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Cervicothoracic sign

The cervicothoracic sign, a variant of the silhouette sign, helps to discern the anterior or posterior location of mass in the superior mediastinum on frontal chest radiographs. 

As the anterior mediastinum ends at the level of the clavicles, so simply anterior mediastinal lesions does not extend above the clavicles, but any lesion extends above that level and still remains sharply outlined must be located posteriorly in the chest; i.e apical segments of upper lobes, pleura, or posterior mediastinum; this is the cervicothoracic sign3.

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