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Figure 3 sign fleischner sign-fissure sign-headcheese sign-hilar overlay sign-the anterior junction line-bulging fissure sign
 

Figure 3 sign fleischner sign-fissure sign-headcheese sign-hilar overlay sign-the anterior junction line-bulging fissure sign

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Figure 3 sign-Fleischner sign-Fissure sign-Headcheese sign-Hilar overlay sign-The Anterior Junction Line-Bulging fissure sign

Figure 3 sign-Fleischner sign-Fissure sign-Headcheese sign-Hilar overlay sign-The Anterior Junction Line-Bulging fissure sign

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    Figure 3 sign fleischner sign-fissure sign-headcheese sign-hilar overlay sign-the anterior junction line-bulging fissure sign Figure 3 sign fleischner sign-fissure sign-headcheese sign-hilar overlay sign-the anterior junction line-bulging fissure sign Presentation Transcript

    • Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusaibaty@gmail.com
      • Figure 3 sign
      • Fleischner sign
      • Fissure sign
      • Headcheese sign
      • Hilar overlay sign
      • The Anterior Junction Line
      • Bulging fissure sign
    • Topic Outline
      • Figure 3 sign
      • Fleischner sign
      • Fissure sign
      • Headcheese sign
      • Hilar overlay sign
      • The Anterior Junction Line
      • Bulging fissure sign
      2
    • Figure 3 signMogul Sign
      3
      3
    • Figure 3 sign
      Refers to the abnormal contour of aortic arch in coarctation of aorta.
    • Figure 3 sign
      • The upper arc is the dilated arch proximal to the coarctation
      3
    • Figure 3 sign
      • The lower arc is the post stenotic dilatation
      3
    • Figure 3 sign
      • The indentation between the 2 arcs is the coarctation
      3
    • Figure 3 sign
      8
    • Figure 3 sign
      Coarctation
      9
    • Figure 3 sign
    • Spiral CT angiography in an infant with a hypoplastic aortic arch
      2D reconstruction showing hypoplastic aortic arch (arrowheads) with coarctation of aorta (arrow).
      11
    • Spiral CT angiography in an infant with a hypoplastic aortic arch
      3D reconstruction displays the coarctation of the aorta (arrow).
      12
    • Summary
      13
    • Fleischner sign
    • Radiographic signs with a relatively high specificity but low sensitivity for PTE
      Pleura-based areas of increased opacity (Hampton sign)
      Decreased vascularity in the peripheral lung (Westermarck sign)
      Enlargement of the central pulmonary artery (Fleischner sign)
      Hemidiaphragm elevation
      15
      Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, RavinCE.Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189:
    • Radiographic signs with a relatively high specificity but low sensitivity for PTE
      Pleura-based areas of increased opacity (Hampton sign)
      Decreased vascularity in the peripheral lung (Westermarck sign)
      Enlargement of the central pulmonary artery (Fleischner sign)
      Hemidiaphragm elevation
      16
      Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, RavinCE.Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189:
    • Fleischner sign
      Refers to the prominence of central pulmonary artery
    • Fleischner sign
      Pulmonary hypertension that develops secondary to :
      • PE
      • Or by distension of the vessel by a large clot
    • Fissure sign
    • A ventilation/perfusion lung scan, also called a V/Q lung scan
      A type of medical imaging using scintigraphy and medical isotopes
      Evaluate the circulation of:
      Air
      Blood within a patient's lungs
    • A ventilation/perfusion lung scan, also called a V/Q lung scan
      A type of medical imaging using scintigraphy and medical isotopes
      Evaluate the circulation of:
      Air
      Blood within a patient's lungs
    • Gamma Camera
      22
    • A ventilation/perfusion lung scan, also called a V/Q lung scan
      Evaluate the circulation of:
      Air: Nebulizer of a gaseous radionuclide such as:
      • Xenon
      • Technetium
      • DTPA 
    • A ventilation/perfusion lung scan, also called a V/Q lung scan
      Evaluate the circulation of:
      Blood within a patient's lungs: the intravenous injection of radioactive technetium macro aggregated albumin (Tc99m-MAA)
    • Fissure sign
      Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution
    • Fissure sign
      But, increased separation due to pleural thickening or effusion is seen as linear area of reduced uptake along the fissure referred as fissure sign
    • Headcheese sign
    • Secondary lobule and pulmonary Acinus
      28
    • Radiograph of 1-mm lung slice taken from peripheral lower lobe
      29
    • QuizHow many lobules do you see in this image?
      One lobule
      2 lobules
      3 lobules
      30
    • QuizHow many lobules do you see in this image?
      One lobule
      2 lobules
      3 lobules
      31
    • Why do we see two lobules ?
      32
    • S: Interlobular septa : 0.1 mm
      V: Pulmonary vein : 0.5 mm
      A: Pulmonary arteries : : 1 mm
      33
    • Headcheese sign
    • Headcheese sign
      Hypersensitivity pneumonitis
    • Headcheese sign in hypersensitivity pneumonitis
      Combination of patchy or lobular ground-glass opacity (small arrows) and mosaic perfusion (large arrows)
      36
    • 37
      Headcheese sign in Chronic hypersensitivity pneumonitis
    • 38
      Headcheese sign in Chronic hypersensitivity pneumonitis
      Expiration
      Inspiration
    • Hilar overlay sign
    • Hilar overlay sign
      Refers to the ability to see the hilar structures through the shadow of a mass superimposed on the hilum
    • Hilar overlay sign
      Indicates that the mass lies either in front or behind the hilum
    • Hilar overlay sign
      Anterior lymphoma
      or posterior neurofibroma
    • Hilar overlay sign PA chest X-ray
      A large anterior mediastinal mass.
    • Hilar overlay sign PA chest X-ray
      The hilum overlay sign:
      • The mediastinal mass overlaps the main pulmonary artery which is seen well within the margins of the mass.
    • Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
      The ability to see the hilar structures through the shadow of a mass superimposed on the hilum
      45
    • Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
      The mass localise in:
      Posterior mediastinum
      Anterior mediastinum
      46
    • Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
      The mass localise in:
      • Posterior mediastinum
      • Anterior mediastinum
      Why??
      47
    • 48
    • Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
      The descending aorta is clearly seen (black arrow), indicating that the mass is not within the posterior mediastinum
      49
    • Hilum Overlay Sign
      Hilar vessels are seen through a mediastinal mass
      50
    • Hilum Overlay Sign
      A lymphoma in a HIV-positive patient.
      51
    • The Anterior Junction Line
      52
    • A transverse section of the thorax
      Showing the contents of the middle and the posterior mediastinum.
      53
    • Posteroanterior chest radiograph demonstrates the anterior junction line(arrow)
      54
    • Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow)
      55
    • Chest CT scan
      An anterior mediastinal mass.
      56
    • The anterior junction line is obliterated
      57
    • 58
      Bulging fissure sign
    • Normal major fissures
      Lateral chest radiograph demonstrates the two major fissures
      59
      http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
    • Normal major fissures
      Note that both fissures are seen as double lines
      60
      http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
    • Normal major fissures
      • The left fissure: ??
      • The right fissure: ??
      61
      http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
    • 62
      Normal major fissures
      • The left fissure (arrows)
      • The right fissure (arrowheads)
      http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
    • 63
      CT scan
      HRCT scan
      Normal major fissures
      CT scan shows the major fissures as lucent bands of relative hypovascularity (arrows)
      http://radiographics.rsna.org/content/21/4/861/F3.expansion.html
    • Bulging fissure sign
      Consolidation:
      • Spreading rapidly
      • Causing lobar expansion
      • Bulging of the adjacent fissure inferiorly
      64
    • Bulging Fissure Sign
      Consolidation spreading rapidly, causing lobar expansion and bulging of the adjacent fissure inferiorly
      65
    • What do you think the diagnosis?
      Pneumonia caused by staphylococcus aureus.
      Pneumonia caused by Klebsiella
      TB
      Large cell carcinoma
      66
    • Bulging Fissure Sign
      Historically: Klebsiella pneumoniae involving the right upper lobe .
      67
    • 68