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Signs inchest Xray
Dr. Archana Koshy
RADIOLOGICAL ANATOMY
• The loss of the lung/soft tissue interface due to the
presence of fluid in the normally air-filled lung
• If an intrathoracic opacity is in anatomic contact
with a border, then the opacity will obscure that
border
• Commonly seen with the borders of the heart,
aorta, chest wall, and diaphragm
Silhouette Sign
• Used to describe the location of alesion at the inlet of the thoracic cavity.
• In this anatomical space, the posterior portions of the lung apices are located more
superiorly than the anterior portions .
• A lesion clearly visible above the clavicles on the frontal view must lie posteriorly and be
entirely within the thorax.
• If the cranial border of the lesion is obscured at or below the level of the clavicles, it is
located at the anterior mediastinum
CERVICOTHORACIC SIGN
A tubular outline of an airway made visible due to the filling of the surrounding
alveoli by fluid or inflammatory exudates
Conditions in which air bronchograms are seen:
• Lung consolidation
• Pulmonary edema
• Non-obstructive pulmonary atelectasis
• Interstitial disease
• Neoplasm
• Normal expiration
Air Bronchogram
AIR BRONCHOGRAM
HILUM OVERLAY SIGN
• The hilum overlay sign refers to an appearance on frontal
chest radiographs of patients with a mass 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 as such their silhouette is
obliterated.
• The sign was first described by Benjamin Felson
DEEP SULCUS SIGN
• The deep sulcus sign describes the radiolucency extending from the lateral
costophrenic angle to the hypochondrium
• It is an important clue indicating possible pneumothorax inchestx-rays obtained in
the supine position.
• When plain films are taken with the subject in an upright position, the free air in the
pleural space gathers at the apicolateral space.
• In the supine position, the air accumulating at the anterior space forms a triangular
radiolucency that makes the inferior borders of the lateral costophrenic angle
conspicuous
Air crescent (“meniscus”) sign
• The air crescent (“meniscus”) sign is the result of air
accumulation between a mass or nodule and
normal lung parenchyma.
• It is most frequently encountered in neutropenic
patients with aspergillosis.
The spinnaker sign (the angel wing sign) is a sign of pneumomediastinum seen on
neonatal chest radiographs.
It refers to the thymus being outlined by air with each lobe displaced laterally and
appearing like spinnaker sails.
SPINNAKER SIGN
• It is a wedge-shaped, pleura-based consolidation with a
rounded convex apex directed towards the hilus.
• This sign was first described by Aubrey Otis Hampton.
• It is usually encountered at the lower lobes and heals with
scar formation
HAMPTON HUMP SIGN
• Decrease of vascularization at the periphery of the
lungs due to mechanical obstruction or reflex
vasoconstriction in pulmonary embolism .
WESTERMARK SIGN
FLEISCHNER SIGN
Bulging Fissure Sign
The bulging fissure sign refers to lobar consolidation where the affected
portion of the lung is expanded.
It is now rarely seen due to the widespread use of antibiotics.
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 Diaphragm Sign
• This sign refers to the appearance
of the collapsed lung occurring
with a fractured bronchus .
• The bronchial fracture results in
the lung to fall away from the
hilum, either inferiorly and
laterally in an upright patient or
posteriorly, as seen on CT ina
supine patient.
• DD:
Pneumothorax causes a lung to
collapse inward toward the hilum.
Fallen Lung Sign
• This sign refers to flattening of the contours of the aortic knob and adjacent main
pulmonary artery .
• It is seen in severe collapse of the left lower lobe and is caused by leftward
displacement and rotation of the heart
FLAT WAIST SIGN
The fingeringlove sign can be seen on either chest radiographor CT chest and refers to the
characteristic sign of a bronchocele
In bronchial obstruction, the portion of the bronchus distal to the obstruction is dilated
with the presence of mucous secretions (mucus plugging ).
Fingerin Glove Sign
• When a lobe collapses around a large central mass, the peripheral lung collapses
and the central portion of lung is prevented from collapsing by the presence of
the mass.
• The relevant fissure is concave toward the lung peripherally but convex centrally,
and the shape of the fissure resembles an S ora reverse S .
GOLDEN “S” SIGN
• This sign refers to a small triangular shadow that obscures the dome of the
diaphragm secondary to upper lobe atelectasis .
• The shadow is caused by traction on the lower end of the major fissure, the
inferior accessory fissure, or the inferior pulmonary ligament.
Juxtaphrenic Peak Sign
This peri-aortic lucency has been termed the luftsichel sign, derived from the
German words luft (air) and sichel (sickle).
Luftsichel Sign
• Occurs when mediastinal lymphadenopathy occurs behind
the bronchus intermedius in the subcarinal region
• Lymphadenopathy is seen as lobulated densities on lateral
radiographs
DOUGHNUT SIGN
• Indicates anomalous venous return of the right inferior pulmonary vein (total or
segmental) directly to the hepatic vein, portal vein or inferior vena cava.
• A tubular-shaped opacity extending towards the diaphragm along the right side
of the heart is seen (Fig. 9).
• The abnormal pulmonary vein resembles a Turkish sword called a “pala”.
• The scimitar sign is associated with congenital hypogenetic lung syndrome
(scimitar syndrome)
SCIMITAR SIGN
arch-k-signs-in-chest-xray-160210003601.pptx

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arch-k-signs-in-chest-xray-160210003601.pptx

  • 1. Signs inchest Xray Dr. Archana Koshy
  • 2.
  • 4. • The loss of the lung/soft tissue interface due to the presence of fluid in the normally air-filled lung • If an intrathoracic opacity is in anatomic contact with a border, then the opacity will obscure that border • Commonly seen with the borders of the heart, aorta, chest wall, and diaphragm Silhouette Sign
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  • 7. • Used to describe the location of alesion at the inlet of the thoracic cavity. • In this anatomical space, the posterior portions of the lung apices are located more superiorly than the anterior portions . • A lesion clearly visible above the clavicles on the frontal view must lie posteriorly and be entirely within the thorax. • If the cranial border of the lesion is obscured at or below the level of the clavicles, it is located at the anterior mediastinum CERVICOTHORACIC SIGN
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  • 9. A tubular outline of an airway made visible due to the filling of the surrounding alveoli by fluid or inflammatory exudates Conditions in which air bronchograms are seen: • Lung consolidation • Pulmonary edema • Non-obstructive pulmonary atelectasis • Interstitial disease • Neoplasm • Normal expiration Air Bronchogram
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  • 15. HILUM OVERLAY SIGN • The hilum overlay sign refers to an appearance on frontal chest radiographs of patients with a mass 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 as such their silhouette is obliterated. • The sign was first described by Benjamin Felson
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  • 18. DEEP SULCUS SIGN • The deep sulcus sign describes the radiolucency extending from the lateral costophrenic angle to the hypochondrium • It is an important clue indicating possible pneumothorax inchestx-rays obtained in the supine position. • When plain films are taken with the subject in an upright position, the free air in the pleural space gathers at the apicolateral space. • In the supine position, the air accumulating at the anterior space forms a triangular radiolucency that makes the inferior borders of the lateral costophrenic angle conspicuous
  • 19.
  • 20. Air crescent (“meniscus”) sign • The air crescent (“meniscus”) sign is the result of air accumulation between a mass or nodule and normal lung parenchyma. • It is most frequently encountered in neutropenic patients with aspergillosis.
  • 21.
  • 22. The spinnaker sign (the angel wing sign) is a sign of pneumomediastinum seen on neonatal chest radiographs. It refers to the thymus being outlined by air with each lobe displaced laterally and appearing like spinnaker sails. SPINNAKER SIGN
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  • 25. • It is a wedge-shaped, pleura-based consolidation with a rounded convex apex directed towards the hilus. • This sign was first described by Aubrey Otis Hampton. • It is usually encountered at the lower lobes and heals with scar formation HAMPTON HUMP SIGN
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  • 27. • Decrease of vascularization at the periphery of the lungs due to mechanical obstruction or reflex vasoconstriction in pulmonary embolism . WESTERMARK SIGN
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  • 30. Bulging Fissure Sign The bulging fissure sign refers to lobar consolidation where the affected portion of the lung is expanded. It is now rarely seen due to the widespread use of antibiotics.
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  • 34. 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 Diaphragm Sign
  • 35. • This sign refers to the appearance of the collapsed lung occurring with a fractured bronchus . • The bronchial fracture results in the lung to fall away from the hilum, either inferiorly and laterally in an upright patient or posteriorly, as seen on CT ina supine patient. • DD: Pneumothorax causes a lung to collapse inward toward the hilum. Fallen Lung Sign
  • 36. • This sign refers to flattening of the contours of the aortic knob and adjacent main pulmonary artery . • It is seen in severe collapse of the left lower lobe and is caused by leftward displacement and rotation of the heart FLAT WAIST SIGN
  • 37. The fingeringlove sign can be seen on either chest radiographor CT chest and refers to the characteristic sign of a bronchocele In bronchial obstruction, the portion of the bronchus distal to the obstruction is dilated with the presence of mucous secretions (mucus plugging ). Fingerin Glove Sign
  • 38.
  • 39. • When a lobe collapses around a large central mass, the peripheral lung collapses and the central portion of lung is prevented from collapsing by the presence of the mass. • The relevant fissure is concave toward the lung peripherally but convex centrally, and the shape of the fissure resembles an S ora reverse S . GOLDEN “S” SIGN
  • 40. • This sign refers to a small triangular shadow that obscures the dome of the diaphragm secondary to upper lobe atelectasis . • The shadow is caused by traction on the lower end of the major fissure, the inferior accessory fissure, or the inferior pulmonary ligament. Juxtaphrenic Peak Sign
  • 41. This peri-aortic lucency has been termed the luftsichel sign, derived from the German words luft (air) and sichel (sickle). Luftsichel Sign
  • 42. • Occurs when mediastinal lymphadenopathy occurs behind the bronchus intermedius in the subcarinal region • Lymphadenopathy is seen as lobulated densities on lateral radiographs DOUGHNUT SIGN
  • 43.
  • 44. • Indicates anomalous venous return of the right inferior pulmonary vein (total or segmental) directly to the hepatic vein, portal vein or inferior vena cava. • A tubular-shaped opacity extending towards the diaphragm along the right side of the heart is seen (Fig. 9). • The abnormal pulmonary vein resembles a Turkish sword called a “pala”. • The scimitar sign is associated with congenital hypogenetic lung syndrome (scimitar syndrome) SCIMITAR SIGN