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The cervicothoracic sign is a variation of the silhouette sign on frontal chest radiography used to determine whether a superior (para)mediastinal soft tissue mass is anterior or posterior to the trachea.
A positive cervicothoracic sign occurs when a thoracic lesion contacts the neck or extends into it, thereby obliterating the upper borders of the lesion on radiographs 1. Because the anterior mediastinum ends at the level of the clavicles, anterior mediastinal masses will disappear as it ascends above the clavicle. Examples include cystic hygroma, left superior vena cava, right aortic arch, and thymic cyst 1.
In contrast, a lesion posterior to the trachea can have its upper border outlined by lung above the level of the clavicles (negative cervicothoracic sign), as the posterior mediastinum ends much higher 2. Any lesion with a discernible upper border above that level must be located posteriorly in the chest, i.e. apical segments of upper lobes, pleura, or posterior mediastinum 3. Examples include posterior mediastinal masses like neurofibroma 1.
The lateral borders of a paratracheal lesion may be visible slightly above the clavicles 1. Examples include thyroid goiter 1.
History and etymology
Benjamin Felson (1913-1988) was an American radiologist who is believed to be the first to describe this sign 1.
- 1. Felson B. More chest roentgen signs and how to teach them. Annual Oration in memory of L. Henry Garland, M.D., 1903-1966. (1968) Radiology. 90 (3): 429-41. doi:10.1148/90.3.429 - Pubmed
- 2. George PP, Irodi A, Nidugala Keshava S, Lamont AC. 'Felson Signs' revisited. (2014) Journal of medical imaging and radiation oncology. 58 (1): 64-74. doi:10.1111/1754-9485.12031 - Pubmed
- 3. Kazerooni EA, Gross BH. Cardiopulmonary Imaging. Lippincott Williams & Wilkins. (2004) ISBN:0781736552. Read it at Google Books - Find it at Amazon
- 4. Algın O, Gökalp G, Topal U. Signs in chest imaging. Diagn Interv Radiol. 2011;17 (1): 18-29. doi:10.4261/1305-3825.DIR.2901-09.1 - Pubmed citation