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Silhouette Sign – Left Lung
Posterior Anterior
Abbreviations
LUL – Left upper lobe
LLL – Left lower lobe
LV – Left ventricle
Left: sagittal CT image through the middle of the left thorax in lung windows.
NB: Sagittal thorax views are normally presented facing the other way but this image has been flipped to more
accurately represent a left lateral chest x-ray. This image demonstrates the oblique fissure (orange line). The lobes
are labelled appropriately. The sagittal heart outline (red outline) demonstrates its anterior position and its close
proximity to the LUL.
Right: annotated diagram of the heart.
LV
LUL
LLL
Hung Do 2019
Silhouette Sign – Left Lung
LUL pathology
Left: PA image showing loss of left cardiac border as annotated by yellow arrow. The heart is located in the anterior
chest compartment and is bordered by the lingua of the left lung. Often if there is pathologies with similar tissue
density to the heart located near the lingua of the LUL, the normal cardiac border will be lost. NB: The rationale for
detection of apical LUL pathology is the same.
Right: The lateral view confirms the pathology is located anteriorly in the LUL.
Silhouette Sign – Left Lung
LLL pathology
Left: PA image showing no loss of left cardiac border as annotated by blue arrow. The heart is located in the anterior
chest compartment and is bordered by the lingua of the left lung. Since there is no loss of heart border, the
pathology is most likely contained in the posterior compartment and in the LLL.
Right: The lateral view confirms the pathology is located anteriorly in the LLL.

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Silhouette Sign left lung

  • 1. Silhouette Sign – Left Lung Posterior Anterior Abbreviations LUL – Left upper lobe LLL – Left lower lobe LV – Left ventricle Left: sagittal CT image through the middle of the left thorax in lung windows. NB: Sagittal thorax views are normally presented facing the other way but this image has been flipped to more accurately represent a left lateral chest x-ray. This image demonstrates the oblique fissure (orange line). The lobes are labelled appropriately. The sagittal heart outline (red outline) demonstrates its anterior position and its close proximity to the LUL. Right: annotated diagram of the heart. LV LUL LLL Hung Do 2019
  • 2. Silhouette Sign – Left Lung LUL pathology Left: PA image showing loss of left cardiac border as annotated by yellow arrow. The heart is located in the anterior chest compartment and is bordered by the lingua of the left lung. Often if there is pathologies with similar tissue density to the heart located near the lingua of the LUL, the normal cardiac border will be lost. NB: The rationale for detection of apical LUL pathology is the same. Right: The lateral view confirms the pathology is located anteriorly in the LUL.
  • 3. Silhouette Sign – Left Lung LLL pathology Left: PA image showing no loss of left cardiac border as annotated by blue arrow. The heart is located in the anterior chest compartment and is bordered by the lingua of the left lung. Since there is no loss of heart border, the pathology is most likely contained in the posterior compartment and in the LLL. Right: The lateral view confirms the pathology is located anteriorly in the LLL.

Editor's Notes

  1. https://radiologyassistant.nl/chest/chest-x-ray-basic-interpretation
  2. https://radiologyassistant.nl/chest/chest-x-ray-basic-interpretation