Deep sulcus sign fallen lung sign-ct angiogram sign-flat-waist sign

Deep sulcus sign-Fallen Lung Sign-CT angiogram sign-Flat-waist sign

1. Deep sulcus sign Fallen Lung Sign CT angiogram sign Flat-waist sign Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: [email protected]

2. Topic Outline Deep sulcus sign Fallen Lung Sign CT angiogram sign Flat-waist sign 2

3. Deep sulcus sign

4. Deep sulcus sign Refers to a deep lateral costophrenic angle on a supine CXR. 4

5. What is your diagnosis?

6. Deep sulcus sign Representing gas collection in a subpulmonary location due to pneumothorax and may be the only sign of it 6

7. Deep Sulcus Sign AP position Bilateral pneumothorax Lucency of the left lateral costophrenic angle 7

8. Supine chest radiograph of a neonate Deep sulcus sign with abnormal deepening and lucency of the left lateral costophrenic angle (∗) 8

9. ARDS Deep sulcus sign Right pneumothorax 9

10. Deep Sulcus Sign Left pneumothorax 10

11. Conclusion Deep sulcus sign on a supine radiograph - indicates pneumothorax 11

12. Fallen Lung Sign 12

13. Fallen lung sign This sign refers to the appearance of the collapsed lung occurring with a fractured bronchus

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16. Fallen lung sign Either inferiorly and laterally in an upright patient 16

17. Fallen lung sign Or posteriorly, as seen on CT in a supine patient 17

18. Conclusion fallen lung sign - indicates a fractured bronchus

19. CT Angiogram Sign 19

20. 20 Terminology Gray Low Attenuation Radiolucent Skin and Muscles White High Attenuation Radiopaque Fingres

21. The criteria to define the CT angiogram sign are: Pulmonary vessels extending 3 cm or more along a single channel Diffuse homogeneous low attenuation of the consolidated lung parenchyma compared with the attenuation of the chest wall musculature. 21

22. The criteria to define the CT angiogram sign Attenuation of Lung consolidation less than Attenuation of chest wall musculature 28 HU LC < 74 HU CWM 22

23. The criteria to define the CT angiogram sign are: A mean attenuation value of 27.6 HU was found in cases of bronchoalveolar cell carcinoma in contrast to the mean attenuation value of 73.5 HU on the images obtained in patients who did not have bronchoalveolar cell carcinoma; the mean attenuation value of muscle on the images obtained in these patients was 74 HU 23

24. The CT angiogram sign is seen on contrast material–enhanced scans Results from the normally enhancing pulmonary vessels

25. The CT angiogram sign is seen on contrast material–enhanced scans Within the low-attenuating consolidated lung parenchyma relative to the chest wall musculature.

26. CT Angiogram Sign The vessels are prominently seen against a background of low-attenuation material.

27. CT Angiogram sign The CT angiogram sign was initially described as a specific sign of lobar bronchoalveolar cell carcinoma Specificity can be as high as 92.3% 27

28. CT Angiogram sign Pneumonia Pulmonary edema Obstructive pneumonitis due to central lung tumors Lymphoma Metastasis from gastrointestinal carcinomas 28

29. Conclusion: CT angiogram sign Enhancing pulmonary vessels against a background of low attenuation material in the lung 29

30. Flat-waist sign علامة الوسط المسطح

31. Flat-waist sign A symmetrical frontal CXR

32. Flat-waist sign Refers to the loss of concavity of the left heart border

33. Flat-waist sign Due to slight anterior oblique rotation of the heart seen.

34. Flat-waist sign Due in some cases of left lower lobe collapse .

35. Flat waist Sign

36. Flat waist Sign Atelectasis LLL 36

37. Conclusion Flat waist sign- indicates left lower lobe collapse 37