This document discusses several radiographic signs seen on chest imaging: 1. The deep sulcus sign refers to an abnormally deep lateral costophrenic angle on supine chest x-rays and indicates the presence of a pneumothorax. 2. The fallen lung sign describes a collapsed lung that has fallen away from the hilum, either inferiorly and laterally in upright patients or posteriorly in supine patients, and indicates a fractured bronchus. 3. The CT angiogram sign is seen on contrast-enhanced CT scans as enhancing pulmonary vessels within a region of low attenuating lung consolidation and suggests conditions like pneumonia or lung tumors. 4. The flat waist sign is the loss

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:
Qusaibaty@gmail.com

2. Topic Outline
1. Deep sulcus sign
2. Fallen Lung Sign
3. CT angiogram sign
4. 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

14. The
bronchial
fracture
Results in
the lung to
fall away
from the
hilum
Either
inferiorly
and
laterally in
an upright
patient
14

15. The
bronchial
fracture
Results in
the lung to
fall away
from the
hilum
Either
inferiorly
and
laterally in
an upright
patient
Or
posteriorly,
as seen on
CT in a
supine
patient
15

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:
1. Pulmonary vessels extending 3 cm or more
along a single channel
2. 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 CT angiogram sign is seen on contrast
material–enhanced scans
• Results from the
normally enhancing
pulmonary vessels

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

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

26. 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%
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27. CT Angiogram sign
1. Pneumonia
2. Pulmonary edema
3. Obstructive
pneumonitis due to
central lung tumors
4. Lymphoma
5. Metastasis from
gastrointestinal
carcinomas
28

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

29. Flat-waist sign
‫المسطح‬ ‫الوسط‬ ‫عالمة‬

30. Flat-waist sign
A symmetrical frontal
CXR

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

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

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

34. Flat waist Sign

35. Flat waist Sign
Atelectasis LLL
36

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

37. REFERENCES
• 1. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW.
Signs in thoracic imaging. J.Thorac.Imaging 2006;21:76-90
• 2. Webb WR. Thin-section CT of the secondary pulmonary lobule:
anatomy and the image—the 2004 Fleischner lecture.Radiology.
2006 May;239(2):322-38
• 3. Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP,
Remy-Jardin M, Webb WR, Zerhouni EA. Glossary of terms for
CT of the lungs: recommendations of the Nomenclature
Committee of the Fleischner Society. Radiology 1996;200(2):327-31
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