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Deep sulcus sign fallen lung sign-ct angiogram sign-flat-waist sign

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Deep sulcus sign-Fallen Lung Sign-CT angiogram sign-Flat-waist sign

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Deep sulcus sign fallen lung sign-ct angiogram sign-flat-waist sign

  1. 1. Deep sulcus sign Fallen Lung Sign CT angiogram sign Flat-waist sign 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. Deep sulcus sign 2. Fallen Lung Sign 3. CT angiogram sign 4. Flat-waist sign 2
  3. 3. Deep sulcus sign
  4. 4. Deep sulcus sign • Refers to a deep lateral costophrenic angle on a supine CXR. 4
  5. 5. What is your diagnosis?
  6. 6. Deep sulcus sign • Representing gas collection in a subpulmonary location due to pneumothorax and may be the only sign of it 6
  7. 7. Deep Sulcus Sign AP position • Bilateral pneumothorax • Lucency of the left lateral costophrenic angle 7
  8. 8. Supine chest radiograph of a neonate Deep sulcus sign with abnormal deepening and lucency of the left lateral costophrenic angle (∗)8
  9. 9. ARDS • Deep sulcus sign • Right pneumothorax 9
  10. 10. Deep Sulcus Sign Left pneumothorax 10
  11. 11. Conclusion • Deep sulcus sign on a supine radiograph - indicates pneumothorax 11
  12. 12. Fallen Lung Sign 12
  13. 13. Fallen lung sign • This sign refers to the appearance of the collapsed lung occurring with a fractured bronchus
  14. 14. The bronchial fracture Results in the lung to fall away from the hilum Either inferiorly and laterally in an upright patient 14
  15. 15. 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 in a supine patient 15
  16. 16. Fallen lung sign • Either inferiorly and laterally in an upright patient 16
  17. 17. Fallen lung sign • Or posteriorly, as seen on CT in a supine patient 17
  18. 18. Conclusion • fallen lung sign - indicates a fractured bronchus
  19. 19. CT Angiogram Sign 19
  20. 20. 20 Terminology • Gray • Low Attenuation • Radiolucent • Skin and Muscles • White • High Attenuation • Radiopaque • Fingres
  21. 21. The criteria to define the CT angiogram sign are: 1. Pulmonary vessels extending 3 cm or more along a single channel 2. Diffuse homogeneous low attenuation of the consolidated lung parenchyma compared with the attenuation of the chest wall musculature. 21
  22. 22. The criteria to define the CT angiogram sign • Attenuation of Lung consolidation less than Attenuation of chest wall musculature • 28 HU LC < 74 HU CWM 22
  23. 23. The CT angiogram sign is seen on contrast material–enhanced scans • Results from the normally enhancing pulmonary vessels
  24. 24. The CT angiogram sign is seen on contrast material–enhanced scans • Within the low- attenuating consolidated lung parenchyma relative to the chest wall musculature.
  25. 25. CT Angiogram Sign • The vessels are prominently seen against a background of low- attenuation material.
  26. 26. CT Angiogram sign  The CT angiogram sign was initially described as a specific sign of lobar bronchoalveolar cell carcinoma  Specificity can be as high as 92.3% 27
  27. 27. CT Angiogram sign 1. Pneumonia 2. Pulmonary edema 3. Obstructive pneumonitis due to central lung tumors 4. Lymphoma 5. Metastasis from gastrointestinal carcinomas 28
  28. 28. Conclusion: CT angiogram sign • Enhancing pulmonary vessels against a background of low attenuation material in the lung 29
  29. 29. Flat-waist sign ‫المسطح‬ ‫الوسط‬ ‫عالمة‬
  30. 30. Flat-waist sign A symmetrical frontal CXR
  31. 31. Flat-waist sign Refers to the loss of concavity of the left heart border
  32. 32. Flat-waist sign Due to slight anterior oblique rotation of the heart seen.
  33. 33. Flat-waist sign Due in some cases of left lower lobe collapse.
  34. 34. Flat waist Sign
  35. 35. Flat waist Sign Atelectasis LLL 36
  36. 36. Conclusion • Flat waist sign- indicates left lower lobe collapse 37
  37. 37. REFERENCES • 1. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW. Signs in thoracic imaging. J.Thorac.Imaging 2006;21:76-90 • 2. Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image—the 2004 Fleischner lecture.Radiology. 2006 May;239(2):322-38 • 3. Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, Webb WR, Zerhouni EA. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996;200(2):327-31 38

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