The silhouette sign. Dr Etienne Leroy-Terquem Centre hospitalier de Meulan les Mureaux. France French-cambodian association for pneumology (OFCP)
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1 The silhouette sign Dr Etienne Leroy-Terquem Centre hospitalier de Meulan les Mureaux. France French-cambodian association for pneumology (OFCP)
2 The silhouette sign When 2 opacities of the same density are in contact with each other, their contours disappear. When they are separated by any tissue of a different density (air), their respective contours are visible.
3 Normal chest radiography
4 anterior opacity: medium lobe, in contact with heart (and small pleural effusion in posterior cul-de-sac )
5 Anterior opacity: middle lobe. The right heart contour disappears
6 Posterior opacity: the right contour of the heart is visible. In profile the posterior part of the diaphragm in contact with the opacity has disapeared.
7 Posterior opacity: the right contour of the heart is visible
8 Right posterior alveolar opacity. Notice the positive silhouette sign on the lateral view With the posterior part of the right diaphragm
9 Left anterior opacity: positive silhouette sign with the heart apex
10 Round left opacity. Negative silhouette sign. The opacity is visible behind The heart, in the posterior cul de sac (bronchial cancer)
11 The left contour of the heart is visible: posterior opacity
12 Middle lobe and left inferior lobe pneumonias
13 Alveolar opacity visible behind heart silhouette: posterior opacity
14 Decubitus chest x-ray. The left diaphragm is less visible than the right: alveolar opacity in contact with left diaphragm (notice the poorer quality of the picture because of the decubitus position)
15 2 abnormal opacities: the first one right and anterior, in contact with the heart (middle lobe), the second one behind the heart less visible.
16 Application of the silhouette sign: Iceberg sign The opacity is above the diaphragm The opacity is above and under the diaphragm
17 The opacity is completely intra-thoracic, behind the right diaphragm
18 Pott s disease: the opacity is above and under the diaphragm
19 Pott s disease
20
21 Hiatal hernia
22 Application of the silhouette sign: The cervico-thoracic pass sign 2 1 clavicle 2 1 1: The external and superior edges of the mediastinal opacity disappear above the clavicles. This sign means that the opacity is anterior in the superior mediastinum 2 2: The superior edge of the opacity is visible in the pulmonary air: the opacity is posterior
23 Anterior intrathoracic goitre
24 Anteror intrathoracic goitre.this goitre is compressive: notice the compression of the trachea
25 Posterior goitre (courtesy of Dr Bellamy)
26 Posterior or anterior opacity? Posterior: bronchial cancer of the left lung apex +++ notice the destruction of the posterior arch of the third rib
27 Posterior (bronchial cancer of the left lung apex)
28 Silhouette sign applied to the mediastinum: disappearance of the aorta arch: contact with a tissular mass (Hodgkin s adenopathy)
29 Filling of the aortopulmonary space aorta Adenopathy in aorto-pulmonary space Pulmonary artery
30 mediastinal adenopathies in the hilus, in the aortopulmonary space, and, possibly in the superior mediastinum
31 Normal Radiography
32 Sarcoidosis
33 Filling of the aorto-pulmonary space (sarcoidosis)
34 Convergence sign of the hilus Aorto pulmonary space Pulmonary artery The ramifications of the pulmonary artery lose their silhouette on the edge of the opacity: So this opacity is the pulmonary artery
35 The «overlap» sign of the hilus opacity covering the hilus Pulmonary vessels are visible throughout the opacity The ramifications of the pulmonary artery are visible throughout the opacity: It can be: -an adenopathy -a posterior or an anterior mass: (anterior or posterior overlap)
36 Convergence sign of the hilus Courtesy of Dr. Anthoine
37 Convergence sign of the hilus
38 Adenopathy of the right hilus (overlap sign)
39 Adenopathy of the right hilus (overlap sign)
40 Hilar adenopathy Normal hilus
41 Posterior overlap sign: right hilar opacity. The pulmonary artery is visible through the opacity, which does not erase the heart contour: This opacity is posterior.
42 Posterior overlap sign: left hilar opacity. The pulmonary artery is visible through the opacity, which does not erase heart contour: This opacity is posterior.
43 OFCP Filling in of the clear space inside the pulmonary artery Normal chest radiography
44 Filling in of the retro-cardiac clear space Normal lateral view
45 normal thorax Scan
46 Anterior overlap sign: opacity of the left hilus. The pulmonary artery is visible through this opacity. The mediastinum edge is erased: This opacity is anterior (courtesy of Dr. Bellamy)
47 Anterior overlap (courtesy of Dr. Anthoine)
48 posterior overlap anterior overlap
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