The Golden S sign is a radiographic finding seen on chest x-rays and CT scans that indicates right upper lobe collapse. It appears as a reverse S shape of the minor fissure, with the proximal portion convex inferiorly and distal portion concave inferiorly. This sign suggests the presence of a central mass, raising suspicion for bronchogenic carcinoma or other tumors. While cancer cannot be definitively diagnosed, the Golden S sign should alert radiologists to consider malignancy as a potential cause of the collapse.

1. <br />Skip to main page content<br />HOME<br /> <br />CURRENT<br /> <br />ARCHIVE<br /> <br />COLLECTIONS<br /> <br />COVER GALLERY<br /> <br />中国 (ABSTRACTS)<br /> <br />RADIOGRAPHICS<br />Principio del formulario<br />SearchGO<br />Advanced Search<br />Final del formulario<br />Principio del formulario<br />User NamePassword Sign In<br />Final del formulario<br />Minimize<br />The Golden S Sign<br />Punita Gupta, MD, MPH<br />+Author Affiliations<br />1From the New England Medical Center, 750 Washington St, Box 299, Boston, MA 02111. Received October 28, 2002; revision requested January 8, 2003; final revision received July 17; accepted August 6. Address correspondence to the author (e-mail: punagupta@yahoo.com).<br /> <br />Next Section<br />© RSNA, 2004<br />Previous SectionNext Section<br />APPEARANCE<br />The Golden S sign is a finding that can be seen not only on posteroanterior chest radiographs, but also on computed tomographic (CT) scans (1). Because this sign resembles a reverse S shape, which the minor fissure sometimes assumes with right upper lobe collapse, it is also referred to as the “reverse S sign of Golden” (2,3). On the posteroanterior chest radiograph, the proximal or medial portion of the minor fissure is convex inferiorly, and the distal or lateral portion of the fissure is concave inferiorly (Fig 1). The analogous appearance at CT is a convex bulge along the fissural margin of a collapsed lobe (Fig 2). Although typically seen with right upper lobe collapse, the S sign can also be seen with the collapse of other lobes and has been demonstrated on the lateral chest radiograph (2,3).<br />View larger version:<br />In this page<br /> <br />In a new window<br />Download as PowerPoint Slide<br />Figure 1. Posteroanterior radiograph of the chest demonstrates the Golden S sign. Note the convexity (arrowhead) from the mass and the concavity (arrow) of the minor fissure.<br />View larger version:<br />In this page<br /> <br />In a new window<br />Download as PowerPoint Slide<br />Figure 2. Transverse postcontrast CT image of the chest demonstrates a convexity (arrow) with collapse of the right upper lobe.<br />Previous SectionNext Section<br />EXPLANATION<br />The right upper lobe lies anterior to the major fissure and is bordered inferiorly by the minor fissure and posteriorly by the major fissure. The lobe is also bordered laterally by the chest wall and medially by the mediastinum (3,4). When volume loss occurs in the right upper lobe, the resultant anatomic changes include fissure displacement, a shift of structures, and an increased lung opacity, depending on the severity of the volume loss (5–7). During right upper lobe collapse, the minor and major fissures move superiorly and medially toward the mediastinum, and there is a compensatory hyperexpansion of the right middle and lower lobes. The result can be seen on posteroanterior chest radiographs as a downward concavity of the minor fissure and a triangular opacity that represents the collapsed lobe, with the apex of the lobe located at the elevated hilum and the broad base of the lobe located against the chest wall. With severe right upper lobe collapse, the minor fissure may either lie parallel to the mediastinum to simulate a widened mediastinum or be compressed superiorly to resemble an apical cap (6,8).<br />The Golden S sign can be seen on posteroanterior chest radiographs of right upper lobe collapse when a large enough central mass is present to produce a downward convexity of the medial or proximal portion of the minor fissure. At CT, a mass may also form a convex bulge at the fissural margin to produce an S shape (9).<br />Previous SectionNext Section<br />DISCUSSION<br />The Golden S sign is created by a central mass and should raise suspicion of a central neoplasm, such as primary bronchial carcinoma. Bronchial carcinoma is one of the leading causes of cancer deaths among men and women. In 2002, 1 284 900 new cases were predicted to occur (10). Eighty percent of lung cancers are non–small cell lung carcinomas, which include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Small cell lung carcinoma is the most aggressive and has the worst prognosis (11). Other central masses to consider include metastasis, primary mediastinal tumor, or enlarged lymph nodes (12). However, sometimes patterns of upper lobe collapse can result in an apparent Golden S sign in the absence of a mass (3).<br />Although bronchogenic carcinoma cannot be diagnosed definitively on the basis of this radiographic sign, the Golden S sign should be recognized and should alert the radiologist to consider the diagnosis.<br />Previous SectionNext Section<br />Previous SectionNext Section<br />Footnotes<br />Author stated no financial relationship to disclose.<br />A trainee (resident or fellow) wishing to submit a manuscript for Signs in Imaging should first write to the Editor for approval of the sign to be prepared, to avoid duplicate preparation of the same sign.<br />Index terms:Bronchi, neoplasms, 61.311, 61.321Lung, collapse, 61.3232Signs in imaging<br />