曾嘉成 醫師

高雄長庚醫院 胸腔內科

SILHOUETTE SIGNSILHOUETTE SIGN• Silhouette : Silhouette : 就是就是 << 輪廓、側影輪廓、側影 >> 的意思的意思• 在在 xx 光片上的兩個連接的影像，如果兩個影像在前後光片上的兩個連接的影像，如果兩個影像在前後

的層面是同一層的，則界限不清楚的層面是同一層的，則界限不清楚

AnatomyAnatomy

Silhouette sign(+)

Silhouette Sign in

Heart Aorta & Diaphragm

Silhouette

Sign(+)

HEART AORTA DIAPHRAGM BORDERS

Silhouette Sign(-)

Pneumonia with RML Collapse

Silhoutte sign(+) right heart border

NSLC with RLL Collapse

Silhouette sign(+) diaphragm; Silhouette sign(-) right heart border

Pneumonia with Left Lingular lobe collapse

Silhouette sign(+) left heart border

pneumonia with LLL Collapse

Silhouette sign(+) diaphragm;Silhouette sign(-) left heart border

Detracardia ?

放錯邊 ?

RLL segment collapseRLL segment collapse

NSCLC LLL

Silhouette sign(+) descending aorta ; Silhouette sign (-) left heart border

Adenocarcinoma with lung metastasis

Silhouette sign(+) descending aorta

Pericardial Cyst

Silhouette sign(+) right heart border

Silhouette Sign in Mediastinum

MediastinumMediastinum• 1. PA + Lat.1. PA + Lat.

• 2. Width.2. Width.

• 3. Density.3. Density.

• 4. Free air and line. 4. Free air and line.

MediastinumMediastinum• 1. Anterior.1. Anterior.

• 2. Middle.2. Middle.

• 3. Posterior.3. Posterior.

Mediastinum lesionMediastinum lesion

• AnteriorAnterior mediastinum lesion: mediastinum lesion: 3 T (thyroid goiter, thymoma, teratoma) 3 T (thyroid goiter, thymoma, teratoma)

+ 1 L (lymphoma)+ 1 L (lymphoma)• MiddleMiddle mediastinum lesion: bronchogen mediastinum lesion: bronchogen

ic cyst + lymph node , or vascular ,esophic cyst + lymph node , or vascular ,esophagus lesion agus lesion

• PosteriorPosterior mediastinum : neurogenic tum mediastinum : neurogenic tumor, TB cold abscess or, TB cold abscess

Silhouette sign (-) left heart border

Ganglioneuroblastoma

Intrathoracic Goitre

Cervicothoracic sign(+) anterior location

Silhouette sign(+) ascending aorta

Thymoma

Thymoma

Silhouette sign(-) aortic arch

Left Hilar Mass,NSCLC, Silhouette sign(+) aortic arch

Teratoma Rupture

Silhouette sign(-) aortic arch

Silhouette sign(+) left heart border

Lymphoma

Descending aorta aneurysmDescending aorta aneurysmSilhouette sign Silhouette sign (+) descending (+) descending aortaaorta

Descending aorta aneurysmDescending aorta aneurysm

Aortic Dissection

>0.5 cm

Silhouette sign (+) aortic arch

Neurogenic tumor with ribbon ribNeurogenic tumor with ribbon rib

Cervicothoracic sign(+)Cervicothoracic sign(+)

Neurogenic tumor, SchwanomaNeurogenic tumor, SchwanomaCervicothoracic sign (+)Cervicothoracic sign (+)

Immature Teratoma

Silhouette sign (+) ascending aorta

Silhouette’s Sign

in Hillum

Hilar Convergent Sign腫大的左肺動脈有時酷似腫瘤，此時可見肺動脈的分支向此腫瘤聚集，表此腫瘤是由肺動脈構成的。

若肺動脈分支未向此腫瘤集中，則此腫瘤並非擴大的左肺動脈

Pulmonary Trunk Dilatation

Hilar Convergent Sign

Hilar Overlay Sign

Hilar Overlay SignLymphangioma

Silhouette’s Sign in Extrapulmonary lesio

n

Pulmonary & Extra-pulmonary ‘s Sign

Liver abscess with reactive pleural effusion (phantom tumor)

Pulmonary embolism & s/p mammoplasty

Asbestosis

Empyema (incomplete border sign)

Empyema (incomplete border sign)

Silhouette Sign in

Upper lung field

Cervico-Thoracic Sign

Cervico-Thoracic Sign

Neurogenic tumor, SchwanomaNeurogenic tumor, Schwanoma

Silhouette Sign in

Thorax vs Diaphragm

Thoraco-Abdominal Sign

Thoraco-Abdominal Sign

Thoracoabdominal sign(-)

Silhouette sign(+) desceding aorta : Incomplete border(+) ; Thoracoabdominal sign(+)

Hiatal hernia

Signs in CXRSigns in CXR

• Silhouette sign Silhouette sign • Cervicothoracic sign Cervicothoracic sign • Thoracoabdominal sThoracoabdominal s

ign ign • Hilum overlay sign Hilum overlay sign • Hilum convergence sHilum convergence s

ign ign

• Extrapulmonary sign Extrapulmonary sign • Incomplete border siIncomplete border si

gn gn