Signs in Thoracic Radiology : Role of radiographic signs in the present era

Transcription

1 Signs in Thoracic Radiology : Role of radiographic signs in the present era Poster No.: C-3278 Congress: ECR 2010 Type: Educational Exhibit Topic: Chest Authors: A. Mahajan; Mumbai/IN Keywords: CHEST XRAY, SIGNS, HRCT DOI: /ecr2010/C-3278 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 33

2 Learning objectives The aim of this exhibit is to provide a pictorial review of the classic signs so that the radiologist can define, identify and state the significance of these signs. To briefly describe there role in diagnosis of the specific entity. Background Chest X-Ray is something which is very basic to Radiology Practise even in todays world of complicated machines and imaging devices. Very often the competence of a Radiology Resident is judged by his interpretation of a chest X-ray and application of various signs in Chest Roengtenology. Imaging findings OR Procedure details There are 30 signs and include: # air bronchogram # angiogram sign# Fissure sign# Headcheese sign# Signet/pearl ring sign# Air crescent sign# Halo sign#. Flat-waist sign# Hilar overlay sign# Silhouette sign# Bulging fissure sign# Deep sulcus sign# Fleischner sign# Luftsichel sign# Comet tail sign # Double density sign# Gloved finger sign# Positive bronchus sign# Thymic sail sign# Continuous diaphragm sign# Fallen lung sign# Golden S sign# Ring around the artery sign and many more Images for this section: Page 2 of 33

3 Fig. 1: Air bronchogram sign presence of air filled (patent) bronchi surrounded by air spaces filled with pus or fluid; simply indicates air space disease; e.g. pneumonia Page 3 of 33

4 Fig. 2: Air crescent sign air surrounding a radio opaque material in a crescentric manner along both its inner and outer margins indicating cavitary disease; e.g. aspergilloma in an old TB cavity Page 4 of 33

5 Fig. 3: Bulging fissure sign convex configuration a fissure takes to accommodate an adjacent swollen/enlarged lobe; e.g. Klebsiella pneumonia Page 5 of 33

6 Fig. 4: Comet tail sign an unusual form of focal lung collapse simulating a mass (body of the comet) with distorted vessels and bronchi (tail of the comet) radiating towards hilum; asbestos exposure in 70% Page 6 of 33

7 Fig. 5: Continuous diaphragm sign presence of air between heart & diaphragm (pneumomediatinum) or within pericardium (pneumopericardium) making normally invisible parts of central dipahgram visible in continuation with both hemidiaphragms Page 7 of 33

8 Fig. 6: Split pleura sign two layers (visceral and parietal) of enhancing pleura split by the presence of an pleural inflammatory process such as empyema Page 8 of 33

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10 Fig. 7: Positive bronchus sign tubular area of hypoattenuation representing air filled bronchus leading to a peripheral nodule; If this extends into the nodule/mass, an air bronchogram sign in produced Fig. 8: Luftsichel sign paraaortic crescentric lucency caused by the hyperexpanded superior segment of the left lower lobe in cases of left upper lobe collapse (German = Luft- air; sichel- crescent) Page 10 of 33

11 Fig. 9: Hilar overlay sign ability to see the hilar structures through the shadow of a mass superimposed on the hilum; indicates that the mass lies either in front or behind the hilum; e.g. anterior lymphoma or posterior neurofibroma Page 11 of 33

12 Fig. 10: Thymic sail sign outlining of normal thymus by air which also elevates the thymus giving it the configuration of a sail; indicates pneumomediastinum Page 12 of 33

13 Fig. 11: Tree-in-bud sign pattern of opacity seen in a HRCT; the terminal tufts of TIB represent inflammatory material filling respiratory bronchioles and alveolar ducts and the stalks of TIB represent filling within terminal bronchiole; e.g. Endobronchial TB Page 13 of 33

14 Fig. 12: Westermark sign an area of o!igemia with minimal change in lung volume distal to a large PE; this regional oligemia is caused either by mechanical obstruction to blood flow by the clot or by reflex vasoconstriction Page 14 of 33

15 Fig. 13: Silhouette sign inability to see the border of a normal structure such as heart or aorta masked by an opacity of similar density anatomically contiguous with this border; e.g. right middle lobe consolidation masking right heart border Page 15 of 33

16 Fig. 14: Signet/pearl ring sign combination of a small soft tissue attenuating circle (pulmonary artery- pearl on a ring) abutting a larger soft tissue attenuating ring (wall of a bronchus- ring); ring surrounds a low-attenuating circle (air within bronchus); indicates bronchiectasis Page 16 of 33

17 Fig. 15: Scimitar sign curved vascular shadow (resembling a short, curved Turkish sword called scimitar) representing an anomalous pulmonary vein draining the right lung that descends toward the diaphragm located to the right of the heart Page 17 of 33

18 Fig. 16: Hampton hump sign homogeneous wedge-shaped consolidation in the lung periphery with a base contiguous to a visceral pleural surface and a rounded convex apex directed toward the hilum; associated with pulmonary infarct Page 18 of 33

19 Fig. 17: Golden S sign a reverse S shaped shadow caused by right upper lobe collapse forming the upper curve of the reverse S (concave infero-laterally) and a central mass causing the collapse forming the lower curve (convex infero-medially) Page 19 of 33

20 Fig. 18: Gloved finger sign branching finger like opacities representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery; e.g. ABPA Page 20 of 33

21 Fig. 19: Fallen lung sign collapse of lung away from the mediastinum when the normal central bronchial anchoring attachment of the lung is disrupted as in bronchial tear/ fracture. Page 21 of 33

22 Fig. 20: Figure 3 sign abnormal contour of aortic arch in coarctation of aorta. The upper arc is the dilated arch proximal to the coarctation, the lower arc is the poststenotic dilatation & the indentation between the 2 arcs is the coarctation. Page 22 of 33

23 Fig. 21: Fissure sign Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution; but, increased separation due to pleural thickening or effusion is seen as linear area of reduced uptake along the fissure referred as fissure sign Page 23 of 33

24 Fig. 22: Flat-waist sign loss of concavity of the left heart border on a symmetrical frontal CXR due to slight anterior oblique rotation of the heart seen in some cases of left lower lobe collapse. Page 24 of 33

25 Fig. 23: Fleischner sign prominence of central pulmonary artery caused either by pulmonary hypertension that develops secondary to PE or by distension of the vessel by a large clot Page 25 of 33

26 Fig. 24: Ring around the artery sign lucency caused by air around a vessel such as pulmonary artery; indicates pneumomediastinum Page 26 of 33

27 Fig. 25: Crazy paving sign combination of ground glass attenuation superimposed on a network of interlobular septal thickening giving it an appearance of a surface paved with slabs of differing shapes; e.g. alveolar proteinosis Page 27 of 33

28 Fig. 26: CT angiogram sign conspicuous enhancing pulmonary vessels in a background of homogeneous low-attenuating consolidation relative to chest wall musculature; e.g. Bronchoalveolar cell carcinoma Page 28 of 33

29 Fig. 27: CT halo sign zone of ground-glass attenuation (the halo) surrounding a pulmonary nodule or mass; e.g. invasive aspergillosis Page 29 of 33

30 Fig. 28: Deep sulcus sign deep lateral costophrenic angle on a supine CXR representing gas collection in a subpulmonary location due to pneumothorax and may be the only sign of it Page 30 of 33

31 Fig. 29: Double density sign abnormal density overlying right heart border; the normal right heart forms its usual density and the abnormality forms the other density; e.g. left atrial enlargement Page 31 of 33

32 Fig. 30: Headcheese sign the combined presence of ground glass opacity, normal lung and reduced attenuation due to air trapping giving the lung a geographic appearance resembling the variegated appearance of a sausage made from head of a hog; e.g. hypersensitivity pneumonitis Page 32 of 33

33 Conclusion These radiographic signs in thoracic imaging will help in identifying the disease process and leading the radiologist to specific pathology. Less accounted, but they prove play improtant role in diagnositic thoracic imaging. Personal Information Author details: Dr. Abhishek Mahajan, MBBS,MD Fellow in Cancer Imaging Dept of Radiodiagnosis & Imaging Tata Memorial Hospital Dr E Borges Road Parel Mumbai Maharashtra India ( ) drabhishek.mahajan@yahoo.in References Pulmonary Curriculum: Signs in Thoracic Radiology Page 33 of 33