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A pictorial review of “signs in thoracic imaging 02”


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 02”

  1. 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. 2. Topic Outline 1. Luftsichel sign 2. The Ring-around-the-Artery Sign 3. Continuous Diaphragm Sign 2
  3. 3. Luftsichel sign
  4. 4. Luftsichel sign In German language Luft = Air  Sichel = crescent
  5. 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. 6. Luftsichel sign Para-aortic crescentric lucency
  7. 7. Luftsichel sign Caused by the: • Hyperexpanded superior segment of the left lower lobe Para-aortic crescentric lucency
  8. 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. 9. Luftsichel sign This aerated segment of left lower lobe is hyperlucent and shaped like a sickle. 9
  10. 10. Luftsichel sign Lateral chest radiograph • Left upper lobe collapse 10
  11. 11. Luftsichel sign / Lateral chest radiograph • Anterior displacement of the major fissure (arrows) 11
  12. 12. • Retrosternal opacification 12 Luftsichel sign / Lateral chest radiograph
  13. 13. Luftsichel sign Lateral chest radiograph • The superior segment of the lower lobe extends to the apex of the chest 14
  14. 14. Luftsichel sign 15
  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. 16. Luftsichel sign The white arrows outline the medial and posterior aspects of the opaque collapsed left upper lobe.17
  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. 18. This 68 year-old male patient presented with cough and dyspnoea • Opacity in the left upper zone 19
  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. 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. 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. 22. The luftsichel sign lateral film • Shows anterior displacement of the oblique fissure 23
  23. 23. The luftsichel sign lateral film • A prominant bulge in the hilar region suggesting a mass 24
  24. 24. The luftsichel sign lateral film • A prominant bulge in the hilar region suggesting a mass 25
  25. 25. Diagnosis • This patient have a hilar carcinoma causing obstruction of the left upper lobe bronchus. 26
  26. 26. The Ring-around-the-Artery Sign 29
  27. 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. 28. What is your diagnosis?
  29. 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. 30. • A well-defined lucency (arrows) along the right pulmonary artery 33
  31. 31. • A well-defined lucency (arrows) along the right pulmonary artery 34
  32. 32. • A well-defined lucency (arrows) along the right pulmonary artery 35
  33. 33. The Ring-around-the-Artery Sign Lateral chest radiograph • Air surrounding the right pulmonary artery (arrows) • pneumomediastinum 36
  34. 34. 37 Continuous Diaphragm Sign
  35. 35. Continuous Diaphragm Sign • Refers to presence of air between heart & diaphragm • (Pneumomediastinum)
  36. 36. What is your diagnosis?
  37. 37. Continuous Diaphragm Sign • Pneumomediastinum
  38. 38. Continuous Diaphragm Sign Refers to presence of air within pericardium (Pneumopericardium) 41
  39. 39. Continuous Diaphragm Sign Making normally invisible parts of central dipahgram visible in continuation with both hemidiaphragms 42
  40. 40. Continuous Diaphragm Sign Pneumomediastinum 43
  41. 41. Continuous Diaphragm Sign PA chest film shows the thymus to be outlined by air and a continuous diaphragm sign. 44
  42. 42. Pneumomediastinum 45
  43. 43. Pneumomediastinum 46
  44. 44. Pneumomediastinum 47
  45. 45. Pneumomediastinum 48
  46. 46. Pneumomediastinum 49
  47. 47. Quiz (4) 1: Pneumopericardium 2: Pneumomediastinum 3: Pneumoperitoneum 4: Subcutaneous emphysema 50
  48. 48. What is your diagnosis?
  49. 49. Barotrauma 52
  50. 50. Conclusion: continuous diaphragm sign • Indicates pneumomediastinum 53

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