Holly leaf sign - refers to the typical chest radiograph appearance of calcified pleural plaques. The well-defined but irregular thickened edges simulate the appearance of a holly leaf. ‘Geographic density’ is another common term used to describe their appearance. Pleural plaques are the most common form of asbestos related disease.
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Golden S sign - a chest radiograph sign of right upper lobe collapse due to an obstructing central mass. The margin of the collapsed upper lobe forms a reverse S shape (blue line) as the peripheral lung collapses with a concave outline while the more central lung maintains a convex margin around the mass. The sign is highly suggestive of primary lung cancer and should prompt further investigation with CT.
Garland triad - a chest radiograph sign of sarcoidosis. It refers to a triad of lymph node enlargement; right paratracheal, right hilar and left hilar. This pattern of nodal enlargement, also known as the 1-2-3 sign, is not typical of lung caner or lymphoma which are other common causes of lymphadenopathy on chest xray. This patient also had lung parenchymal involvement with predominantly perihilar opacity simulating pulmonary oedema.
Pancoast tumour - a primary lung cancer that arises in the lung apex and invades soft tissues such as the brachial plexus. Although classically these tumours present with Pancoast syndrome (shoulder pain, C8 to T1 radiculopathy, Horner’s syndrome) this only occurs in approximately 25% of cases. The lung apex is an important check area on chest radiographs. Any density difference between the left and right is suspicious. CT in this case confirms a lung mass invading adjacent soft tissues and destroying the second rib.
Unilateral hyperlucent hemithorax - when one side of the chest is more lucent (black) than the other on a frontal chest radiograph. There are many potential causes including a few tricky ones. Some important things to consider:
- rotated patient - can create a dramatic density difference
- chest wall soft-tissue differences - particularly mastectomy (left image)
- pneumothorax - always important! (right image)
- air-trapping - particularly inhaled foreign bodies (check valve effect)
- reduced lung vascularity - eg. pulmonary embolism (Wetermark’s sign)
- contralateral increased density - eg. pleural effusion on other side