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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

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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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  • 1. Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusaibaty@gmail.com
    • Figure 3 sign
    • 2. Fleischner sign
    • 3. Fissure sign
    • 4. Headcheese sign
    • 5. Hilar overlay sign
    • 6. The Anterior Junction Line
    • 7. Bulging fissure sign
  • Topic Outline
    • Figure 3 sign
    • 8. Fleischner sign
    • 9. Fissure sign
    • 10. Headcheese sign
    • 11. Hilar overlay sign
    • 12. The Anterior Junction Line
    • 13. Bulging fissure sign
    2
  • 14. Figure 3 signMogul Sign
    3
    3
  • 15. Figure 3 sign
    Refers to the abnormal contour of aortic arch in coarctation of aorta.
  • 16. Figure 3 sign
    • The upper arc is the dilated arch proximal to the coarctation
    3
  • 17. Figure 3 sign
    • The lower arc is the post stenotic dilatation
    3
  • 18. Figure 3 sign
    • The indentation between the 2 arcs is the coarctation
    3
  • 19. Figure 3 sign
    8
  • 20. Figure 3 sign
    Coarctation
    9
  • 21. Figure 3 sign
  • 22. Spiral CT angiography in an infant with a hypoplastic aortic arch
    2D reconstruction showing hypoplastic aortic arch (arrowheads) with coarctation of aorta (arrow).
    11
  • 23. Spiral CT angiography in an infant with a hypoplastic aortic arch
    3D reconstruction displays the coarctation of the aorta (arrow).
    12
  • 24. Summary
    13
  • 25. Fleischner sign
  • 26. 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:
  • 27. 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:
  • 28. Fleischner sign
    Refers to the prominence of central pulmonary artery
  • 29. Fleischner sign
    Pulmonary hypertension that develops secondary to :
    • PE
    • 30. Or by distension of the vessel by a large clot
  • Fissure sign
  • 31. 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
  • 32. 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
  • 33. Gamma Camera
    22
  • 34. A ventilation/perfusion lung scan, also called a V/Q lung scan
    Evaluate the circulation of:
    Air: Nebulizer of a gaseous radionuclide such as:
  • 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)
  • 37. Fissure sign
    Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution
  • 38. 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
  • 39. Headcheese sign
  • 40. Secondary lobule and pulmonary Acinus
    28
  • 41. Radiograph of 1-mm lung slice taken from peripheral lower lobe
    29
  • 42. QuizHow many lobules do you see in this image?
    One lobule
    2 lobules
    3 lobules
    30
  • 43. QuizHow many lobules do you see in this image?
    One lobule
    2 lobules
    3 lobules
    31
  • 44. Why do we see two lobules ?
    32
  • 45. S: Interlobular septa : 0.1 mm
    V: Pulmonary vein : 0.5 mm
    A: Pulmonary arteries : : 1 mm
    33
  • 46. Headcheese sign
  • 47. Headcheese sign
    Hypersensitivity pneumonitis
  • 48. Headcheese sign in hypersensitivity pneumonitis
    Combination of patchy or lobular ground-glass opacity (small arrows) and mosaic perfusion (large arrows)
    36
  • 49. 37
    Headcheese sign in Chronic hypersensitivity pneumonitis
  • 50. 38
    Headcheese sign in Chronic hypersensitivity pneumonitis
    Expiration
    Inspiration
  • 51. Hilar overlay sign
  • 52. Hilar overlay sign
    Refers to the ability to see the hilar structures through the shadow of a mass superimposed on the hilum
  • 53. Hilar overlay sign
    Indicates that the mass lies either in front or behind the hilum
  • 54. Hilar overlay sign
    Anterior lymphoma
    or posterior neurofibroma
  • 55. Hilar overlay sign PA chest X-ray
    A large anterior mediastinal mass.
  • 56. 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
  • 57. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
    The mass localise in:
    Posterior mediastinum
    Anterior mediastinum
    46
  • 58. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph
    The mass localise in:
    • Posterior mediastinum
    • 59. Anterior mediastinum
    Why??
    47
  • 60. 48
  • 61. 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
  • 62. Hilum Overlay Sign
    Hilar vessels are seen through a mediastinal mass
    50
  • 63. Hilum Overlay Sign
    A lymphoma in a HIV-positive patient.
    51
  • 64. The Anterior Junction Line
    52
  • 65. A transverse section of the thorax
    Showing the contents of the middle and the posterior mediastinum.
    53
  • 66. Posteroanterior chest radiograph demonstrates the anterior junction line(arrow)
    54
  • 67. Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow)
    55
  • 68. Chest CT scan
    An anterior mediastinal mass.
    56
  • 69. The anterior junction line is obliterated
    57
  • 70. 58
    Bulging fissure sign
  • 71. Normal major fissures
    Lateral chest radiograph demonstrates the two major fissures
    59
    http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
  • 72. Normal major fissures
    Note that both fissures are seen as double lines
    60
    http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
  • 73. Normal major fissures
    • The left fissure: ??
    • 74. The right fissure: ??
    61
    http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
  • 75. 62
    Normal major fissures
    • The left fissure (arrows)
    • 76. The right fissure (arrowheads)
    http://radiographics.rsna.org/content/21/4/861/F2.expansion.html
  • 77. 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
  • 78. Bulging fissure sign
    Consolidation:
    • Spreading rapidly
    • 79. Causing lobar expansion
    • 80. Bulging of the adjacent fissure inferiorly
    64
  • 81. Bulging Fissure Sign
    Consolidation spreading rapidly, causing lobar expansion and bulging of the adjacent fissure inferiorly
    65
  • 82. What do you think the diagnosis?
    Pneumonia caused by staphylococcus aureus.
    Pneumonia caused by Klebsiella
    TB
    Large cell carcinoma
    66
  • 83. Bulging Fissure Sign
    Historically: Klebsiella pneumoniae involving the right upper lobe .
    67
  • 84. 68

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