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Golden S sign

Dr Andrew Dixon and Dr Frank Gaillard et al.

The Golden S sign is a sign seen in both PA chest radiographs and in CT scans. It is called so because this sign resembles a reverse S shape and is therefore sometimes referred to as the reverse S sign of Golden.

Although typically seen with right upper lobe collapse, the S sign can also be seen with the collapse of other lobes. It is created by a central mass obstructing the upper lobe bronchus and should raise suspicion of a primary bronchogenic carcinoma. It can also be caused by other central masses such as metastasis, primary mediastinal tumour, or enlarged lymph nodes.

Radiographic features

Chest radiographs

The Golden S sign is seen on frontal radiographs. In the most common situation, the appearance is that of right upper lobar collapse, (the right upper lobe appearing dense and shifting medially and upwards) with a central mass expanding the hilum. The combination results in the peripheral lung collapsing with a concave margin, whereas the mass remains, forming a convex margin. The two together form a reverse S shape.