Air crescent sign (lung)
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An air crescent sign describes the crescent of air that can be seen in invasive aspergillosis, semi-invasive aspergillosis, or other processes that cause pulmonary necrosis. It usually heralds recovery and is the result of increased granulocyte activity.
It should not be confused with the Monod sign 2 which describes the air that surrounds an aspergilloma. Unfortunately, the air around the fungal ball is also crescent-shaped and the term air crescent sign is often used interchangeably in that instance - opinion as to the validity of this latter use is controversial.
Causes include 5:
- aspergilloma: often described as the Monod sign
- angioinvasive aspergillosis
- hydatid cyst
- other rare causes
In angioinvasive fungal infection, the nodules are composed of infected hemorrhagic and infarcted lung tissue. As the neutrophil count recovers and the patient mounts an immune response, peripheral reabsorption of necrotic tissue causes the retraction of the infarcted center and air fills the space in between 7. This creates an air crescent within the nodules and is a good prognostic finding because it marks the recovery phase of the infection. This sign is seen in ~50% of patients 2.
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- 2. Thompson BH, Stanford W, Galvin JR, et al. Varied radiologic appearances of pulmonary aspergillosis. Radiographics. 1995; 15(6): 1273-84. Radiographics [pubmed citation]
- 3. Müller Nestor L, Tomás Franquet, Kyung Soo Lee et al. Imaging of Pulmonary Infections: A Fundamental and Clinical Text. Third Edition. Lippincott Williams & Wilkins, 2006. ISBN: 078177232X.
- 4. Yella LK, Krishnan P, Gillego V. The air crescent sign: A clue to the etiology of chronic necrotizing pneumonia. Chest. 2005; 127(1): 395-7. doi:10.1378/chest.127.1.395 [pubmed citation]
- 5. Franquet Tomás, Nestor L. Müller, Ana Giménez et al. “Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings1.” Radiographics 21, no. 4 (July 2001): 825-837. Radiographics [pubmed citation]
- 6. Enrique Cubillo-Herguera, William H. McAlister. The Pulmonary Meniscus Sign in a Case of Bronchogenic Carcinoma. (1969) Radiology. 92 (6): 1299-300. doi:10.1148/92.6.1299 - Pubmed
- 7. Chiarenza A, Esposto Ultimo L, Falsaperla D, et al. Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists. (2019) Insights into imaging. 10 (1): 114. doi:10.1186/s13244-019-0789-4 - Pubmed