Patterns and Signs in Thoracic Imaging

  • Sivasubramanian Srinivasan
  • Ashish Chawla


The imaging appearances of pulmonary pathologies can be classified into various patterns for the ease of description and to narrow down the differential diagnoses. Imaging pattern refers to a finding or multiple findings suggesting one or more specific conditions [1, 2]. Many characteristic signs have also been described in computed tomography (CT) and radiographs. Along with the clinical features, these signs help in localizing the lesion or in arriving at a diagnosis.


  1. 1.
    Collins J. CT signs and patterns of lung disease. Radiol Clin N Am. 2001;39(6):1115–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722.PubMedCrossRefGoogle Scholar
  3. 3.
    Proto AV, Tocino I. Radiographic manifestations of lobar collapse. Semin Roentgenol. 1980;15(2):117–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Woodring JH, Reed JC. Radiographic manifestations of lobar atelectasis. J Thorac Imaging. 1996;11(2):109–44.PubMedCrossRefGoogle Scholar
  5. 5.
    Felson B, Felson H. Localization of intrathoracic lesions by means of the postero-anterior roentgenogram; the silhouette sign. Radiology. 1950;55(3):363–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW. Signs in thoracic imaging. J Thorac Imaging. 2006;21(1):76–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Algın O, Gökalp G, Topal U. Signs in chest imaging. Diagn Interv Radiol. 2011;17(1):18–29.PubMedGoogle Scholar
  8. 8.
    Matsunaga K, Takanashi Y, Tajima S, Hayakawa T, Neyatani H. Solitary fibrous tumor originating from the visceral pleura presenting an extrapleural sign; report of a case. Kyobu Geka. 2017;70(6):474–6.PubMedGoogle Scholar
  9. 9.
    Kui M, Templeton PA, White CS, Cai ZL, Bai YX, Cai YQ. Evaluation of the air bronchogram sign on CT in solitary pulmonary lesions. J Comput Assist Tomogr. 1996;20(6):983–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Schmidt AJ, Stark P. Radiographic findings in Klebsiella (Friedlander’s) pneumonia: the bulging fissure sign. Semin Respir Infect. 1998;13(1):80–2.PubMedGoogle Scholar
  11. 11.
    Gordon R. The deep sulcus sign. Radiology. 1980;136(1):25–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Schmitt ER, Burg MD. Continuous diaphragm sign. West J Emerg Med. 2011;12(4):526–7.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Gupta P. The golden S sign. Radiology. 2004;233(3):790–1.PubMedCrossRefGoogle Scholar
  14. 14.
    Schramel FM, Westermann CJ, Knaepen PJ, van den Bosch JM. The scimitar syndrome: clinical spectrum and surgical treatment. Eur Respir J. 1995;8(2):196–201.PubMedCrossRefGoogle Scholar
  15. 15.
    Frazier AA, Galvin JR, Franks TJ, Rosado-De-Christenson ML. From the archives of the AFIP: pulmonary vasculature: hypertension and infarction. Radiographics. 2000;20(2):491–524.PubMedCrossRefGoogle Scholar
  16. 16.
    Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark’s and Palla’s signs in acute pulmonary embolism. Circulation. 2007;115(8):e211.PubMedCrossRefGoogle Scholar
  17. 17.
    Blankenbaker DG. The luftsichel sign. Radiology. 1998;208(2):319–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Davis SD, Yankelevitz DF, Wand A, Chiarella DA. Juxtaphrenic peak in upper and middle lobe volume loss: assessment with CT. Radiology. 1996;198(1):143–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Marchiori E, Souza AS, Franquet T, Müller NL. Diffuse high-attenuation pulmonary abnormalities: a pattern-oriented diagnostic approach on high-resolution CT. AJR Am J Roentgenol. 2005;184(1):273–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Sosman MC, Dodd GD, Jones WD, Pillmore GU. The familial occurrence of pulmonary alveolar microlithiasis. Am J Roentgenol Radium Ther Nucl Med. 1957;77(6):947–1012.PubMedGoogle Scholar
  21. 21.
    Abramson S. The air crescent sign. Radiology. 2001;218(1):230–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Haber J, Cervenková J. Invasive pulmonary aspergillosis—imaging and invasive potential of diagnosis. Klin Mikrobiol Infekc Lek. 2007;13(5):190–4.PubMedGoogle Scholar
  23. 23.
    Pinto PS. The CT halo sign. Radiology. 2004;230(1):109–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol. 2003;180(5):1251–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Chou S-HS, Kicska G, Kanne JP, Pipavath S. Cheerio sign. J Thorac Imaging. 2013;28(1):W4.PubMedCrossRefGoogle Scholar
  26. 26.
    Partap VA. The comet tail sign. Radiology. 1999;213(2):553–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Wang Y-XJ, Gong J-S, Suzuki K, Morcos SK. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis. 2014;6(7):872–87.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Johkoh T, Itoh H, Müller NL, Ichikado K, Nakamura H, Ikezoe J, et al. Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings. Radiology. 1999;211(1):155–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Aikins A, Kanne JP, Chung JH. Galaxy sign. J Thorac Imaging. 2012;27(6):W164.PubMedCrossRefGoogle Scholar
  30. 30.
    Chong BJ, Kanne JP, Chung JH. Headcheese sign. J Thorac Imaging. 2014;29(1):W13.PubMedCrossRefGoogle Scholar
  31. 31.
    Sherrick AD, Swensen SJ, Hartman TE. Mosaic pattern of lung attenuation on CT scans: frequency among patients with pulmonary artery hypertension of different causes. AJR Am J Roentgenol. 1997;169(1):79–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Ch’ng LS, Bux SI, Liam CK, Rahman NA, Ho CY. Sandstorm appearance of pulmonary alveolar microlithiasis incidentally detected in a young, asymptomatic male. Korean J Radiol. 2013;14(5):859–62.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Kerimoglu U, Kapicioglu S, Emlik D, Arazi M, Ural O. Case 161: hydatid disease with water lily sign manifesting as a soft-tissue mass in the calf of a child. Radiology. 2010;256(3):1007–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Zacharopoulos G, Adam A, Ind PW. The positive bronchus sign in patients with known lung cancer. Eur J Radiol. 1990;10(2):130–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Ouellette H. The signet ring sign. Radiology. 1999;212(1):67–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Cantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR Am J Roentgenol. 2009;193(3):W158–71.PubMedCrossRefGoogle Scholar
  37. 37.
    Gosset N, Bankier AA, Eisenberg RL. Tree-in-bud pattern. AJR Am J Roentgenol. 2009;193(6):W472–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Nguyen ET. The gloved finger sign. Radiology. 2003;227(2):453–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Shah RM, Friedman AC. CT angiogram sign: incidence and significance in lobar consolidations evaluated by contrast-enhanced CT. AJR Am J Roentgenol. 1998;170(3):719–21.PubMedCrossRefGoogle Scholar
  40. 40.
    Dodd JD, Souza CA, Müller NL. High-resolution MDCT of pulmonary septic embolism: evaluation of the feeding vessel sign. AJR Am J Roentgenol. 2006;187(3):623–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard J-AO, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics. 2004;24(5):1219–38.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Sivasubramanian Srinivasan
    • 1
  • Ashish Chawla
    • 1
  1. 1.Department of Diagnostic RadiologyKhoo Teck Puat HospitalSingaporeSingapore

Personalised recommendations