The Golden S Sign

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    The Golden S Sign

    Shoutout to the awesome David Cisweski for following up this tidbit from conference and giving us this pearl.

    Remember in conference when Dr. Jacobi was going over chest X-rays, was talking about the Golden S sign, and we could neither see the S nor the gold?

    What? – The Golden S sign is also referred to by the more accurate name of “reverse S sign of Golden.” It was named after Dr. R Golden, not for a color or anything having to do with valuable Au. It actually resembles a REVERSE S shape.

    Why? – It is usually associated with a central mass obstructing the upper lobe bronchus (think primary bronchogenic carcinoma), but can also be related to metastasis, primary mediastinal tumors, or enlarged lymph nodes.

    When? – Typically seen with right upper lobe collapse because of the mass, but other lobes are possible. The sign is created by the fissures displacing — the minor and major fissures move superiorly and medially toward the mediastinum and the right middle and lower lobes hyperexpand, creating the odd shape.

    The reverse S (blue line) seen when R upper lobe collapses moves in medially (green arrow) to fill in collapsed space; curve created by bulging into the hilum (yellow circle)

    Resources:

    Golden R (1925). “The effect of bronchostenosis upon the roentgen ray shadow in carcinoma of the bronchus”. Am J Roentgenol. 13 (21).

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