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A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
A pictorial review of “signs in thoracic imaging 02”
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A pictorial review of “signs in thoracic imaging 02”

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3. Luftsichel sign
4. The Ring-around-the-Artery Sign
5. Continuous Diaphragm Sign

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  • A Pictorial Review of “Signs in Thoracic Imaging” Karuppasamy, K.1, Abhyankar-Gupta, M.1, Fewins, H.1, Curtis, J.2 1The Cardiothoracic Centre - Liverpool NHS Trust, 2Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • The luftsichel sign may be seen on posteroanterior chest
    radiographs obtained in patients with left upper lobe collapse
    (1). The sign manifests as a paraaortic crescent of hyperlucency
    with sharp margins that extend anywhere from the apex of the
    left hemithorax to the left superior pulmonary vein (Fig 1) and
    outline the medial aspect and sometimes the upper aspect of
    the opaque collapsed left upper lobe.
  • Refers to the paraaortic crescentric lucency caused by the hyperexpanded superior segment of the left lower lobe in cases of left upper lobe collapse (German = Luft- air; sichel- crescent)
  • Refers to the paraaortic crescentric lucency caused by the hyperexpanded superior segment of the left lower lobe in cases of left upper lobe collapse (German = Luft- air; sichel- crescent)
    Lucency : شفوفية
  • Refers to the paraaortic crescentric lucency caused by the hyperexpanded superior segment of the left lower lobe in cases of left upper lobe collapse (German = Luft- air; sichel- crescent)
  • Refers to the paraaortic crescentric lucency caused by the hyperexpanded superior segment of the left lower lobe in cases of left upper lobe collapse (German = Luft- air; sichel- crescent)
  • In left upper lobe collapse, the superior segment of the left lower lobe, which is positioned between the aortic arch and the collapsed left upper lobe, is hyperinflated. This aerated segment of left lower lobe is hyperlucent and shaped like a sickle, where it outlines the aortic arch on the frontal chest radiograph.
    This peri-aortic lucency has been termed the luftsichel sign, derived from the German words luft (air) and sichel (sickle).
  • Lateral chest radiograph obtained
    in the same patient shows left
    upper lobe collapse, with anterior displacement
    of the major fissure (arrows) and retrosternal
    opacification. The hyperexpanded left lower
    lobe is located behind the upper lobe, and the
    superior segment of the lower lobe extends to
    the apex of the chest.
  • Lateral chest radiograph obtained
    in the same patient shows left
    upper lobe collapse, with anterior displacement
    of the major fissure (arrows) and retrosternal
    opacification. The hyperexpanded left lower
    lobe is located behind the upper lobe, and the
    superior segment of the lower lobe extends to
    the apex of the chest.
  • Lateral chest radiograph obtained
    in the same patient shows left
    upper lobe collapse, with anterior displacement
    of the major fissure (arrows) and retrosternal
    opacification. The hyperexpanded left lower
    lobe is located behind the upper lobe, and the
    superior segment of the lower lobe extends to
    the apex of the chest.
  • Lateral chest radiograph obtained
    in the same patient shows left
    upper lobe collapse, with anterior displacement
    of the major fissure (arrows) and retrosternal
    opacification. The hyperexpanded left lower
    lobe is located behind the upper lobe, and the
    superior segment of the lower lobe extends to
    the apex of the chest.
  • Lateral chest radiograph obtained
    in the same patient shows left
    upper lobe collapse, with anterior displacement
    of the major fissure (arrows) and retrosternal
    opacification. The hyperexpanded left lower
    lobe is located behind the upper lobe, and the
    superior segment of the lower lobe extends to
    the apex of the chest.
  • CT scan obtained in the same patient
    as in Figure 1 helps to confirm medial
    interposition of the hyperexpanded superior
    segment of the left lower lobe (black arrows)
    between the aortic arch and the collapsed left
    upper lobe. The white arrows outline the medial
    and posterior aspects of the opaque collapsed
    left upper lobe.
  • CT scan obtained in the same patient
    as in Figure 1 helps to confirm medial
    interposition of the hyperexpanded superior
    segment of the left lower lobe (black arrows)
    between the aortic arch and the collapsed left
    upper lobe. The white arrows outline the medial
    and posterior aspects of the opaque collapsed
    left upper lobe.
  • CT scan obtained in the same patient
    as in Figure 1 helps to confirm medial
    interposition of the hyperexpanded superior
    segment of the left lower lobe (black arrows)
    between the aortic arch and the collapsed left
    upper lobe. The white arrows outline the medial
    and posterior aspects of the opaque collapsed
    left upper lobe.
  • CT scan obtained in the same patient
    as in Figure 1 helps to confirm medial
    interposition of the hyperexpanded superior
    segment of the left lower lobe (black arrows)
    between the aortic arch and the collapsed left
    upper lobe. The white arrows outline the medial
    and posterior aspects of the opaque collapsed
    left upper lobe.
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • This 68 year-old male patient presented with cough and dyspnoea. The PA chest xray above shows a veil - like opacity in the left upper zone, and silhouetting of the left heart border, typical of left upper lobe collapse. The trachea is shifted to the left and there is a small juxtaphrenic peak. The luftsichel sign is present due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum (click image for arrows). The
    lateral film shows anterior displacement of the oblique fissure, with a prominant bulge in the hilar region suggesting a mass. This patient did indeed have a hilar carcinoma causing obstruction of the left upper lobe bronchus.

    Around 50% of all lung cancers exhibit some degree of atelectasis or consolidation as a result of obstruction of main, lobar or segmental bronchi. Air bronchograms may be absent due to filling of the bronchi with secretions.

    Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005
  • Refers to the outlining of normal thymus by air which also elevates the thymus giving it the configuration of a sail; indicates pneumomediastinum
    Outlining : إرتسام
  • Lateral chest radiograph (close-up view of hilar area) in a 17-year-old boy with asthma with spontaneous pneumomediastinum shows a well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air. This appearance is known as the ring-around-the-artery sign.
  • Lateral chest radiograph (close-up view of hilar area) in a 17-year-old boy with asthma with spontaneous pneumomediastinum shows a well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air. This appearance is known as the ring-around-the-artery sign.
  • Lateral chest radiograph (close-up view of hilar area) in a 17-year-old boy with asthma with spontaneous pneumomediastinum shows a well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air. This appearance is known as the ring-around-the-artery sign.
  • Air surrounding the right pulmonary artery (arrows, image below) has been documented in only a few cases and is diagnostic of pneumomediastinum. It is best seen on the lateral projection and may be the only radiographic evidence of pneumomediastinum.
    A 15-year-old boy who experienced acute pleurisy following a severe bout of vomiting.
  • Continuous lucency outlining the base of the heart, representing pneumomediastinum .

    Air in the mediastinum tracks extrapleurally, between the heart and diaphragm .

    Pneumopericardium can have a similar appearance but will show air circumferentially outlining the heart.
  • Continuous lucency outlining the base of the heart, representing pneumomediastinum .

    Air in the mediastinum tracks extrapleurally, between the heart and diaphragm .

    Pneumopericardium can have a similar appearance but will show air circumferentially outlining the heart.
  • Blue arrow points to "continuous diaphragm sign." The entire diaphragm is visualized from one side to the other because air in the mediastinum outlines the central portion which is usually obscured by the heart and mediastinal soft tissue structures that are in contact with the diaphragm. The red arrow points to the air beneath and posterior to the heart.
  • Transcript

    • 1. A Pictorial Review of “Signs in Thoracic Imaging” Part 02 Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: Qusaibaty@gmail.com
    • 2. Topic Outline 1. Luftsichel sign 2. The Ring-around-the-Artery Sign 3. Continuous Diaphragm Sign 2
    • 3. Luftsichel sign
    • 4. Luftsichel sign In German language Luft = Air  Sichel = crescent
    • 5. Left Lung Posterior view of segments • Left lower lobe: 1. Superior Segment (which is positioned between the aortic arch ) 2. Lateral Basal Segment 3. Posterior Basal Segment 5
    • 6. Luftsichel sign Para-aortic crescentric lucency
    • 7. Luftsichel sign Caused by the: • Hyperexpanded superior segment of the left lower lobe Para-aortic crescentric lucency
    • 8. Luftsichel sign Caused by the: • Hyperexpanded superior segment of the left lower lobe • In cases of left upper lobe collapse Para-aortic crescentric lucency
    • 9. Luftsichel sign This aerated segment of left lower lobe is hyperlucent and shaped like a sickle. 9
    • 10. Luftsichel sign Lateral chest radiograph • Left upper lobe collapse 10
    • 11. Luftsichel sign / Lateral chest radiograph • Anterior displacement of the major fissure (arrows) 11
    • 12. • Retrosternal opacification 12 Luftsichel sign / Lateral chest radiograph
    • 13. Luftsichel sign Lateral chest radiograph • The superior segment of the lower lobe extends to the apex of the chest 14
    • 14. Luftsichel sign 15
    • 15. Luftsichel sign Medial interposition of the hyperexpanded superior segment of the left lower lobe (black arrows) between the aortic arch and the collapsed left upper lobe16
    • 16. Luftsichel sign The white arrows outline the medial and posterior aspects of the opaque collapsed left upper lobe.17
    • 17. Luftsichel sign The posterior margin of the collapsed lobe (major fissure) has a V-shaped contour extending from the apex of the collapsed lobe to the hilum 18
    • 18. This 68 year-old male patient presented with cough and dyspnoea • Opacity in the left upper zone 19
    • 19. This 68 year-old male patient presented with cough and dyspnoea • Silhouetting of the left heart border • Typical of left upper lobe collapse. 20
    • 20. This 68 year-old male patient presented with cough and dyspnoea • The trachea is shifted to the left • A small juxtaphrenic peak 21
    • 21. The luftsichel sign • Due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum 22
    • 22. The luftsichel sign lateral film • Shows anterior displacement of the oblique fissure 23
    • 23. The luftsichel sign lateral film • A prominant bulge in the hilar region suggesting a mass 24
    • 24. The luftsichel sign lateral film • A prominant bulge in the hilar region suggesting a mass 25
    • 25. Diagnosis • This patient have a hilar carcinoma causing obstruction of the left upper lobe bronchus. 26
    • 26. The Ring-around-the-Artery Sign 29
    • 27. The Ring-around-the-Artery Sign Lateral chest radiograph (close-up view of hilar area) • A well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air. 30
    • 28. What is your diagnosis?
    • 29. The Ring-around-the-Artery Sign Lateral chest radiograph (close-up view of hilar area) • A 17-year-old boy with asthma : Spontaneous pneumomediastinum 32
    • 30. • A well-defined lucency (arrows) along the right pulmonary artery 33
    • 31. • A well-defined lucency (arrows) along the right pulmonary artery 34
    • 32. • A well-defined lucency (arrows) along the right pulmonary artery 35
    • 33. The Ring-around-the-Artery Sign Lateral chest radiograph • Air surrounding the right pulmonary artery (arrows) • pneumomediastinum 36
    • 34. 37 Continuous Diaphragm Sign
    • 35. Continuous Diaphragm Sign • Refers to presence of air between heart & diaphragm • (Pneumomediastinum)
    • 36. What is your diagnosis?
    • 37. Continuous Diaphragm Sign • Pneumomediastinum
    • 38. Continuous Diaphragm Sign Refers to presence of air within pericardium (Pneumopericardium) 41
    • 39. Continuous Diaphragm Sign Making normally invisible parts of central dipahgram visible in continuation with both hemidiaphragms 42
    • 40. Continuous Diaphragm Sign Pneumomediastinum 43
    • 41. Continuous Diaphragm Sign PA chest film shows the thymus to be outlined by air and a continuous diaphragm sign. 44
    • 42. Pneumomediastinum 45
    • 43. Pneumomediastinum 46
    • 44. Pneumomediastinum 47
    • 45. Pneumomediastinum 48
    • 46. Pneumomediastinum 49
    • 47. Quiz (4) 1: Pneumopericardium 2: Pneumomediastinum 3: Pneumoperitoneum 4: Subcutaneous emphysema 50
    • 48. What is your diagnosis?
    • 49. Barotrauma 52
    • 50. Conclusion: continuous diaphragm sign • Indicates pneumomediastinum 53

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