Download - Tree in-bud sign golden s sign
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
1. Tree-in-bud sign2. Golden S sign
2
Topic Outline
1. Tree-in-bud sign2. Golden S sign
3
Tree-in-bud sign
4
Airways
Central
Peripheral
5
Airways
Central Cartilage
Peripheral
Non cartilage
6
Airways
Central Cartilage
>2mm of internal diameter
Peripheral Non cartilage
<2mm internal diameter
7
Airways
Central Cartilage
>2mm of internal diameter
0-16
Peripheral Non cartilage
<2mm internal diameter
7 - 23
Airways
Central
Conducting zone
Peripheral
Transitional and Respiratory
zone
Dead Space The portion of each
breath that does not
participate in gas exchange
Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
Conducting zone
Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
Conducting zone
Alveoli that are well-ventilated but poorly perfused
Quiz
• Asthma always attacks:A. Lung parenchymaB. Central airwaysC. Peripheral airwaysD. B + C
15
Quiz
• Asthma always attacks:A. Lung parenchyma
B. Central airwaysC. Peripheral airwaysD. B + C
16
Quiz
• COPD always attacks:A. Central airwaysB. Peripheral airwaysC. Lung parenchymaD. B + C
17
Quiz
• COPD always attacks:A. Central airwaysB. Peripheral airwaysC. Lung parenchyma
D. B + C
18
21
Volume-rendered images demonstrate normal central and peripheral airways / Axial image
Volume-rendered images demonstrate normal central and peripheral airways / Coronal image
Volume-rendered images demonstrate normal central and peripheral airways / Sagittal image
Peripheral airways
TB: Terminal BronchioleRB1: Respiratory
Bronchiole 1RB2: Respiratory
Bronchiole 2RB3: Respiratory
Bronchiole 3AD: Alveolar DuctAS: Alveolar sac
Tree-in-bud sign
Inflammatory material filling:TBRBAD
Quiz / Tree-in-bud sign
This sign could be seen in :
A. HRCT scanner of thorax
B. CT scanner of thorax
C. PA chest x rayD. Left profile chest x
ray
Tree-in-bud sign
This sign could be seen in :A. HRCT scanner of
thoraxB. CT scanner of
thoraxC. PA chest x rayD. Left profile chest x
ray
Tree-in-bud sign could be seen
• In:A. Endobronchial
TuberculosisB. AsthmaC. Bronchoalveolar
carcinoma
28
Tree-in-bud sign could be seen
• In:A. Endobronchial
TuberculosisB. AsthmaC. Bronchoalveolar
carcinoma
29
Case 1
• A 29-year-old man• Acute myeloid leukemia after bone marrow
transplantation• The patient had a history of fever and cough
30
Case 1
HRCT in RLL
31
Case 1
• Multiple, small, centrolobular nodules of soft-tissue attenuation connected to linear branching opacities (arrows)
• Tree-in-bud sign
32
Case 1At serologic examination, an infection with
A. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
33
Case 1At serologic examination, an infection with
A. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
34
Tree-in-bud sign associated with bronchiolar infection
• Transverse thin-section CT scan through right lower lobe in a patient with airways disease and bacterial infection related to AIDS (acquired immunodeficiency syndrome)
35
Tree-in-bud sign associated with bronchiolar infection
• Multiple impacted centrilobular bronchioles result in tree-in-bud appearance (arrowheads).
• Bronchiectasis is also present
36
Lung slice from patient with bronchopneumonia
• Impacted mucus- and pus-filled bronchioles (arrows) are visible throughout the lung
37
38
Golden S sign
40
Concave
Convex
Golden S sign
Refers to a reverse S shaped shadow
Golden S sign
Caused by right upper lobe collapse
Golden S sign
The upper curve of the reverse S
(concave infero-laterally)
Golden S sign
A central mass causing the collapse forming the lower curve (convex infero-medially)
45
• When a lobe collapses around a large central mass, the peripheral lung collapses and the central portion of lung is prevented from collapsing by the presence of the mass.
46
• The relevant fissure is concave toward the lung peripherally but convex centrally, and the shape of the fissure resembles an S or a reverse S .
47
Conclusion
• Golden S sign - indicates lobar collapse with a central mass, suggesting an obstructing bronchogenic carcinoma in an adult