Deep sulcus signFallen Lung SignCT angiogram signFlat-waist sign

Dr Mazen QusaibatyMD, DIS

Head Pulmonary and Internist Department Ibnalnafisse Hospital

Ministry of Syrian healthEmail:

Qusaibaty@gmail.com

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Topic Outline

1. Deep sulcus sign2. Fallen Lung Sign3. CT angiogram sign4. Flat-waist sign

Deep sulcus sign

Deep sulcus sign

• Refers to a deep lateral costophrenic angle on a supine CXR.

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What is your diagnosis?

Deep sulcus sign

• Representing gas collection in a subpulmonary location due to pneumothorax and may be the only sign of it

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Deep Sulcus SignAP position

• Bilateral pneumothorax

• Lucency of the left lateral costophrenic angle

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Supine chest radiograph of a neonate

Deep sulcus sign with abnormal deepening and lucency of the left lateral costophrenic angle ( )∗

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ARDS

• Deep sulcus sign • Right pneumothorax

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Deep Sulcus Sign

Left pneumothorax

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Conclusion

• Deep sulcus sign on a supine radiograph - indicates pneumothorax

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Fallen Lung Sign

Fallen lung sign

• This sign refers to the appearance of the collapsed lung occurring with a fractured bronchus

The bronchial fracture

Results in the lung to fall

away from the hilum

Either inferiorly and laterally in an

upright patient

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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

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Fallen lung sign

• Either inferiorly and laterally in an upright patient

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Fallen lung sign

• Or posteriorly, as seen on CT in a supine patient

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Conclusion

• fallen lung sign - indicates a fractured bronchus

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CT Angiogram Sign

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Terminology

• Gray• Low

Attenuation• Radiolucent• Skin and

Muscles

• White• High

Attenuation

• Radiopaque

• Fingres

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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.

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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

The CT angiogram sign is seen on contrast material–enhanced scans

• Results from the normally enhancing pulmonary vessels

The CT angiogram sign is seen on contrast material–enhanced scans

• Within the low-attenuating consolidated lung parenchyma relative to the chest wall musculature.

CT Angiogram Sign

• The vessels are prominently seen against a background of low-attenuation material.

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%

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CT Angiogram sign

1. Pneumonia2. Pulmonary edema3. Obstructive

pneumonitis due to central lung tumors

4. Lymphoma5. Metastasis from

gastrointestinal carcinomas

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Conclusion: CT angiogram sign

• Enhancing pulmonary vessels against a background of low attenuation material in the lung

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Flat-waist sign المسطح الوسط عالمة

Flat-waist sign

A symmetrical frontal

CXR

Flat-waist sign

Refers to the loss of

concavity of the left

heart border

Flat-waist sign

Due to slight anterior oblique rotation of the heart seen.

Flat-waist sign

Due in some cases of left lower lobe collapse.

Flat waist Sign

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Flat waist Sign

Atelectasis LLL

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Conclusion

• Flat waist sign- indicates left lower lobe collapse

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

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