Hanging chin sign
Updates to Article Attributes
The hanging chin sign, also known as the chin-on-chest sign, is a radiological sign appreciated on plain chest radiograph in a geriatric (≥65 years of age) patient population.
The sign describes when, on a plain chest radiograph, the mandible projects over one or more ribs1,2. This sign is classically seen on an AP projection 1.
This sign has been shown to be of prognostic significance in a geriatric population 1-3. In geriatric patients presenting to the emergency department or intensive care unit with a positive hanging chin sign on initial plain chest radiograph, they were more likely to be frail and have a higher mortality 1,2. Similarly, in geriatric patients presenting with a neck of femur fracture, presence of the hanging chin sign on initial plain chest radiograph was associated with increased frailty and mortality 3.
Differential diagnosis
neuromuscular weakness causing dropped head syndrome1
kyphosis (e.g. due to osteoporosis) 1, which when excessively present (i.e. hyperkyphosis) in a geriatric population may also be a predictor for mortality 4
- +<p>The <strong>hanging chin sign</strong>, also known as the <strong>chin-on-chest sign</strong>, is a radiological sign appreciated on <a href="/articles/chest-radiograph" title="Plain chest radiograph">plain chest radiograph</a> in a geriatric (≥65 years of age) patient population.</p><p>The sign describes when, on a plain chest radiograph, the <a href="/articles/mandible" title="Mandible">mandible</a> projects over one or more <a href="/articles/ribs" title="Ribs">ribs</a> <sup>1,2</sup>. This sign is classically seen on an AP projection <sup>1</sup>.</p><p>This sign has been shown to be of prognostic significance in a geriatric population <sup>1-3</sup>. In geriatric patients presenting to the emergency department or intensive care unit with a positive hanging chin sign on initial plain chest radiograph, they were more likely to be frail and have a higher mortality <sup>1,2</sup>. Similarly, in geriatric patients presenting with a neck of femur fracture, presence of the hanging chin sign on initial plain chest radiograph was associated with increased frailty and mortality <sup>3</sup>.</p><h4>Differential diagnosis</h4><ul>
- +<li><p>neuromuscular weakness causing <a href="/articles/dropped-head-syndrome" title="dropped head syndrome">dropped head syndrome</a> <sup>1</sup></p></li>
- +<li><p><a href="/articles/kyphosis" title="Kyphosis">kyphosis</a> (e.g. due to <a href="/articles/osteoporosis-3" title="Osteoporosis">osteoporosis</a>) <sup>1</sup>, which when excessively present (i.e. hyperkyphosis) in a geriatric population may also be a predictor for mortality <sup>4</sup></p></li>
- +</ul>
References changed:
- 1. Huijgens A, van Baardewijk L, Keijsers C. The Hanging Chin Sign as a Mortality Predictor in Geriatric Patients at the Emergency Department: A Retrospective Cohort Study. BMC Geriatr. 2022;22(1):95. <a href="https://doi.org/10.1186/s12877-022-02780-7">doi:10.1186/s12877-022-02780-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35114953">Pubmed</a>
- 2. Van Beijnen M, Zegers M, Van Leuken M, PC De Jager C, S Simons K. Association Between the Hanging Chin Sign and Mortality in Critically Ill Patients, a Retrospective Observational Study. Emerg Med. 2018;08(02). <a href="https://doi.org/10.4172/2165-7548.1000369">doi:10.4172/2165-7548.1000369</a>
- 3. Egglestone A, Dietz-Collin G, Eardley W, Baker P. Chin-On-Chest in Neck of Femur Fracture (COCNOF) Sign: A Simple Radiographic Predictor of Frailty and Mortality in Hip Fracture Patients. Injury. 2021;52(6):1494-9. <a href="https://doi.org/10.1016/j.injury.2020.10.098">doi:10.1016/j.injury.2020.10.098</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33143868">Pubmed</a>
- 4. Kado D, Lui L, Ensrud K et al. Hyperkyphosis Predicts Mortality Independent of Vertebral Osteoporosis in Older Women. Ann Intern Med. 2009;150(10):681-7. <a href="https://doi.org/10.7326/0003-4819-150-10-200905190-00005">doi:10.7326/0003-4819-150-10-200905190-00005</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19451575">Pubmed</a>
Sections changed:
- Signs
Systems changed:
- Chest
Tags changed:
- geriatrics
Image 1 X-ray ( create )
Image 2 X-ray (Frontal) ( create )
Image 3 X-ray ( create )
Image 4 X-ray (Frontal) ( create )
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