A pictorial review of “signs in thoracic imaging 02”
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Transcript of A pictorial review of “signs in thoracic imaging 02”
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A Pictorial Review of “Signs in Thoracic
Imaging” Part 02
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
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Topic Outline
1. Luftsichel sign2. The Ring-around-the-Artery Sign3. Continuous Diaphragm Sign
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Luftsichel sign
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Luftsichel signIn German language
Luft = Air Sichel = crescent
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Left Lung Posterior view of segments
• Left lower lobe:1. Superior Segment (which
is positioned between the aortic arch )
2. Lateral Basal Segment3. Posterior Basal
Segment
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Luftsichel sign
Para-aortic crescentric lucency
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Luftsichel sign
Para-aortic crescentric lucency
Caused by the:•H
yperexpanded
superi
or
seg
ment
of
the
l
eft
lower
lobe
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Luftsichel sign
Para-aortic crescentric lucency
Caused by the:•H
yperexpanded
superi
or
seg
ment
of
the
l
eft
lower
lobe• I
n
cases
of
left
upper
lobe
coll
apse
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Luftsichel signThis aerated segment of left lower lobe is hyperlucent and shaped like a sickle. 9
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Luftsichel sign Lateral chest radiograph
• Left upper lobe collapse
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Luftsichel sign / Lateral chest radiograph
• Anterior displacement of the major fissure (arrows)
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12 • Retrosternal opacification
Luftsichel sign / Lateral chest radiograph
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Luftsichel sign Lateral chest radiograph
• The superior segment of the lower lobe extends to the apex of the chest
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Luftsichel sign
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Luftsichel sign
Medial interposition of the hyperexpanded superior segment of the left lower lobe (black arrows) between the aortic arch and the collapsed left upper lobe16
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Luftsichel sign
The white arrows outline the medialand posterior aspects of the opaque collapsedleft upper lobe.
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Luftsichel sign
The posterior margin of the collapsed lobe (major
fissure) has a V-shaped contour extending from the apex of the collapsed lobe to the hilum
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This 68 year-old male patient presented with cough and dyspnoea
• Opacity in the left upper zone
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This 68 year-old male patient presented with cough and dyspnoea
• Silhouetting of the left heart border
• Typical of left upper lobe collapse.
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This 68 year-old male patient presented with cough and dyspnoea
• The trachea is shifted to the left
• A small juxtaphrenic peak
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The luftsichel sign
• Due to the superior segment of the left lower lobe insinuating itself between the collapsed upper lobe and the mediastinum
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The luftsichel sign lateral film
• Shows anterior displacement of the oblique fissure
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The luftsichel sign lateral film
• A prominant bulge in the hilar region suggesting a mass
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The luftsichel sign lateral film
• A prominant bulge in the hilar region suggesting a mass
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Diagnosis
• This patient have a hilar carcinoma causing obstruction of the left upper lobe bronchus.
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The Ring-around-the-Artery Sign
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The Ring-around-the-Artery SignLateral chest radiograph (close-up view of hilar area)
• A well-defined lucency (arrows) along the right pulmonary artery due to mediastinal air.
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What is your diagnosis?
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The Ring-around-the-Artery SignLateral chest radiograph (close-up view of hilar area)
• A 17-year-old boy with asthma :
Spontaneous pneumomediastinum
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• A well-defined lucency (arrows) along the right pulmonary artery
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• A well-defined lucency (arrows) along the right pulmonary artery
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• A well-defined lucency (arrows) along the right pulmonary artery
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The Ring-around-the-Artery Sign Lateral chest radiograph
• Air surrounding the right pulmonary artery (arrows)
• pneumomediastinum
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Continuous Diaphragm Sign
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Continuous Diaphragm Sign
• Refers to presence of air between heart & diaphragm
• (Pneumomediastinum)
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What is your diagnosis?
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Continuous Diaphragm Sign
• Pneumomediastinum
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Continuous Diaphragm Sign
Refers to presence of air within pericardium (Pneumopericardium)
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Continuous Diaphragm Sign
Making normally invisible parts of central dipahgram visible in continuation with both hemidiaphragms
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Continuous Diaphragm Sign
Pneumomediastinum
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Continuous Diaphragm SignPA chest film shows the thymus to be outlined by air and a continuous diaphragm sign.
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Pneumomediastinum
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Pneumomediastinum
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Pneumomediastinum
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Pneumomediastinum
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Pneumomediastinum
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Quiz (4)
1: Pneumopericardium
2: Pneumomediastinum
3: Pneumoperitoneum
4: Subcutaneous emphysema
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What is your diagnosis?
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Barotrauma
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Conclusion: continuous diaphragm sign
• Indicates pneumomediastinum