Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusai...
Fleischner sign
Fissure sign
Headcheese sign
Hilar overlay sign
The Anterior Junction Line
Bulging fissure sign</li></li></ul><li>Topic Outline<br /><ul><li>Figure 3 sign
Fleischner sign
Fissure sign
Headcheese sign
Hilar overlay sign
The Anterior Junction Line
Bulging fissure sign</li></ul>2<br />
Figure 3 signMogul Sign<br />3<br />3<br />
Figure 3 sign<br />Refers to the abnormal contour of aortic arch in coarctation of aorta. <br />
Figure 3 sign<br /><ul><li>The upper arc is the dilated arch proximal to the coarctation</li></ul>3<br />
Figure 3 sign<br /><ul><li>The lower arc is the post stenotic dilatation</li></ul>3<br />
Figure 3 sign<br /><ul><li>The indentation between the 2 arcs is the coarctation</li></ul>3<br />
Figure 3 sign<br />8<br />
Figure  3  sign<br />Coarctation<br />9<br />
Figure  3  sign<br />
Spiral CT angiography in an infant with a hypoplastic aortic arch<br />2D reconstruction showing hypoplastic aortic arch (...
Spiral CT angiography in an infant with a hypoplastic aortic arch<br />3D reconstruction displays the coarctation of the a...
Summary<br />13<br />
Fleischner sign<br />
Radiographic signs with a relatively high specificity but low sensitivity for PTE<br />Pleura-based areas of increased opa...
Radiographic signs with a relatively high specificity but low sensitivity for PTE<br />Pleura-based areas of increased opa...
Fleischner sign<br />Refers to the prominence of central pulmonary artery<br />
Fleischner sign<br />Pulmonary hypertension that develops secondary to :<br /><ul><li>PE
Or by distension of the vessel by a large clot</li></li></ul><li>Fissure sign<br />
A ventilation/perfusion lung scan, also called a V/Q lung scan<br />A type of medical imaging using scintigraphy and medic...
A ventilation/perfusion lung scan, also called a V/Q lung scan<br />A type of medical imaging using scintigraphy and medic...
Gamma Camera<br />22<br />
A ventilation/perfusion lung scan, also called a V/Q lung scan<br />Evaluate the circulation of:<br />Air: Nebulizer of a ...
Technetium
DTPA </li></li></ul><li>A ventilation/perfusion lung scan, also called a V/Q lung scan<br />Evaluate the circulation of:<b...
Fissure sign<br />Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution<br />
Fissure sign<br />But, increased separation due to pleural thickening or effusion is seen as linear area of reduced uptake...
Headcheese sign<br />
Secondary lobule and pulmonary Acinus<br />28<br />
Radiograph of 1-mm lung slice taken from peripheral lower lobe<br />29<br />
QuizHow many lobules do you see in this image?<br />One lobule<br />2 lobules<br />3 lobules<br />30<br />
QuizHow many lobules do you see in this image?<br />One lobule<br />2 lobules<br />3 lobules<br />31<br />
Why do we see two lobules ?<br />32<br />
S: Interlobular septa : 0.1 mm <br />V: Pulmonary vein : 0.5 mm <br />A: Pulmonary arteries : : 1 mm <br />33<br />
Headcheese sign<br />
Headcheese sign<br />Hypersensitivity pneumonitis<br />
Headcheese sign in hypersensitivity pneumonitis<br />Combination of patchy or lobular ground-glass opacity (small arrows) ...
37<br />Headcheese sign in Chronic hypersensitivity pneumonitis <br />
38<br />Headcheese sign in Chronic hypersensitivity pneumonitis <br />Expiration<br />Inspiration<br />
Hilar overlay sign<br />
Hilar overlay sign<br />Refers to the ability to see the hilar structures through the shadow of a mass superimposed on the...
Hilar overlay sign<br />Indicates that the mass lies either in front or behind the hilum<br />
Hilar overlay sign<br />Anterior lymphoma<br />or posterior neurofibroma <br />
Hilar overlay sign PA chest X-ray <br />A large anterior mediastinal mass. <br />
Hilar overlay sign PA chest X-ray <br />The hilum overlay sign:<br /><ul><li>The mediastinal mass overlaps the main pulmon...
Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The mass localise in:<br />Posterior ...
Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The mass localise in:<br /><ul><li>Po...
Anterior mediastinum</li></ul>Why??<br />47<br />
48<br />
Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The descending aorta is clearly seen ...
Hilum Overlay Sign<br />Hilar vessels are seen through a mediastinal mass<br />50<br />
Hilum Overlay Sign<br />A lymphoma in a HIV-positive patient.<br />51<br />
The Anterior Junction Line<br />52<br />
A transverse section of the thorax<br />Showing the contents of the middle and the posterior mediastinum. <br />53<br />
Posteroanterior chest radiograph demonstrates the anterior junction line(arrow)<br />54<br />
Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow)<br />55<b...
Chest CT scan<br />An anterior mediastinal mass. <br />56<br />
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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

  1. 1. Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusaibaty@gmail.com<br /><ul><li>Figure 3 sign
  2. 2. Fleischner sign
  3. 3. Fissure sign
  4. 4. Headcheese sign
  5. 5. Hilar overlay sign
  6. 6. The Anterior Junction Line
  7. 7. Bulging fissure sign</li></li></ul><li>Topic Outline<br /><ul><li>Figure 3 sign
  8. 8. Fleischner sign
  9. 9. Fissure sign
  10. 10. Headcheese sign
  11. 11. Hilar overlay sign
  12. 12. The Anterior Junction Line
  13. 13. Bulging fissure sign</li></ul>2<br />
  14. 14. Figure 3 signMogul Sign<br />3<br />3<br />
  15. 15. Figure 3 sign<br />Refers to the abnormal contour of aortic arch in coarctation of aorta. <br />
  16. 16. Figure 3 sign<br /><ul><li>The upper arc is the dilated arch proximal to the coarctation</li></ul>3<br />
  17. 17. Figure 3 sign<br /><ul><li>The lower arc is the post stenotic dilatation</li></ul>3<br />
  18. 18. Figure 3 sign<br /><ul><li>The indentation between the 2 arcs is the coarctation</li></ul>3<br />
  19. 19. Figure 3 sign<br />8<br />
  20. 20. Figure 3 sign<br />Coarctation<br />9<br />
  21. 21. Figure 3 sign<br />
  22. 22. Spiral CT angiography in an infant with a hypoplastic aortic arch<br />2D reconstruction showing hypoplastic aortic arch (arrowheads) with coarctation of aorta (arrow). <br />11<br />
  23. 23. Spiral CT angiography in an infant with a hypoplastic aortic arch<br />3D reconstruction displays the coarctation of the aorta (arrow). <br />12<br />
  24. 24. Summary<br />13<br />
  25. 25. Fleischner sign<br />
  26. 26. Radiographic signs with a relatively high specificity but low sensitivity for PTE<br />Pleura-based areas of increased opacity (Hampton sign)<br />Decreased vascularity in the peripheral lung (Westermarck sign)<br />Enlargement of the central pulmonary artery (Fleischner sign)<br />Hemidiaphragm elevation<br />15<br />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:<br />
  27. 27. Radiographic signs with a relatively high specificity but low sensitivity for PTE<br />Pleura-based areas of increased opacity (Hampton sign)<br />Decreased vascularity in the peripheral lung (Westermarck sign)<br />Enlargement of the central pulmonary artery (Fleischner sign)<br />Hemidiaphragm elevation<br />16<br />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:<br />
  28. 28. Fleischner sign<br />Refers to the prominence of central pulmonary artery<br />
  29. 29. Fleischner sign<br />Pulmonary hypertension that develops secondary to :<br /><ul><li>PE
  30. 30. Or by distension of the vessel by a large clot</li></li></ul><li>Fissure sign<br />
  31. 31. A ventilation/perfusion lung scan, also called a V/Q lung scan<br />A type of medical imaging using scintigraphy and medical isotopes<br />Evaluate the circulation of:<br />Air<br />Blood within a patient's lungs<br />
  32. 32. A ventilation/perfusion lung scan, also called a V/Q lung scan<br />A type of medical imaging using scintigraphy and medical isotopes<br />Evaluate the circulation of:<br />Air<br />Blood within a patient's lungs<br />
  33. 33. Gamma Camera<br />22<br />
  34. 34. A ventilation/perfusion lung scan, also called a V/Q lung scan<br />Evaluate the circulation of:<br />Air: Nebulizer of a gaseous radionuclide such as:<br /><ul><li>Xenon
  35. 35. Technetium
  36. 36. DTPA </li></li></ul><li>A ventilation/perfusion lung scan, also called a V/Q lung scan<br />Evaluate the circulation of:<br />Blood within a patient's lungs: the intravenous injection of radioactive technetium macro aggregated albumin (Tc99m-MAA)<br />
  37. 37. Fissure sign<br />Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution<br />
  38. 38. Fissure sign<br />But, increased separation due to pleural thickening or effusion is seen as linear area of reduced uptake along the fissure referred as fissure sign<br />
  39. 39. Headcheese sign<br />
  40. 40. Secondary lobule and pulmonary Acinus<br />28<br />
  41. 41. Radiograph of 1-mm lung slice taken from peripheral lower lobe<br />29<br />
  42. 42. QuizHow many lobules do you see in this image?<br />One lobule<br />2 lobules<br />3 lobules<br />30<br />
  43. 43. QuizHow many lobules do you see in this image?<br />One lobule<br />2 lobules<br />3 lobules<br />31<br />
  44. 44. Why do we see two lobules ?<br />32<br />
  45. 45. S: Interlobular septa : 0.1 mm <br />V: Pulmonary vein : 0.5 mm <br />A: Pulmonary arteries : : 1 mm <br />33<br />
  46. 46. Headcheese sign<br />
  47. 47. Headcheese sign<br />Hypersensitivity pneumonitis<br />
  48. 48. Headcheese sign in hypersensitivity pneumonitis<br />Combination of patchy or lobular ground-glass opacity (small arrows) and mosaic perfusion (large arrows)<br />36<br />
  49. 49. 37<br />Headcheese sign in Chronic hypersensitivity pneumonitis <br />
  50. 50. 38<br />Headcheese sign in Chronic hypersensitivity pneumonitis <br />Expiration<br />Inspiration<br />
  51. 51. Hilar overlay sign<br />
  52. 52. Hilar overlay sign<br />Refers to the ability to see the hilar structures through the shadow of a mass superimposed on the hilum<br />
  53. 53. Hilar overlay sign<br />Indicates that the mass lies either in front or behind the hilum<br />
  54. 54. Hilar overlay sign<br />Anterior lymphoma<br />or posterior neurofibroma <br />
  55. 55. Hilar overlay sign PA chest X-ray <br />A large anterior mediastinal mass. <br />
  56. 56. Hilar overlay sign PA chest X-ray <br />The hilum overlay sign:<br /><ul><li>The mediastinal mass overlaps the main pulmonary artery which is seen well within the margins of the mass.</li></li></ul><li>Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The ability to see the hilar structures through the shadow of a mass superimposed on the hilum<br />45<br />
  57. 57. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The mass localise in:<br />Posterior mediastinum<br />Anterior mediastinum<br />46<br />
  58. 58. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The mass localise in:<br /><ul><li>Posterior mediastinum
  59. 59. Anterior mediastinum</li></ul>Why??<br />47<br />
  60. 60. 48<br />
  61. 61. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph <br />The descending aorta is clearly seen (black arrow), indicating that the mass is not within the posterior mediastinum<br />49<br />
  62. 62. Hilum Overlay Sign<br />Hilar vessels are seen through a mediastinal mass<br />50<br />
  63. 63. Hilum Overlay Sign<br />A lymphoma in a HIV-positive patient.<br />51<br />
  64. 64. The Anterior Junction Line<br />52<br />
  65. 65. A transverse section of the thorax<br />Showing the contents of the middle and the posterior mediastinum. <br />53<br />
  66. 66. Posteroanterior chest radiograph demonstrates the anterior junction line(arrow)<br />54<br />
  67. 67. Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow)<br />55<br />
  68. 68. Chest CT scan<br />An anterior mediastinal mass. <br />56<br />
  69. 69. The anterior junction line is obliterated<br />57<br />
  70. 70. 58<br />Bulging fissure sign<br />
  71. 71. Normal major fissures<br />Lateral chest radiograph demonstrates the two major fissures<br />59<br />http://radiographics.rsna.org/content/21/4/861/F2.expansion.html<br />
  72. 72. Normal major fissures<br />Note that both fissures are seen as double lines<br />60<br />http://radiographics.rsna.org/content/21/4/861/F2.expansion.html<br />
  73. 73. Normal major fissures<br /><ul><li>The left fissure: ??
  74. 74. The right fissure: ??</li></ul>61<br />http://radiographics.rsna.org/content/21/4/861/F2.expansion.html<br />
  75. 75. 62<br />Normal major fissures<br /><ul><li>The left fissure (arrows)
  76. 76. The right fissure (arrowheads)</li></ul>http://radiographics.rsna.org/content/21/4/861/F2.expansion.html<br />
  77. 77. 63<br />CT scan<br />HRCT scan<br />Normal major fissures<br />CT scan shows the major fissures as lucent bands of relative hypovascularity (arrows)<br />http://radiographics.rsna.org/content/21/4/861/F3.expansion.html<br />
  78. 78. Bulging fissure sign<br />Consolidation:<br /><ul><li>Spreading rapidly
  79. 79. Causing lobar expansion
  80. 80. Bulging of the adjacent fissure inferiorly </li></ul>64<br />
  81. 81. Bulging Fissure Sign<br />Consolidation spreading rapidly, causing lobar expansion and bulging of the adjacent fissure inferiorly<br />65<br />
  82. 82. What do you think the diagnosis?<br />Pneumonia caused by staphylococcus aureus.<br />Pneumonia caused by Klebsiella<br />TB<br />Large cell carcinoma<br />66<br />
  83. 83. Bulging Fissure Sign<br />Historically: Klebsiella pneumoniae involving the right upper lobe .<br />67<br />
  84. 84. 68<br />

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