Figure 3 sign-Fleischner sign-Fissure sign-Headcheese sign-Hilar overlay sign-The Anterior Junction Line-Bulging fissure sign

2. Fleischner sign

3. Fissure sign

4. Headcheese sign

5. Hilar overlay sign

6. The Anterior Junction Line

8. Fleischner sign

9. Fissure sign

10. Headcheese sign

11. Hilar overlay sign

12. The Anterior Junction Line

13. Bulging fissure sign2

14. Figure 3 signMogul Sign 3 3

15. Figure 3 sign Refers to the abnormal contour of aortic arch in coarctation of aorta.

19. Figure 3 sign 8

20. Figure 3 sign Coarctation 9

21. Figure 3 sign

22. Spiral CT angiography in an infant with a hypoplastic aortic arch 2D reconstruction showing hypoplastic aortic arch (arrowheads) with coarctation of aorta (arrow). 11

23. Spiral CT angiography in an infant with a hypoplastic aortic arch 3D reconstruction displays the coarctation of the aorta (arrow). 12

24. Summary 13

25. Fleischner sign

26. Radiographic signs with a relatively high specificity but low sensitivity for PTE Pleura-based areas of increased opacity (Hampton sign) Decreased vascularity in the peripheral lung (Westermarck sign) Enlargement of the central pulmonary artery (Fleischner sign) Hemidiaphragm elevation 15 Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, RavinCE.Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189:

27. Radiographic signs with a relatively high specificity but low sensitivity for PTE Pleura-based areas of increased opacity (Hampton sign) Decreased vascularity in the peripheral lung (Westermarck sign) Enlargement of the central pulmonary artery (Fleischner sign) Hemidiaphragm elevation 16 Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, RavinCE.Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189:

28. Fleischner sign Refers to the prominence of central pulmonary artery

31. A ventilation/perfusion lung scan, also called a V/Q lung scan A type of medical imaging using scintigraphy and medical isotopes Evaluate the circulation of: Air Blood within a patient's lungs

32. A ventilation/perfusion lung scan, also called a V/Q lung scan A type of medical imaging using scintigraphy and medical isotopes Evaluate the circulation of: Air Blood within a patient's lungs

33. Gamma Camera 22

35. Technetium

37. Fissure sign Normal separation of lobes by fissures is not seen in perfusion scans due to low resolution

38. Fissure sign But, increased separation due to pleural thickening or effusion is seen as linear area of reduced uptake along the fissure referred as fissure sign

39. Headcheese sign

40. Secondary lobule and pulmonary Acinus 28

41. Radiograph of 1-mm lung slice taken from peripheral lower lobe 29

42. QuizHow many lobules do you see in this image? One lobule 2 lobules 3 lobules 30

43. QuizHow many lobules do you see in this image? One lobule 2 lobules 3 lobules 31

44. Why do we see two lobules ? 32

45. S: Interlobular septa : 0.1 mm V: Pulmonary vein : 0.5 mm A: Pulmonary arteries : : 1 mm 33

46. Headcheese sign

47. Headcheese sign Hypersensitivity pneumonitis

48. Headcheese sign in hypersensitivity pneumonitis Combination of patchy or lobular ground-glass opacity (small arrows) and mosaic perfusion (large arrows) 36

49. 37 Headcheese sign in Chronic hypersensitivity pneumonitis

50. 38 Headcheese sign in Chronic hypersensitivity pneumonitis Expiration Inspiration

51. Hilar overlay sign

52. Hilar overlay sign Refers to the ability to see the hilar structures through the shadow of a mass superimposed on the hilum

53. Hilar overlay sign Indicates that the mass lies either in front or behind the hilum

54. Hilar overlay sign Anterior lymphoma or posterior neurofibroma

55. Hilar overlay sign PA chest X-ray A large anterior mediastinal mass.

57. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph The mass localise in: Posterior mediastinum Anterior mediastinum 46

59. Anterior mediastinumWhy?? 47

60. 48

61. Hilum overlay sign in a patient with lymphoma Posteroanterior chest radiograph The descending aorta is clearly seen (black arrow), indicating that the mass is not within the posterior mediastinum 49

62. Hilum Overlay Sign Hilar vessels are seen through a mediastinal mass 50

63. Hilum Overlay Sign A lymphoma in a HIV-positive patient. 51

64. The Anterior Junction Line 52

65. A transverse section of the thorax Showing the contents of the middle and the posterior mediastinum. 53

66. Posteroanterior chest radiograph demonstrates the anterior junction line(arrow) 54

67. Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow) 55

68. Chest CT scan An anterior mediastinal mass. 56

69. The anterior junction line is obliterated 57

70. 58 Bulging fissure sign

71. Normal major fissures Lateral chest radiograph demonstrates the two major fissures 59 http://radiographics.rsna.org/content/21/4/861/F2.expansion.html

72. Normal major fissures Note that both fissures are seen as double lines 60 http://radiographics.rsna.org/content/21/4/861/F2.expansion.html

74. The right fissure: ??61 http://radiographics.rsna.org/content/21/4/861/F2.expansion.html

76. The right fissure (arrowheads)http://radiographics.rsna.org/content/21/4/861/F2.expansion.html

77. 63 CT scan HRCT scan Normal major fissures CT scan shows the major fissures as lucent bands of relative hypovascularity (arrows) http://radiographics.rsna.org/content/21/4/861/F3.expansion.html

79. Causing lobar expansion

80. Bulging of the adjacent fissure inferiorly 64

81. Bulging Fissure Sign Consolidation spreading rapidly, causing lobar expansion and bulging of the adjacent fissure inferiorly 65

82. What do you think the diagnosis? Pneumonia caused by staphylococcus aureus. Pneumonia caused by Klebsiella TB Large cell carcinoma 66

83. Bulging Fissure Sign Historically: Klebsiella pneumoniae involving the right upper lobe . 67

84. 68