a pictorial review of “signs in thoracic imaging 01”

A Pictorial Review of “Signs in Thoracic Imaging”Part 01

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. Air bronchogram sign2. Air crescent sign

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Air bronchogram signالهوائي القصبي االرتسام عالمة

Air bronchogram signالهوائي القصبي االرتسام عالمة

على • القدرة هيالحدود مشاهدة

ضمن القصبيةالرئوي المتن

بحديثة المصابتقيحية مرضية ) وذمية) أو قيح

) ماء) •. الرئة ذات

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Air bronchogram sign

RUL Consolidation Sterp Pneumonia

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Air bronchogram sign Pneumococcal pneumonia

• Consolidation with multiple air bronchograms ( black

branching structures) in the:A. RULB. RMLC. RLL

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Air bronchogram sign Pneumococcal pneumonia

• Consolidation with multiple air bronchograms in the:A. Segment anterior

of RULB. RMLC. RLL

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Air bronchogram sign

Diffuse Alveolar Hemorrhage

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Air bronchogram sign

Acute eosinophilic pneumonia

Air Bronchogram Sign

DD:PneumoniaLymphoma Bronchoalveolar cell carcinoma.

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Conclusion: Air bronchogram

Indicates a parenchymal process

Including non-obstructive atelectasis

Distinguished from pleural or mediastinal processes

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Air crescent signالغازي الهالل عالمة

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Crescent-shaped area of air within:

Nodule

Mass

Consolidation

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Air crescent sign results most commonly from mycetoma (fungus ball) within:

• Pulmonary cavity• Ectatic bronchus

• Angioinvasive aspergillosis in patients with severe neutropenia

Air crescent signالغازي الهالل عالمة

The air surrounding a radio opaque material

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Air crescent signالغازي الهالل عالمة

In a crescentric manner along both its inner and outer margins indicating cavitary disease

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Air crescent signالغازي الهالل عالمة

Aspergilloma in an old TB cavity

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o The arrows denote an ill-defined nodular opacity in medial aspect of right upper lobe with ill-defined rim of lucency surrounding it.

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Invasive aspergillosis in a 6-year-old girl with neutropenia and acute

lymphocytic leukemia19

Frontal chest radiograph shows two air crescent signs (arrowheads)

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Chest roentgenogram PA view

Rightpneumothorax

Mycetoma with air-crescent sign

The tip ofintercostal drain is also visible near the base.

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Computed tomogram of the thorax

Various viewsof the mycetoma

Rupture into the pleural cavity leading to pneumothorax22

Coronal reformation imageIntracavitary aspergilloma (*) in the left upper lobe

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Air crescent –shaped surrounding oval opacity within cavity

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• Subpleural honeycombing in the lower lobes consistent with idiopathic pulmonary fibrosis.

What is your diagnosis?

The patient was a 58-year-old man with previous tuberculosis and intracavitary aspergilloma

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Sagittal reformat from a CT scan of the chest

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• A 14 year-old female with acute myeloblastic leukaemia

Where is located this lesion?

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A. Left LungB. Right Lung

Where is located this lesion?

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A. Left LungB. Apical segment of

Right Upper Lobe in lateral position

Correct description

A Mycetoma with air-crescent sign located in apical segment of right upper lobe in lateral position

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Air crescent sign in anterior segment of right upper lobeAspergilloma

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PA Projection radiograph

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• Patchy airspace disease with areas of lucency suggestive of cavitation in the right upper lobe.

PA Projection radiograph

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• Emphysematous changes are seen bilaterally.

Chest CT scan

Air crescent sign within the consolidated right upper lobe.

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Chest CT scan

Paraseptal emphysema

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Chest CT scanA cavity with an intracavitary mass within the consolidated right upper lobe

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Conclusion: Air crescent sign

• indicates a lung cavity, often due to fungal infection