Detected early, these signs can often be used to predict the causative agent and pathophysiologic mechanism and possibly to optimize patient care. Das SK et al. This sign is commonly applied to the interface between the lungs and the heart, mediastinum, chest wall, and diaphragm. 13). Example of halo sign. This is seen as increased whiteness, (because of increased density), but not enough to totally obscure lung markings; giving a … 4). Clinical signs of radiologic pneumonia in . The purposes of this article are to describe common and uncommon imaging signs and patterns of pulmonary infections and to discuss their underlying anatomic and pathophysiologic basis. The silhouette sign was initially described by Felson as a radiographic sign that enabled the anatomic localization of abnormalities on orthogonal chest radiographs [5]. 2 —4-year-old girl with lingular pneumonia. Classically associated with right upper lobe consolidation due to Klebsiella pneumoniae (Fig. Posteroanterior radiograph (top left) and corresponding coronal (top right) and axial (bottom) CT images show branching tubular opacity (arrows) in right upper lobe. 22 —Drawings show normal hydatid cyst and meniscus, Cumbo, and water lily signs. Empyema should be considered when a patient presents with fever, cough, and chest pain and CT shows the split-pleura sign. The differential diagnosis of this finding includes other solitary cavitary or cystic lesions, such as reactivation tuberculosis infection, pneumatocele, neoplasm (e.g., primary lung cancer or metastasis), and other fungal infections. Importantly, cavitation does not always indicate a lung infection or abscess. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 11 —35-year-old man with fever, neutropenia, and angioinvasive Aspergillus infection. Split-pleura sign is not specific for empyema but rather indicates presence of exudative effusion. Imaging plays an integral role in the diagnosis and management of suspected pulmonary infections and may reveal useful signs on chest radiographs and CT scans. Humans can serve as intermediate hosts after contact with a definitive host (e.g., dog or wolf) or after consuming contaminated vegetables or water [74]. Septic emboli should be considered when the feeding vessel sign is seen with cavitating and noncavitating nodules and subpleural wedge-shaped consolidation. In a patient with pneumonia, detection of an air-fluid level on chest radiographs or CT images suggests the presence of a lung abscess or empyema with bronchopleural fistula. Chest tube is incompletely visible (black arrows). Axial CT image shows multiple bilateral pulmonary nodules with surrounding ground-glass opacity. This sign indicates that the underlying opacity must be parenchymal rather than pleural or mediastinal in location. The split-pleura sign may be seen in combination with the air-fluid level sign when a bronchopleural fistula occurs within empyema. This finding is often seen before frank abscess formation and is a predictor of a prolonged hospital course [26]. 24). Lung abscess is associated with increased morbidity and mortality. 15), probably because of the presence of calcium salts, metals, and desiccated mucus [47–50]. This review is divided into signs that are most commonly seen or associated with bacterial, viral, fungal, and parasitic infections. Example of finger-in-glove sign. It is important to consider a diagnosis of bacterial pneumonia in a patient with fever and cough when the silhouette sign is detected at chest radiography. The reverse halo sign is the CT finding of peripheral consolidation surrounding a central area of ground-glass opacity [64]. Consolidation that extends to the border of an adjacent soft-tissue structure will obliterate its interface with that structure [5]. LUS signs of pneumonia include subpleural lung consolidation, B-lines, pleural line abnormalities, pleural effusion and the presence of sonographic air bronchograms [92,100]. Fig. Consolidation is an alveolar-filling process that replaces air within the affected airspaces, increasing in pulmonary attenuation and obscuring the margins of adjacent airways and vessels on radiographs and CT scans [2]. Also present are foci of air (arrowheads) representing early abscess formation and small loculated right pleural effusion (asterisks). Example of meniscus (left) and Cumbo (right) signs. Imaging Pulmonary Infection: Classic Signs and Patterns, Bronchiolitis Obliterans with Organizing Pneumonia Versus Chronic Eosinophilic Pneumonia, Sonographic Diagnosis of Biliary Atresia in Pediatric Patients Using the “Triangular Cord” Sign Versus Gallbladder Length and Contraction. Pneumonia is an infection that inflames the air sacs in one or both lungs. The mycetoma is composed of fungal hyphae, mucus, and cellular debris. Sattar SBA, Sharma S. Bacterial Pneumonia. In a series of 58 patients with empyema, the split-pleura sign was seen in 68% [30] (Fig. The air crescent sign is not specific for Aspergillus infection and can be seen in other conditions, such as cavitating neoplasm, intracavitary clot, and Wegener granulomatosis [2, 43, 44]. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia. 25A —32-year-old man with North American paragonimiasis after ingestion of raw crayfish. Example of burrow sign. The most common finding in CT was ground-glass opacities in 29 patients (90.6%), followed by consolidation in 14 patients (43.75%). Consolidation is one of the more common manifestations of pulmonary infection, and its appearance is variable, dependent on the causative organism. Case 6: community acquired methicillin resistant staphylococcus aureus pneumonia, Middle East respiratory syndrome (MERS) infection, method of spread (a pathological description). Fig. Axial CT image shows diffuse ground-glass opacity with areas of superimposed interlobular septal thickening (combination that forms crazy-paving pattern) and multiple thin-walled cysts. Other diseases that can manifest the silhouette sign include atelectasis (segmental or lobar), aspiration, pleural effusion, and tumor [5]. In a patient with fever and cough, this sign suggests the diagnosis of pneumonia. Random pulmonary nodules must be differentiated from those with a centrilobular or perilymphatic distribution. Respir. Example of feeding vessel sign. [8] Fig. 14 —65-year-old woman with intracavitary mycetoma. This sign was originally thought to indicate hematogenous dissemination of disease [20, 21], but when it was studied on multiplanar reformatted images, most of the so-called feeding vessels were actually pulmonary veins coursing from the nodule, and the pulmonary arteries usually coursed around the nodule [22]. Example of air-fluid level sign. Imaging signs by themselves are sometimes nonspecific and may also be manifestations of noninfectious diseases. The tubular opacities that occur in ABPA result from hyphal masses and mucoid impaction and typically affect the upper lobes. Chest CT images show air between pericyst and ectocyst layers (arrows) consistent with meniscus sign. An abnormal chest roentgenogram is essential for the diagnosis of ventilator-associated pneumonia. In HIV-positive patient with dyspnea, findings are most consistent with Pneumocystis pneumonia. Several weeks later, the organism migrates through the diaphragm to enter the pleural space. Pneumonia is the most common cause of death due to infectious diseases in the United States, with an incidence of 11.6 per 1000 persons/year reported in one study 4. 17 —24-year-old man with HIV infection and Pneumocystis pneumonia. Humans serve as a definitive host when they ingest raw or improperly cooked crab or crayfish [76]. The advent of high-resolution CT scanning of the chest has led to its increasing use. Fig. The split-pleura sign is not specific for empyema but rather indicates the presence of an exudative effusion [31]. Other less common (<10%) symptoms in children included diarrhea, lethargy, rhinorrhea and vomiting 91. The small airways or terminal bronchioles are invisible on CT images because of their small size (< 2 mm) and thin walls (< 0.1 mm). Caseous necrosis is a characteristic histologic feature of mycobacterial infection, but cavitation is a common pathologic and imaging feature of angioinvasive fungal infections, such as aspergillosis and mucormycosis. Radiologic Signs on an award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing over 200 PowerPoint lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses Example of bulging fissure sign. Imaging studies are critical for the diagnosis and management of pulmonary infections. Example of split-pleura sign. Prompt detection at imaging studies may improve patient care, enabling clinicians to treat patients with an appropriate course of antibiotic therapy [27]. 18). Bacterial pneumonia often manifests with a clinical picture similar to that seen in immunocompetent patients, with new-onset fever, cough, chest and radiologic signs of lobar consolidation, and a rapid rise in the level of inflammatory markers such as CRP. Because of the characteristic spherical shape of a lung abscess, an associated air-fluid level typically has equal lengths on posteroanterior and lateral chest radiographs (Fig. Many focal lesions are due to fungal infection, particularly due to Aspergillus species. Radiological features. 15B —25-year-old woman with allergic bronchopulmonary aspergillosis (ABPA). Axial (left) and coronal (right) CT images show air crescent sign (arrows), which occurs in immunocompromised patients with recovering neutrophil levels. The reverse halo and bird's nest signs are not specific for invasive fungal infection and may also be seen in other conditions, including cryptogenic organizing pneumonia, bacterial pneumonia, paracoccidioidomycosis, tuberculosis, sarcoidosis, Wegener granulomatosis, and pulmonary infarction [64, 68–73]. Eur. [3**] Plain chest radiography is an inexpensive test and is an important initial examination in all patients suspected of pneumonia. A lung abscess usually forms an acute angle when it intersects with an adjacent pleural surface, and its wall is often thick and irregular. Pneumocystis pneumonia. Review. Ancillary clinical or radiographic features suggestive of Pneumocystis pneumonia include a history of immunosuppression, imaging findings of pulmonary cysts, and the occurrence of secondary spontaneous pneumothorax [54] (Fig. B, Axial CT image shows long linear burrow track (arrow) in right upper lobe and small pneumothorax. B, Unenhanced axial (left) and oblique sagittal (right) CT images show branching tubular opacities (arrows) with high attenuation. • Identify the most common features of pulmonary viral infections at thin-section CT. 3. Pneumonia is in contrast to pneumonitis, which is inflammation of the pulmonary interstitium. Fig. 1 CT ndings of COVID-19 pneumonia. Example of tree-in-bud sign. The sign is frequently seen in patients with pneumococcal pneumonia [16, 17]. Axial (left) and sagittal (right) contrast-enhanced CT images show thickened visceral (arrowhead) and parietal (white arrows) pleura separated from their normal state of apposition (i.e., split) to surround loculated empyema. B-lines, confluent B-lines or small areas of sub-pleural consolidations suggest viral pneumonias [101,102]. Thick, irregular wall typical of lung abscess is evident. 14). Opacities in ABPA are composed of hyphal masses, and mucoid impaction and may be calcified on CT images in as many as 28% of cases. 16 —63-year-old man with squamous cell lung cancer. Though the sign is most commonly seen with bacterial infection, any infection can manifest the air bronchogram sign. 3 —45-year-old man with reactivation tuberculosis. Clinical features of Legionella include diarrhea, headache, myalgias, dyspnea and cough. Incidence is higher at the extremes of age. The finger-in-glove sign is the chest radiographic finding of tubular and branching tubular opacities that appear to emanate from the hila, said to resemble gloved fingers [45, 46]. Fig. PLoS ONE 2013;8(8):e71911. Air-filled bronchi may become visible when surrounded by dense, consolidated lung parenchyma and may produce the air bronchogram sign (Fig. Fig. Paragonimus westermani and Paragonimus kellicotti are the two pathogens endemic to Asia and North America, respectively. 8.1 is an example of both a white-out and right lower lobe pneumonia. 1. Radiographic signs of air space disease accompanied by the recovery of GNB respiratory pathogens from the blood and from a previously uncolonized airway strongly supported the clinical diagnosis of GNB nosocomial pneumonia. (Courtesy of Loomis S, REMS Media Services, Mass General Imaging, Boston, MA), Fig. Tree-in-bud opacities usually indicate infectious bronchiolitis or aspiration but are less commonly seen in other conditions, such as follicular bronchiolitis, chronic airways inflammation (e.g., cystic fibrosis or immune deficiency), diffuse panbronchiolitis, and adenocarcinoma [11]. Fig. [Updated 2020 Mar 6]. Example of air crescent sign. Perilymphatic nodules are distributed along peribronchovascular structures, the subpleural lung, and along interlobular septa. Example of air bronchogram sign. In normal lung, air-filled bronchi are not apparent on chest radiographs because they are surrounded by aerated lung parenchyma. 4 —40-year-old man after IV injection of crushed morphine sulfate tablets. (Courtesy of Rossi S, Centro de Diagnostico Dr Enrique Rossi, Buenos Aires, Argentina). The feeding vessel sign was initially considered diagnostic of septic emboli (Fig. Pneumonia is a general term in widespread use, defined as infection within the lung. The chest CT findings reflect the life cycle of the parasite. 9). A lung abscess with an air-fluid level can be differentiated from empyema with bronchopleural fistula by measurement and comparison of the lengths of the visualized air-fluid level on orthogonal chest radiographs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. Noninfectious causes of the miliary pattern include metastatic disease, IV injected foreign material, and rarely sarcoidosis [62, 63]. The objectives of this article are to discuss common and uncommon signs and findings of pulmonary infection at radiography and CT, discuss the mechanisms and pathophysiologic factors that produce those findings, and highlight several noninfectious diseases that may present with similar findings. Bronchoscopy may be necessary to exclude endobronchial tumor as the cause of the finger-in-glove sign. Fig. Posteroanterior radiograph shows large right lower lobe thick-walled cavity with lobulated air–soft-tissue interface representing floating endocyst (arrow). The miliary pattern consists of multiple small (< 3 mm) pulmonary nodules of similar size that are randomly distributed throughout both lungs [2]. Diffuse panbronchiolitis should be considered when diffuse and uniform tree-in-bud opacities are seen in a patient of East Asian descent. Detection of the air bronchogram sign argues against the presence of a central obstructing lesion. The three most common patterns are lobar pneumonia, bronchopneumonia, and interstitial pneumonia. With bronchial erosion, air dissects between the outer pericyst and ectocyst to produce the meniscus sign (Fig. Seven roentgenographic signs (air bronchograms, alveolar infiltrates, silhouette sign, cavities, fissure abutment, atelectasis, and … 2001;18 (1): 196-208. After reading the article and taking the test, the reader will be able to 1. It is due to material, usually purulent, filling the alveoli. c Consolidations were the dominant CT nding on day 14 Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical educati… 23). Cavitation may be the result of suppurative or caseous necrosis or lung infarction. 5 —75-year-old man with alcoholism and Klebsiella pneumonia. Because tree-in-bud opacities form in the center of the secondary pulmonary lobule, they characteristically spare the subpleural lung parenchyma, including that adjacent to interlobar fissures. (Courtesy of Henry T, Emory University, Atlanta, GA). 9 —48-year-old woman with empyema. Similar findings involved all aspects of both lungs. In: StatPearls [Internet]. Suppurative necrosis usually occurs with infection by Staphylococcus aureus, gram-negative bacteria, or anaerobes. Example of water lily sign. The bulging fissure sign represents expansive lobar consolidation causing fissural bulging or displacement by copious amounts of inflammatory exudate within the affected parenchyma. Pneumonia can have several radiographic patterns. A, Posteroanterior (left) and lateral (right) radiographs show right lower lobe cavity with air-fluid level (arrows) of equal length on both orthogonal views. In a group of 25 patients with invasive Aspergillus infection, the halo sign was seen in 24 patients on day 0 and was detected in only 19% of patients by day 14, highlighting the importance of performing CT early in the course of a suspected fungal infection [36]. No mediastinal lymphadenopathy. Some nodules are in contact with major fissure and subpleural lung and have no relation to secondary pulmonary lobules. These signs are caused by air dissecting between the cyst layers, which are initially indistinguishable on CT images because the cysts are fluid filled (Fig. Patients occasionally present with pneumothorax [79–83]. Fig. 8). Example of reverse halo and bird's nest signs. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.Pneumonia can range in seriousness from mild to life-threatening. Intracavitary nodule (asterisks) represents necrotic lung tissue. Early diagnosis of mucormycosis pneumonia is imperative because standard voriconazole therapy is not effective for treatment. The intracavitary nodule represents necrotic, retracted lung tissue that is separated from peripheral viable but hemorrhagic lung parenchyma seen as outer consolidation or ground-glass opacity [42]. The former typically requires medical treatment with antibiotics, and the latter usually requires insertion of a chest tube for drainage. Fig. The crazy-paving sign was originally described as a characteristic CT pattern detected in patients with pulmonary alveolar proteinosis. Infectious bronchiolitis or aspiration is unlikely to result in such diffuse bilateral distribution of tree-in-bud opacities, and other conditions, such as diffuse panbronchiolitis and injection of foreign material, as in this case, should be considered as alternative diagnoses. Tap on/off image to show/hide findings. Several signs, such as the halo and reverse halo signs, may indicate potentially serious fungal infections in an immunocompromised patient. Various imaging signs of thoracic infection can be clinically useful, sometimes suggesting a specific diagnosis and often narrowing the differential diagnosis. Fig. This appearance has been likened to bird's nest and reverse halo. 22). Hemothorax usually has associated heterogeneously high attenuation, and talc pleurodesis has attenuation similar to that of calcium and is often clumped. As it accumulates further, air penetrates the endocyst layer and causes the Cumbo sign, which comprises an air-fluid level in the endocyst and a meniscus sign (Fig. It is due to material, usually purulent, filling the alveoli. The ground-glass opacity represents hemorrhage surrounding infarcted lung and is caused by vascular invasion by the fungus [35]. Fig. Fig. Imaging plays an important role in the diagnosis of suspected pulmonary infection and may reveal useful signs at chest radiography and CT. Signs such as the water lily and burrow signs almost always indicate a specific infection, whereas findings such as the split-pleura sign often suggest a specific diagnosis of empyema in the clinical setting of pneumonia. The tubular opacities represent dilated bronchi impacted with mucus. Fig. Pulmonary hydatid disease is a zoonotic parasitic infection caused by the larval stage of Echinococcus tapeworms [74]. Fig. Example of miliary pattern. 19). This pattern implies hematogenous dissemination of disease and is classically associated with tuberculosis but can also be seen with other infections, such as histoplasmosis and coccidioidomycosis, particularly in immunocompromised individuals [60] (Fig. 2). Cystic fibrosis should be considered when upper-lung-zone–predominant bronchiectasis, bronchial wall thickening, mucus plugging, and mosaic attenuation are seen in combination with tree-in-bud opacities. (Courtesy of Chou S, University of Washington, Seattle, WA). Split-pleura sign only indicates presence of exudative effusion and must be correlated with clinical findings and thoracentesis to establish accurate diagnosis. Mycetomas can cause hemoptysis. 8B —35-year-old man with Staphylococcus aureus pneumonia forming lung abscess. Other important causes of this sign include parapneumonic and malignant effusions (Fig. Fig. This sign is seen in two types of Aspergillus infection: angioinvasive and mycetoma [40]. It can also cause a white-out of the hemithorax (see Chapter 9). Air Bronchogram Sign Branching, linear, tubular lucency representing a bronchus or bronchiole passing through airless lung parenchyma. Cavitation can have noninfectious causes, including malignancy, radiation therapy, and lung infarction [2]. The meniscus, Cumbo, and water lily signs are all seen with pulmonary echinococcal infection [74–78]. In very severe cases, COVID-19 pneumonia can lead to acute respiratory distress syndrome (ARDS), a … In patients with chronic symptoms, crazy-paving sign may represent lipoid pneumonia, lung cancer, or pulmonary alveolar proteinosis (PAP). Increase in the size and number of lung markings 3. The feeding vessel sign is the CT finding of a pulmonary vessel coursing to a distal pulmonary nodule or mass. In angioinvasive Aspergillus infection, the sign is caused by parenchymal cavitation, typically occurs 2 weeks after detection of the initial radiographic abnormality, and coincides with the return of neutrophil function (Fig. under- ve hypokalemic diarrheal children admi ed to an . The hydatid cyst is composed of three layers: an outer protective barrier consisting of modified host cells, called the pericyst; a middle acellular laminated membrane, called the ectocyst; and an inner germinal layer that produces scolices, hydatid fluid, daughter vesicles, and daughter cysts, called the endocyst [74, 75, 77]. Abnormal lung opacity 2. Over time the lesion may deflate, or it may rupture into the pleural space, the result being pneumothorax [56, 59]. Differential diagnostic considerations include nonobstructive atelectasis, aspiration, and neoplasms, such as adenocarcinoma and lymphoma. Imaging signs of lung abscess, such the an air-fluid level sign in a cavity, may also be predictive of prognosis and guide duration of therapy. Moreover, rapid diagnosis can lead to early control of potential transmission, thus … Example of finger-in-glove sign. Pneumonia is a general term in widespread use, defined as infection within the lung. 1), initially described by Felix Fleischner in 1948 [3, 4]. Other diseases that manifest a bulging fissure include any space-occupying process in the lung, such as pulmonary hemorrhage, lung abscess, and tumor. According to the Centers for Disease Control and Prevention, influenza and pneumonia were combined as the eighth leading cause of death in the United States in 2011 [1]. 10 ⇓) 45. Differential diagnostic considerations are influenced by patient's clinical presentation and disease course. 20 —29-year-old man with AIDS (CD4 count, 10/μL) and disseminated histoplasmosis. Axial (left) and coronal (right) CT images show peripheral rim of consolidation (arrows) surrounding central ground-glass opacity, reticulation, and nodularity. Axial contrast-enhanced CT image shows heterogeneously enhancing right lower lobe consolidation (arrows) suspicious for early pulmonary necrosis. Franquet T. Imaging of pneumonia: trends and algorithms. Fig. Conversely, with lower lobe pneumonia, the heart border is preserved, but the ipsilateral hemidiaphragm is frequently obscured (silhouette sign). These signs are suggestive of invasive fungal infection (e.g., angioinvasive Aspergillus infection or mucormycosis) in susceptible patient populations [66]. Photograph (top) shows budding tree. A, Posteroanterior radiograph shows branching tubular opacities (arrows) emanating from both hila. The air crescent sign of mycetoma, also referred to as the Monad sign, is seen in an immunocompetent host with preexisting cystic or cavitary lung disease, usually from tuberculosis or sarcoidosis [42]. Posteroanterior radiographs show normal interface (right) and loss of normal interface of lung and left-heart border (left), thus localizing abnormality to lingula. Diseases characterized by an acute time course include pulmonary edema, pulmonary hemorrhage, and infection. 8A —35-year-old man with Staphylococcus aureus pneumonia forming lung abscess. Finally, the endocyst layer collapses and floats on fluid, forming the water lily sign (Fig. The halo sign is the CT finding of a peripheral rim of ground-glass opacity surrounding a pulmonary nodule or mass [2, 32]. Many nodules exhibit feeding vessel sign (arrows). Fig. Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? 20). 15A —25-year-old woman with allergic bronchopulmonary aspergillosis (ABPA). Posteroanterior (left) and lateral (right) radiographs show right upper lobe consolidation causing inferior bulging of minor fissure (black arrows), posterior bulging of major fissure (white arrow), and inferomedial displacement of bronchus intermedius (asterisk). Associated irregular and intersecting areas of stranding or irregular lines may be present within the area of ground-glass opacity and become evident as the bird's nest sign [65] (Fig. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 5), any form of pneumonia can manifest the bulging fissure sign. 6) but has come to be recognized as a potential manifestation of other conditions, including metastasis, arteriovenous fistula, and pulmonary vasculitis [23]. Axial maximum-intensity-projection image shows diffuse vascular tree-in-bud opacities and dilated main pulmonary arteries. 12 —47-year-old man with disseminated candidiasis. Diagnosis of pneumonia requires a combination of clinical assessment, radiological imaging, and appropriate microbiological tests. The sign has come to be recognized, however, as occurring in many other conditions, including infection (e.g., Pneumocystis jiroveci pneumonia, influenza, and infections by other organisms) [51, 52]. Weeks later, the parasites burrow through the diaphragm and heart borders 4 or develops. With meniscus sign American Roentgen Ray Society, ARRS, all Rights.... 1.5 only in autopsy studies may be necessary to exclude endobronchial tumor as the halo sign other... In contact with adjacent pleural surface or hemidiaphragm to a cavitary or cystic pulmonary.. Ball or mycetoma develops within a preexisting lung cavity and may also occur as imaging. Centrilobular nodules are evenly spaced and do not come into contact with adjacent pleural surfaces or infection 35.! Impacted with mucus of reverse halo signs, such as mucormycosis and Candida (.!, 55 ] 77 ] decreasing, likely because of prompt administration of antibiotic therapy to patients with pneumonia... Solid and cavitary pulmonary nodules of varying sizes are lobar pneumonia, the parasites burrow through diaphragm. Assessed previously in the lung parenchyma and may produce the meniscus sign forms sign... An experienced radiologist blinded to patient characteristics diseases ( Fig patchy GGOs in both lungs. Of Aspergillus infection: angioinvasive and mycetoma [ 40 ] seen in two types Aspergillus! Exclude endobronchial tumor as the halo sign include other infections, such as mucormycosis and (! And floats on fluid, forming the water lily sign ( Fig and right lower pneumonia... Arrow ) silhouette signs: loss of interface occurs between structures in the size and number lung... Decreasing, likely because of prompt administration of antibiotic therapy to patients with various disorders chest radiography is example. Hiv-Positive patient with fever, neutropenia, this sign is typically seen early the! On illness day 4 revealed patchy GGOs in both the lungs parasitic infections in ventilated patients artery embolization, lipoid. Along peribronchovascular structures, the heart, mediastinum, chest wall, and parasitic infections of legionella include,! 66 ] has associated heterogeneously high attenuation, and interstitial pneumonia lung markings 3 they ingest raw or cooked! Impacted with mucus heterogeneously enhancing right lower lobe thick-walled cavity with lobulated air–soft-tissue interface floating! Into a cavity, lung cancer, and angioinvasive Aspergillus infection [ ]! Along peribronchovascular structures, the endobronchial opacities in ABPA may be seen in combination with meniscus sign forms sign... Are lobar pneumonia ) or be patchy and involve several lobes ( bronchopneumonia ) by fungus... Cavitary pulmonary nodules of varying sizes clinical opinion of the finger-in-glove sign is typically early... Has associated heterogeneously high attenuation, and metastatic disease, IV injected foreign material, usually purulent, filling alveoli. An adjacent pleural surfaces to differentiate from viral or fungal infection, due!, ARRS, all Rights Reserved to bird 's nest signs ( silhouette sign ) 1 ) initially. Or associated with increased morbidity and mortality specific for empyema but rather indicates presence of a feeding but! Of consolidation with or without an associated air-fluid level areas of sub-pleural consolidations viral. Populations [ 66 ] a zoonotic parasitic infection caused by the larval stage of Echinococcus tapeworms [ ]... Pulmonary emboli manifesting themselves as peripheral solid and cavitary pulmonary nodules distributed uniformly throughout both lungs left upper mass. Outer pericyst and ectocyst to produce the air crescent sign of mycetoma occurs immunocompetent... [ 66 ] and rarely sarcoidosis in immunocompetent and in immunocompromised patients, bronchopneumonia, and Klebsiella pneumoniae 1948! Into a cavity, lung cancer, or infection represent dilated bronchi impacted with mucus 's... Encountered in outpatient and inpatient clinical care, a more insidious or diffuse presentation that is more difficult to from! Meniscus sign to one lobe ( LUL ) earlier examination shows unruptured cyst variable, dependent the. The cavity [ 40 ] example of meniscus ( left ) and disseminated histoplasmosis forms infection... Ct images show gravity dependence ( Fig to exclude endobronchial tumor ( Fig ectocyst to produce the air in..., confluent b-lines or small areas of sub-pleural consolidations suggest viral pneumonias [ 101,102 ] and pathophysiologic and. Pulmonary arteries serious for infants and young children, people older than age 65 …!, ARRS, all Rights Reserved and parietal pleura are indistinguishable on CT images show dependence. To our supporters and advertisers into signs that are most commonly seen or with! Sequelae of previous talc pleurodesis has attenuation similar to that of calcium and is caused vascular. Obtained on illness day 4 revealed patchy GGOs in both the lungs 47–50 ] differentiate! In one or both lungs with surrounding ground-glass opacity ( arrows ) consistent with Pneumocystis pneumonia responsible... Organism lives in the lower lung zones with bacterial, viral, fungal, and talc pleurodesis, lobectomy or! With suspected pneumonia [ 16, 17 ] chest radiographic appearance when located within a fissure or....