Today’s radiographs belong to a 59-year-old man with two week’s history of chest pain and moderate dyspnea.
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Findings: PA radiograph shows a diffuse opacity of left lung (A, asterisk) which obscures the heart border. A luftsichel sign is visible (A, circle). The left hilum is augmented, and the left main bronchus has a horizontal path (A, red arrow). The left hemidiaphragm is elevated and a juxtaphrenic peak sign is visible (A, yellow arrow).
The lateral view shows a horizontal retro-sternal band (B, arrows) and a typical donut sign (B, circle).
Donut sign is more obvious when comparing with a normal previous chest film
This case is a compendium of typical signs of LUL collapse. As you all know, the most common cause is bronchogenic carcinoma, which in this case is confirmed by detecting enlarged mediastinal lymph nodes (donut sign).
Enhanced CT demonstrates the LUL collapse (E-F, asterisks), a mass occluding the bronchus (E-F, red arrows) and subcarinal adenopathy (E-F, arrows).
Final diagnosis: carcinoma of LUL bronchus with lobar collapse and mediastinal metastases.
9 thoughts on “Cáceres’ Corner Case 243 – SOLVED”
Left upper lobe collapse.
Doughnut sign on the lateral chest radiograph suggesting lymphadenopathy.
Luftsichel sign because left upper lobe colaps + hilar lymphadenopathy +closed left bronhus on lateral image+reticulonodular opacities in right lung apex
Left upper lobe collapse, anterior displacement of the left oblique fissure, hazy left heart border (silhouette sign), compensatory overinflation of the left lower lobe with left apical lucency due to superior seg. VI of the LLL interposition (Lüftsichel sign), in the setting of a spiculated left bronchial mass with abrupt cut-off of the upper lobe bronchus and remarkable pleural tails retracting the left hemidiaphragm.
Good morning! I am agree with Endri!!
Colapse of the LUL with amputation of the main bronchus secundary to hiliar mass. I can see Lüftsichel sign on the PA
Collapse of left upper lobe dt lt hilar mass
There is collapse of left upper lobe (luftsichel sign) with compensatory hype inflation of left lower lobe & juxta phrenic peak sign. Left hila is enlarged with convex margins ? Hilary mass ? Enlarged lymph node compressing upon the left upper lobe bronchus.
Small closed lucencies are also noted in the right uperr, mid and lower zones more around the hila ? Prominent End on bronchus
Most probable diagnosis is
Left Hilary mass with left upper lobe collpase
Advsied cect chest for further evaluation.
LUL collapse. Luftsichel sign. Tagging of left dome diaphragm. Lt main brochus narrow, with abrupt cut off of upper lobe bronchus
Left upper lobe collapse + doughnut sign on lateral view showing left hiliar mass + Left luftsichel sign on PA view due to hyperinflation of the superior segment of the left lower lobe interposing itself between the mediastinum and the collapsed left upper lobe.
Left upper lobe collapse with luftsichel sign