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3. Luftsichel sign4. The Ring-around-the-Artery Sign5. Continuous Diaphragm Sign
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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:
Qusaibaty@gmail.com
2
Topic Outline
1. Luftsichel sign2. The Ring-around-the-Artery Sign3. Continuous Diaphragm Sign
Luftsichel sign
Luftsichel signIn German language
Luft = Air Sichel = crescent
5
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.
17
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.
21
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.
30
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)
41
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
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