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:

Qusaibaty@gmail.com

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Topic Outline

1. Luftsichel sign2. The Ring-around-the-Artery Sign3. Continuous Diaphragm Sign

Luftsichel sign

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

Luftsichel sign

Para-aortic crescentric lucency

Luftsichel sign

Para-aortic crescentric lucency

Caused by the:•H

yperexpanded

superi

or

seg

ment

of

the

l

eft

lower

lobe

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

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)

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

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

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.

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?

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

Continuous Diaphragm Sign

• Refers to presence of air between heart & diaphragm

• (Pneumomediastinum)

What is your diagnosis?

Continuous Diaphragm Sign

• Pneumomediastinum

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

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