag


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Extrapleural sign

Dr Henry KnipeandDr Matt Skalskiet al.

The extrapleural sign, described by Felson in 19731

, refers to the appearance of apulmonaryopacitywith oblique margins that taper slowly to the chest wall when the lesion is viewedtangentially to the x-ray beam. This appearance suggests that the lesion is extrapleural in nature,

as opposed to intrapulmonary where an acute angle would be expected as the lesion meets the

lung periphery. This term may be confused withextrapleural air signwhich refers to a differentfinding.

References

1. Felson B. Chest roentgenology. W.B. Saunders Company. ISBN:0721635911.Read it at Google

Books-Find it at Amazon

2. Principles and Interpretation of Chest X-rays. Orient Longman Limited. (2007)


3. Shields TW, LoCicero J, Reed CE et-al. General Thoracic Surgery. Lippincott Williams & Wilkins.

(2011) ISBN:1451152787.Read it at Google Books-Find it at Amazon
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/docskalskihttp://radiopaedia.org/users/docskalskihttp://radiopaedia.org/users/docskalskihttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/articles/extrapleural-air-signhttp://radiopaedia.org/articles/extrapleural-air-signhttp://books.google.com/books?vid=ISBN0721635911http://books.google.com/books?vid=ISBN0721635911http://books.google.com/books?vid=ISBN0721635911http://books.google.com/books?vid=ISBN0721635911http://www.amazon.com/gp/product/0721635911http://www.amazon.com/gp/product/0721635911http://www.amazon.com/gp/product/0721635911http://books.google.com/books?vid=ISBN8125030069http://books.google.com/books?vid=ISBN8125030069http://books.google.com/books?vid=ISBN8125030069http://www.amazon.com/gp/product/8125030069http://www.amazon.com/gp/product/8125030069http://www.amazon.com/gp/product/8125030069http://books.google.com/books?vid=ISBN1451152787http://books.google.com/books?vid=ISBN1451152787http://books.google.com/books?vid=ISBN1451152787http://www.amazon.com/gp/product/1451152787http://www.amazon.com/gp/product/1451152787http://www.amazon.com/gp/product/1451152787http://www.amazon.com/gp/product/1451152787http://books.google.com/books?vid=ISBN1451152787http://www.amazon.com/gp/product/8125030069http://books.google.com/books?vid=ISBN8125030069http://www.amazon.com/gp/product/0721635911http://books.google.com/books?vid=ISBN0721635911http://books.google.com/books?vid=ISBN0721635911http://radiopaedia.org/articles/extrapleural-air-signhttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/articles/pulmonary-opacificationhttp://radiopaedia.org/users/docskalskihttp://radiopaedia.org/users/henryknipe


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Hilum overlay sign

Dr Henry KnipeandDr Frank Gaillardet al.

The hilum overlay signrefers to an appearance on frontal chest radiographs of patients with amass projected at the level of the hilum which is in fact either anterior or posterior to the hilum.

When a mass arises from the hilum, the pulmonary vessels are in contact with the mass and assuch their silhouette is obliterated. The ability to see the edges of the vessels through the mass

implies that the mass is not contacting the hilum, and is therefore either anterior or posterior to it.

Most of these masses are found to be in theanterior mediastinum.

The sign was first described byBenjamin Felson2.

References

1. Coche EE, Ghaye B, Mey JD. Comparative Interpretation of CT and Standard Radiography of

the Chest. Springer Verlag. (2010) ISBN:3540799419.Read it at Google Books-Find it at Amazon

2. George PP, Irodi A, Nidugala Keshava S et-al. 'Felson Signs' revisited. J Med Imaging Radiat

Oncol. 2014;58 (1): 64-74.doi:10.1111/1754-9485.12031-Pubmed citation
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/articles/anterior-mediastinumhttp://radiopaedia.org/articles/anterior-mediastinumhttp://radiopaedia.org/articles/anterior-mediastinumhttp://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/benjamin-felsonhttp://books.google.com/books?vid=ISBN3540799419http://books.google.com/books?vid=ISBN3540799419http://books.google.com/books?vid=ISBN3540799419http://www.amazon.com/gp/product/3540799419?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3540799419http://www.amazon.com/gp/product/3540799419?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3540799419http://www.amazon.com/gp/product/3540799419?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3540799419http://dx.doi.org/10.1111/1754-9485.12031http://dx.doi.org/10.1111/1754-9485.12031http://dx.doi.org/10.1111/1754-9485.12031http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://dx.doi.org/10.1111/1754-9485.12031http://www.amazon.com/gp/product/3540799419?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3540799419http://books.google.com/books?vid=ISBN3540799419http://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/anterior-mediastinumhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/henryknipe


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From the case:Lymphoma - mediastinal

Modality: Annotated image
http://radiopaedia.org/cases/lymphoma-mediastinalhttp://radiopaedia.org/cases/lymphoma-mediastinalhttp://radiopaedia.org/cases/lymphoma-mediastinalhttp://radiopaedia.org/cases/lymphoma-mediastinal


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From the case:Mediastinal lipoma
http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1


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From the case:Mediastinal lipoma

http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1http://radiopaedia.org/cases/mediastinal-lipoma-1


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From the case:Mediastinal lymphoma

Modality: X-ray
http://radiopaedia.org/cases/mediastinal-lymphoma-3http://radiopaedia.org/cases/mediastinal-lymphoma-3http://radiopaedia.org/cases/mediastinal-lymphoma-3http://radiopaedia.org/cases/mediastinal-lymphoma-3


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From the case:Ascending aortic aneurysm

Modality: X-ray
http://radiopaedia.org/cases/ascending-aortic-aneurysm-3http://radiopaedia.org/cases/ascending-aortic-aneurysm-3http://radiopaedia.org/cases/ascending-aortic-aneurysm-3http://radiopaedia.org/cases/ascending-aortic-aneurysm-3


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From the case:Lung hilar mass - unknown histology

Modality: X-ray
http://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histology


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From the case:Lung hilar mass - unknown histology

Modality: X-ray
http://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histologyhttp://radiopaedia.org/cases/lung-hilar-mass-unknown-histology


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From the case:Hilum overlay and loss of more black signs - colorectal carcinoma metastases

Modality: X-ray
http://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastaseshttp://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastaseshttp://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastaseshttp://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastases


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Hilum convergence sign

Dr Henry KnipeandDr Andrew Dixonet al.

The hilum convergence signis a useful chest radiograph sign to help distinguish a bulky hilumdue topulmonary artery dilatationfrom a mass/nodal enlargement. In the former, pulmonaryvessels can be seen to converge and join a dilated pulmonary artery.

The sign was first described byBenjamin Felson2.

References

1. Parker MS, Chasen MH, Paul N. Radiologic signs in thoracic imaging: case-based review and

self-assessment module. AJR Am J Roentgenol. 2009;192 (3): S34-48.doi:10.2214/AJR.07.7081-

Pubmed citation

2. George PP, Irodi A, Nidugala Keshava S et-al. 'Felson Signs' revisited. J Med Imaging Radiat

Oncol. 2014;58 (1): 64-74.doi:10.1111/1754-9485.12031-Pubmed citation
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/dixonahttp://radiopaedia.org/users/dixonahttp://radiopaedia.org/users/dixonahttp://radiopaedia.org/articles/differential-of-an-enlarged-pulmonary-trunk-on-chest-radiographyhttp://radiopaedia.org/articles/differential-of-an-enlarged-pulmonary-trunk-on-chest-radiographyhttp://radiopaedia.org/articles/differential-of-an-enlarged-pulmonary-trunk-on-chest-radiographyhttp://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/benjamin-felsonhttp://dx.doi.org/10.2214/AJR.07.7081http://dx.doi.org/10.2214/AJR.07.7081http://dx.doi.org/10.2214/AJR.07.7081http://www.ncbi.nlm.nih.gov/pubmed/19234288http://www.ncbi.nlm.nih.gov/pubmed/19234288http://dx.doi.org/10.1111/1754-9485.12031http://dx.doi.org/10.1111/1754-9485.12031http://dx.doi.org/10.1111/1754-9485.12031http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://www.ncbi.nlm.nih.gov/pubmed/24529057http://dx.doi.org/10.1111/1754-9485.12031http://www.ncbi.nlm.nih.gov/pubmed/19234288http://dx.doi.org/10.2214/AJR.07.7081http://radiopaedia.org/articles/benjamin-felsonhttp://radiopaedia.org/articles/differential-of-an-enlarged-pulmonary-trunk-on-chest-radiographyhttp://radiopaedia.org/users/dixonahttp://radiopaedia.org/users/henryknipe


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From the case:Pulmonary arterial hypertension - primary

Modality: X-ray
http://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primary


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From the case:Pulmonary arterial hypertension - primary

Modality: X-ray
http://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primaryhttp://radiopaedia.org/cases/pulmonary-arterial-hypertension-primary


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Holly leaf sign


The holly leaf signrefers to the appearance ofpleural plaqueson chest x-rays. Their irregularthickened nodular edges are likened to the appearance of a holly leaf.



Holly leaf appearance
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From the case:Holly leaf

Modality: Photo
http://radiopaedia.org/cases/holly-leafhttp://radiopaedia.org/cases/holly-leafhttp://radiopaedia.org/cases/holly-leafhttp://radiopaedia.org/cases/holly-leaf


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From the case:Pleural plaques

Modality: X-ray
http://radiopaedia.org/cases/pleural-plaqueshttp://radiopaedia.org/cases/pleural-plaqueshttp://radiopaedia.org/cases/pleural-plaqueshttp://radiopaedia.org/cases/pleural-plaques


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From the case:Calcified pleural plaques
http://radiopaedia.org/cases/calcified-pleural-plaques-1http://radiopaedia.org/cases/calcified-pleural-plaques-1http://radiopaedia.org/cases/calcified-pleural-plaques-1http://radiopaedia.org/cases/calcified-pleural-plaques-1


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Modality: X-ray

From the case:Calcified pleural plaques

Modality: X-ray
http://radiopaedia.org/cases/calcified-pleural-plaques-3http://radiopaedia.org/cases/calcified-pleural-plaques-3http://radiopaedia.org/cases/calcified-pleural-plaques-3http://radiopaedia.org/cases/calcified-pleural-plaques-3


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Finger in glove sign

Dr Henry KnipeandDr Jeremy Joneset al.

The finger in glovesign seen on CXR and CT chest and refers to the characteristic sign of abronchocoele.The same appearance has also been referred to as:

rabbit ear appearance

mickey mouse appearance

toothpaste shaped opacities

Y-shaped opacities

V-shaped opacities

Pathology

Aetiology

Obstructive

In bronchial obstruction, the portion of the bronchus distal to the obstruction is dilated with the

presence of mucous secretions. Causes of bronchial obstruction include :

hamartoma

lipoma

carcinoid

carcinoma

congenitalbronchial atresia(rarely)

Non obstructive

Causes include :

asthma

allergic bronchopulmonary aspergillosis (ABPA)

cystic fibrosis



Finger in glove appearance
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/articles/bronchocoelehttp://radiopaedia.org/articles/bronchocoelehttp://radiopaedia.org/articles/mickey-mouse-appearancehttp://radiopaedia.org/articles/mickey-mouse-appearancehttp://radiopaedia.org/articles/bronchial_atresiahttp://radiopaedia.org/articles/bronchial_atresiahttp://radiopaedia.org/articles/bronchial_atresiahttp://radiopaedia.org/articles/asthma-1http://radiopaedia.org/articles/asthma-1http://radiopaedia.org/articles/allergic-bronchopulmonary-aspergillosishttp://radiopaedia.org/articles/allergic-bronchopulmonary-aspergillosishttp://radiopaedia.org/articles/cystic-fibrosishttp://radiopaedia.org/articles/cystic-fibrosishttp://radiopaedia.org/articles/cystic-fibrosishttp://radiopaedia.org/articles/allergic-bronchopulmonary-aspergillosishttp://radiopaedia.org/articles/asthma-1http://radiopaedia.org/articles/bronchial_atresiahttp://radiopaedia.org/articles/mickey-mouse-appearancehttp://radiopaedia.org/articles/bronchocoelehttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/henryknipe


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Finger-in-glove sign

Rabbit ear appearance

Y-shaped opacities

V-shaped opacities

Gloved finger sign


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From the case:Allergic bronchopulmonary aspergillosis (ABPA)
http://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpa-1http://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpa-1http://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpa-1http://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpa-1


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Modality: X-ray

Glove Image courtesy of Werneuchen. Please see case description page for licence and original file

information.


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Finger in glove appearance of

ABPA


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Finger in glove appearance of ABPAFrom the case:Allergic bronchopulmonary aspergillosis (ABPA)From

the case:Allergic bronchopulmonary aspergillosis (ABPA)

Modality: CT
http://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpahttp://radiopaedia.org/cases/allergic-bronchopulmonary-aspergillosis-abpa


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Flat waist sign

Dr Henry KnipeandDr Vinod G Malleret al.

The flat waist signrefers to flattening of the contours of theaortic archand adjacent mainpulmonary artery.It is seen in severeleft lower lobe collapseand is caused by leftwarddisplacement and rotation of the heart.
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/vinodmallerhttp://radiopaedia.org/users/vinodmallerhttp://radiopaedia.org/users/vinodmallerhttp://radiopaedia.org/articles/aortic_archhttp://radiopaedia.org/articles/aortic_archhttp://radiopaedia.org/articles/aortic_archhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/left-lower-lobe-collapsehttp://radiopaedia.org/articles/left-lower-lobe-collapsehttp://radiopaedia.org/articles/left-lower-lobe-collapsehttp://radiopaedia.org/articles/left-lower-lobe-collapsehttp://radiopaedia.org/articles/missing?article%5Btitle%5D=pulmonary-arteryhttp://radiopaedia.org/articles/aortic_archhttp://radiopaedia.org/users/vinodmallerhttp://radiopaedia.org/users/henryknipe


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Fleishner's sign

Dr Yuranga WeerakkodyandDr Ian Bickleet al.

Fleishner's signis a prominent central artery that can be caused either bypulmonaryhypertensionthat develops or by distension of the vessel by a largepulmonary embolus.

Radiographic appearance

Plain film

Fleishner's sign is a description given to appearances on plain chest x-ray along with

Westermark's signandHampton's hump.These are all rarely seen, and usually in the context of a

largepulmonary embolism.



Fleishner sign
http://radiopaedia.org/users/weer06http://radiopaedia.org/users/weer06http://radiopaedia.org/users/clonvarahttp://radiopaedia.org/users/clonvarahttp://radiopaedia.org/users/clonvarahttp://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/articles/hampton-humphttp://radiopaedia.org/articles/hampton-humphttp://radiopaedia.org/articles/hampton-humphttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/hampton-humphttp://radiopaedia.org/articles/westermarks-signhttp://radiopaedia.org/articles/pulmonary-embolismhttp://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/articles/pulmonary-hypertension-1http://radiopaedia.org/users/clonvarahttp://radiopaedia.org/users/weer06


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From the case:Pulmonary embolism with right atrial thrombus
http://radiopaedia.org/cases/pulmonary-embolism-with-right-atrial-thrombushttp://radiopaedia.org/cases/pulmonary-embolism-with-right-atrial-thrombushttp://radiopaedia.org/cases/pulmonary-embolism-with-right-atrial-thrombushttp://radiopaedia.org/cases/pulmonary-embolism-with-right-atrial-thrombus


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Ginkgo leaf sign

Dr Henry KnipeandDr Bita Abbasiet al.

The ginkgo leaf signis a chest plain radiography appearance which is seen at extensivesubcutaneous emphysemaof the chest wall. Air outlines the fibers of thepectoralis major muscleand creates a branching pattern that resembles the branching pattern in the veins of aginkgoleaf.



Ginkgo leaf appearance

Ginkgo leaf
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/bita_abhttp://radiopaedia.org/users/bita_abhttp://radiopaedia.org/users/bita_abhttp://radiopaedia.org/articles/subcutaneous-emphysemahttp://radiopaedia.org/articles/subcutaneous-emphysemahttp://radiopaedia.org/articles/pectoralis-major-1http://radiopaedia.org/articles/pectoralis-major-1http://radiopaedia.org/articles/pectoralis-major-1http://en.wikipedia.org/wiki/Ginkgo_bilobahttp://en.wikipedia.org/wiki/Ginkgo_bilobahttp://en.wikipedia.org/wiki/Ginkgo_bilobahttp://en.wikipedia.org/wiki/Ginkgo_bilobahttp://radiopaedia.org/articles/pectoralis-major-1http://radiopaedia.org/articles/subcutaneous-emphysemahttp://radiopaedia.org/users/bita_abhttp://radiopaedia.org/users/henryknipe


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Emphizema 3 day after pneumonectomyFrom the case:Subcutaneous emphysema

Modality: X-ray
http://radiopaedia.org/cases/subcutaneous-emphysema-4http://radiopaedia.org/cases/subcutaneous-emphysema-4http://radiopaedia.org/cases/subcutaneous-emphysema-4http://radiopaedia.org/cases/subcutaneous-emphysema-4


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From the case:Subcutaneous emphysema (ginkgo leaf sign)

Modality: X-ray
http://radiopaedia.org/cases/subcutaneous-emphysema-ginkgo-leaf-signhttp://radiopaedia.org/cases/subcutaneous-emphysema-ginkgo-leaf-signhttp://radiopaedia.org/cases/subcutaneous-emphysema-ginkgo-leaf-signhttp://radiopaedia.org/cases/subcutaneous-emphysema-ginkgo-leaf-sign


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Golden S sign

Dr Frank Gaillardet al.

The Golden S signis seen on both PA chest radiographs and on CT scans. It is named becausethis sign resembles a reverse S shape, and is therefore sometimes referred to as the reverse S

sign of Golden.

Although typically seen withright upper lobe collapse,the S sign can also be seen with the

collapse of other lobes. It is created by a central mass obstructing the upper lobe bronchus and

should raise suspicion of a primarybronchogenic carcinoma.It can also be caused by other

central masses, such as: metastasis, primary mediastinal tumour, or enlarged lymph nodes.

Radiographic features

Chest radiographs

The Golden S sign is seen on frontal radiographs. In the most common situation, the appearanceis that of right upper lobar collapse (the right upper lobe appearing dense and shifting medially

and upwards) with a central mass expanding thehilum.These two changes together form areverse S shape.

Etymology

The sign was first described by R Goldenin 19253.



Reverse S sign of Golden

S sign of Golden
http://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/articles/right-upper-lobe-collapsehttp://radiopaedia.org/articles/right-upper-lobe-collapsehttp://radiopaedia.org/articles/right-upper-lobe-collapsehttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=hilumhttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/right-upper-lobe-collapsehttp://radiopaedia.org/users/frank


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From the case:Golden S sign

http://radiopaedia.org/cases/golden-s-signhttp://radiopaedia.org/cases/golden-s-signhttp://radiopaedia.org/cases/golden-s-signhttp://radiopaedia.org/cases/golden-s-sign


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Modality: X-ray
http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1


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Modality: X-ray
http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1http://radiopaedia.org/cases/golden-s-sign-1


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From the case:

S sign of Golden
http://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-golden


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From the case:S sign of

Golden
http://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-goldenhttp://radiopaedia.org/cases/s-sign-of-golden


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From the case:Pleural effusion with right lower lobe atelectasis

Modality: X-ray Case 4: inverted Golden S sign
http://radiopaedia.org/cases/pleural-effusion-with-right-lower-lobe-atelectasishttp://radiopaedia.org/cases/pleural-effusion-with-right-lower-lobe-atelectasishttp://radiopaedia.org/cases/pleural-effusion-with-right-lower-lobe-atelectasishttp://radiopaedia.org/cases/pleural-effusion-with-right-lower-lobe-atelectasis


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Incomplete border sign

Dr Yuranga WeerakkodyandDr Charlie Chia-Tsong Hsuet al.

Theincomplete border signis useful to depict an extrapulmonary mass on chest radiograph.

An extrapulmonary mass will often have a inner well defined border and an ill-defined outer

margin1-3

. This can be attributed to the inner margin being tangential to the x-ray beam and hasgood inherent contrast with the adjacentlung.On the other hand, the outer margin is enface or

partially enface with the x-ray beam and merges with the pleural or chest wall thus the border is

obscured.


Differential diagnosis for extrapulmonary mass can be further divided into pleural or

extrapleural.

Common pleural massesinclude:

loculated pleural collection

haematoma

pleural plaques

fibrous tumour of pleura

Extrapleural causescan arises from component of chest wall, bone/cartilage, nerve, vascular,

fat, muscle and skin. If there is sign of rib/bone involvement on chest radiograph the lesion is

most likely to be extrapleural. In adults, skeletal metastasesare the most common malignantchest wall neoplasm whilechondrosarcomais the most common primary malignant tumor.


Synonyms or Alternative Spelling Include in Listings?

Incomplete border sign on a chest x ray

Incomplete border sign on a chest radiograph
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From the case:Pleural metastases with the 'incomplete border sign'
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Juxtaphrenic peak sign

Dr Henry KnipeandDr Andrew Dixonet al.

Thejuxtaphrenic peak signrefers to the peaked or tented appearance of ahemidiaphragmwhich can occur in the setting oflobar collapse.It is caused by retraction of the lower end ofdiaphragm at aninferior accessory fissure(most common

1), major fissure orinferior pulmonary

ligament.It is commonly seen inupper lobe collapsebut may also be seen inmiddle lobe

collapse.



Juxtaphrenic peak

Juxtaphrenic peak (JP)

Juxta-phrenic peak sign
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From the case:Luftsichel signCase 1: in left upper collapse

Modality: X-ray
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From the case:Luftsichel signCase 1: in left upper collapse

Modality: X-ray
http://radiopaedia.org/cases/luftsichel-signhttp://radiopaedia.org/cases/luftsichel-signhttp://radiopaedia.org/cases/luftsichel-signhttp://radiopaedia.org/cases/luftsichel-sign


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From the case:Juxtaphrenic peak signCase 2 : on right

Modality: X-ray
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Medial stripe sign

Dr Henry KnipeandDr Aditya Shettyet al.

Medial stripe sign refers to an area of increased lucency at the interface of the mediallungandthemediastinumin case ofmedial pneumothorax.A small volume of pneumothorax generallyaccumulates anteriorly or medially which can be difficult to detect hence this sign holds a certain

significance.

Related pathology

neonatal pneumothorax



Medial pneumothorax sign

Medial stripe sign in a pneumothorax
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From the case:Pneumothorax

Modality: X-ray
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Post chest tube


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More black sign


The more black signis a normal finding in lateral chest x-ray, and refers to the gradualincreased apparent radiolucency (blackness) of the vertebral bodies, when proceeding from upper

to lower chest. This is due to the increased proportion of the chest comprised of air containing

lungs over distal dorsal spine compared to the upper parts.

When the air is displaced by higher attenuation material, such asconsolidation,fluidor a mass

(e.g.bronchogenic carcinoma,paraspinal neurogenic tumour)then the lower dorsal vertebral

bodies become more radio-dense; this is referred to as the loss of the more back sign.



Loss of more black sign
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Normal pulmonary artery


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Normal chest x-ray


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Normal chest x-ray


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Left lower lobe consolidation


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Left lower lobe consolidation


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From the case:Small pleural effusion

Modality: X-ray
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From the case:Small pleural effusion

Modality: X-ray
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From the case:

Hilum overlay and loss of more black signs - colorectal carcinoma metastases
http://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastaseshttp://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastaseshttp://radiopaedia.org/cases/hilum-overlay-and-loss-of-more-black-signs-colorectal-carcinoma-metastases


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From the case:

Hiatus and Bochdalek hernias

Modality: X-ray
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From the

case:Hiatus and Bochdalek hernias

Modality: X-ray
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Naclerio's V sign


TheNaclerio's V signis a sign described on the plain film in patients withapneumomediastinumoccurring often secondary to an oesophageal rupture.

It is seen as a V-shaped air collection. One limb of the V is produced by mediastinal air outliningthe left lower lateral mediastinal border. The other limb is produced by air between the parietal

pleura and medial left hemidiaphragm.

Although Naclerios V sign was originally described in patients with oesophageal

rupture, it is not entirely specific to that condition.



Naclerio v sign

Naclerios v sign
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Shmoo sign

Dr Henry KnipeandDr Sahith Reddyet al.

Shmoo sign refers to appearance of prominent, rounded left ventricle and dilated aorta on a plain AP

radiograph of chest giving the appearance of Shmoo, a fictional cartoon character in the comic strip Li'l

Abner in the 1940s. This signs indicatesleft ventricular hypertrophy
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Silhouette sign

Dr Henry KnipeandDr Ayush Goelet al.

Silhouette signwas first described by DrsBenjamin Felsonand Henry Felson in 1950

1

. Thename is somewhat of a misnomer and in the true sense actually denotes the loss of a silhouette,

thus it is sometimes also known as loss of silhouette signor loss of outlinesign4.

The differential attenuation of x-ray photons by two adjacent structures defines the silhouette,

e.g. heart borders against the adjacent lung segments and it is the pathological loss of thisdifferentiation, which the silhouette sign refers to.

Radiographic appearance

Plain film

Recognition of this sign is useful in localising areas ofairspace opacities,atelectasisor

mass within the lung, with the loss of these normal silhouettes on frontal chest radiographs being

generally indicative of the site of pathology3, 4

:

right paratracheal stripe- right upper lobe

right heart border - right middle lobe or medial right lower lobe

right hemidiaphragm - right lower lobe

aortic knuckle - left upper lobe

left heart border - lingula segments of the left upper lobe

lefthemidiaphragmor descending aorta - left lower lobe

Sites of silhouette sign on the lateral chest radiograph include3:

posterior border of the heart +/- posterior left hemidiaphragm - left lower lobe

anterior right hemidiaphragm - right middle lobe

posterior right hemidiaphragm - right lower lobe

The silhouette sign forms the basis of thehilum overlay sign,cerviothoracic signandthoraco-

abdominal sign2.


The presence of a silhouette sign may not be due to intra-pulmonary disease. For example3, 4

:

right heart border -pectus excavatum

posterior border of heart (lateral projection) -hiatus hernia
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Silhouette sign of Felson

Loss of silhouette sign Loss of outline sign


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Cervico-thoracic sign

Dr Yuranga WeerakkodyandDr Omar Bashiret al.

Thecervico-thoracic sign, a variant of thesilhouette sign,believed to have been coined byBenjamin Felson.It helps to discern the anterior or posterior location of mass in the superior

mediastinum on frontal chest radiographs.

As the anterior mediastinum ends at the level of theclaviclesand as such the upper border an

anterior mediastinal lesions cannot be visualised extending above the clavicles. Any lesions witha discernible upper border above that level must be located posteriorly in the chest; i.e apical

segments of upper lobes, pleura, or posterior mediastinum3.



Cervicothoracic sign
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Thoracoabdominal sign

Dr Henry KnipeandDr Ayush Goelet al.

Thoracoabdominal signis a chest x-ray sign probably coined byBenjamin Felson.It definesthe location of a thoracic lesion based on the fact that the posterior costophrenic sulcus extends

caudally than the anterior lung.

Thus a thoracic lesion which has its caudal end visible below the dome ofdiaphragmmust be in

the posterior part.



Thoraco abdominal sign

Abdomino thoracic sign

Thoraco-abdominal sign
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Steeple sign


The steeple sign(also calledwine bottle sign) refers to tapering of the uppertracheaon a frontalchest radiograph reminiscent of a church steeple. The appearance is suggestive ofcroup,which

should be obvious clinically. A corresponding lateral x-ray would show narrowing of the

subglottic trachea and ballooning of the hypopharynx.



Wine bottle sign

Steeple of Salisbury Cathedral

This cropped image of the steeple of Salisbury Cathedral, Wiltshire, England, is from the original

photgraph by Andrew Dunn, available at

http://commons.wikimedia.org/wiki/File:Salisbury_Cathedral.jpg which is published under the

following license: This file is licensed under Creative Commons Attribution ShareAlike 2.0 License
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From the case:Croup - steeple sign

Modality: X-ray
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From the case:Croup - steeple sign

Modality: X-ray
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From the case:Steeple sign- croup

Modality: X-ray
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Spinnaker sign


The spinnaker sign(also known as the angel wing sign)is a sign ofpneumomediastinumseen

on neonatal chest radiographs. It refers to thethymusbeing outlined by air with each lobe

displaced laterally and appearing like spinnaker sails. This is distinct from thesail signappearance of the normal thymus.

See also

sail sign (elbow)

sail sign (lower lobe collapse)



Angel wing sign

Spinnaker sail sign
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From the case:Pneumomediastum (neonate)

Modality: X-ray
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From the case:Pneumomediastum (neonate)

Modality: X-ray
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From the case:Pneumomediastinum
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From the case:Pneumomediastinum
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Water bottle sign


The water bottle sign or configurationrefers to the shape of thecardiac silhouette on erectfrontal chest x-rays in patients who have a very largepericardial effusion.Typically the effusion

has accumulated over many weeks to months (e.g. in patients with malignancy) and the

pericardium has gradually stretched. The fluid, often measuring a litre or more, causes thepericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

References

Synonyms & Alternative SpellingsSynonyms or Alternative Spelling Include in Listings?

Water bottle configuration

Water bottle heart
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/frankhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cardiac+silhouettehttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cardiac+silhouettehttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cardiac+silhouettehttp://radiopaedia.org/articles/pericardial-effusionhttp://radiopaedia.org/articles/pericardial-effusionhttp://radiopaedia.org/articles/pericardial-effusionhttp://radiopaedia.org/articles/pericardial-effusionhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cardiac+silhouettehttp://radiopaedia.org/users/frankhttp://radiopaedia.org/users/henryknipe


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From the case:Pericardial effusion - water bottle sign

Modality: X-ray
http://radiopaedia.org/cases/pericardial-effusion-water-bottle-signhttp://radiopaedia.org/cases/pericardial-effusion-water-bottle-signhttp://radiopaedia.org/cases/pericardial-effusion-water-bottle-signhttp://radiopaedia.org/cases/pericardial-effusion-water-bottle-sign


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From the case:Pericardial effusion

Modality: X-ray
http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4


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From the

case:Pericardial effusion

Modality: X-ray
http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4http://radiopaedia.org/cases/pericardial-effusion-4


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Wave sign

Dr Henry KnipeandRadswikiet al.

The wave signrefers to the indentation of the normalthymusin young children by the ribs,resulting in a wavy border.

References

1. Textbook of radiology and imaging. Churchill Livingstone. ISBN:0443071098.Read it

at Google Books-Find it at Amazon

From the case:Normal thymus
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/articles/thymushttp://radiopaedia.org/articles/thymushttp://radiopaedia.org/articles/thymushttp://books.google.com/books?vid=ISBN0443071098http://books.google.com/books?vid=ISBN0443071098http://books.google.com/books?vid=ISBN0443071098http://books.google.com/books?vid=ISBN0443071098http://www.amazon.com/gp/product/0443071098http://www.amazon.com/gp/product/0443071098http://www.amazon.com/gp/product/0443071098http://radiopaedia.org/cases/normal-thymus-1http://radiopaedia.org/cases/normal-thymus-1http://radiopaedia.org/cases/normal-thymus-1http://radiopaedia.org/images/574436http://radiopaedia.org/images/574436http://radiopaedia.org/images/574436http://radiopaedia.org/images/574436http://radiopaedia.org/cases/normal-thymus-1http://www.amazon.com/gp/product/0443071098http://books.google.com/books?vid=ISBN0443071098http://books.google.com/books?vid=ISBN0443071098http://radiopaedia.org/articles/thymushttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/henryknipe


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From the case:Wavy thymus
http://radiopaedia.org/cases/wavy-thymushttp://radiopaedia.org/cases/wavy-thymushttp://radiopaedia.org/cases/wavy-thymushttp://radiopaedia.org/cases/wavy-thymus


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Modality: X-ray

From the case:Prominent thymus - wavy border

Modality: X-ray
http://radiopaedia.org/cases/prominent-thymus-wavy-borderhttp://radiopaedia.org/cases/prominent-thymus-wavy-borderhttp://radiopaedia.org/cases/prominent-thymus-wavy-borderhttp://radiopaedia.org/cases/prominent-thymus-wavy-border


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Westermark's sign


Westermark's signis a sign ofpulmonary embolus(PE) seen on chest radiographs.

Pathology

In one study (PIOPED) this sign was present on ~10% of chest x-rays of patients with confirmed

PE2.

The theory behind the sign is either obstruction of the pulmonary artery or distal vasoconstriction

in hypoxic lung3.

Radiographic features

Plain film

focal peripheral hyperlucency secondary to oligaemia2, 3, 4

central pulmonary vessels may also be dilated3


emphysema2

References

1. Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark'sand Palla's signs in acute pulmonary embolism. Circulation. 2007;115 (8): e211.

doi:10.1161/CIRCULATIONAHA.106.665422-Pubmed citation

2. Osborn A, Blaser S, Salzman K. Encyclopedia of Diagnostic Imaging. AMIRSYS.(2008) ISBN:0721629059.Read it at Google Books-Find it at Amazon

3. Webb WR, Higgins CB. Thoracic Imaging. Lippincott Williams & Wilkins. (2010)


4. E.Brant MW, A.Helms MC. The Brant and Helms Solution. Lippincott Williams

&Wilkins. (2007) ISBN:B0011ZYZR2.Read it at Google Books-Find it at Amazon
http://radiopaedia.org/users/henryknipehttp://radiopaedia.org/users/henryknipehttp://radiopaedia.org/articles/pulmonary_embolismhttp://radiopaedia.org/articles/pulmonary_embolismhttp://radiopaedia.org/articles/pulmonary_embolismhttp://radiopaedia.org/articles/pulmonary-emphysemahttp://radiopaedia.org/articles/pulmonary-emphysemahttp://dx.doi.org/10.1161/CIRCULATIONAHA.106.665422http://dx.doi.org/10.1161/CIRCULATIONAHA.106.665422http://www.ncbi.nlm.nih.gov/pubmed/17325249http://www.ncbi.nlm.nih.gov/pubmed/17325249http://www.ncbi.nlm.nih.gov/pubmed/17325249http://books.google.com/books?vid=ISBN0721629059http://books.google.com/books?vid=ISBN0721629059http://books.google.com/books?vid=ISBN0721629059http://www.amazon.com/gp/product/0721629059http://www.amazon.com/gp/product/0721629059http://www.amazon.com/gp/product/0721629059http://books.google.com/books?vid=ISBN1605479764http://books.google.com/books?vid=ISBN1605479764http://books.google.com/books?vid=ISBN1605479764http://www.amazon.com/gp/product/1605479764http://www.amazon.com/gp/product/1605479764http://www.amazon.com/gp/product/1605479764http://books.google.com/books?vid=ISBNB0011ZYZR2http://books.google.com/books?vid=ISBNB0011ZYZR2http://books.google.com/books?vid=ISBNB0011ZYZR2http://www.amazon.com/gp/product/B0011ZYZR2http://www.amazon.com/gp/product/B0011ZYZR2http://www.amazon.com/gp/product/B0011ZYZR2http://www.amazon.com/gp/product/B0011ZYZR2http://books.google.com/books?vid=ISBNB0011ZYZR2http://www.amazon.com/gp/product/1605479764http://books.google.com/books?vid=ISBN1605479764http://www.amazon.com/gp/product/0721629059http://books.google.com/books?vid=ISBN0721629059http://www.ncbi.nlm.nih.gov/pubmed/17325249http://dx.doi.org/10.1161/CIRCULATIONAHA.106.665422http://radiopaedia.org/articles/pulmonary-emphysemahttp://radiopaedia.org/articles/pulmonary_embolismhttp://radiopaedia.org/users/henryknipe


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From the case:Saddle pulmonary embolus with Westermark's sign

Modality: X-ray
http://radiopaedia.org/cases/saddle-pulmonary-embolus-with-westermarks-signhttp://radiopaedia.org/cases/saddle-pulmonary-embolus-with-westermarks-signhttp://radiopaedia.org/cases/saddle-pulmonary-embolus-with-westermarks-signhttp://radiopaedia.org/cases/saddle-pulmonary-embolus-with-westermarks-sign


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Documents

SHËNJAT RADIOLOGJIKE PULMONARE