Golden S sign

Case contributed by Dr Yair Glick


Fever, productive cough, shortness of breath. Known bronchogenic tumour.

Patient Data

Age: 40 years
Gender: Male
Modality: X-ray

Golden S sign of the right upper lobe (RUL) - right hilar mass with collapsed RUL.

Modality: CT

RUL totally collapsed due to obstructed bronchus to RUL, with numerous small air-filled cavities which likely represent bronchiectasis. Cavitation at the centre of the lobe measuring 51 mm across, with air-high density fluid level.

Moderate right hilar and right mediastinal lymphadenopathy.

Calcified right and left coronary arteries (RCA, LMCA, LAD, and several of its diagonals).

Mild hepatomegaly.

Long-standing pneumobiliaSplenomegaly.

Previous radiograph, 2 years prior

Modality: X-ray

Erect chest radiograph taken exactly 2 years previously:

There is an irregular focal opacity with indistinct borders in the upper field of the right lung.

No hilar or mediastinal widening.

Modality: CT

Coronal oblique MIP reconstruction of previous chest CT demonstrates an irregular mass in the RUL.

Case Discussion

Patient presented with a productive cough and fever. He probably neglected to seek treatment for his malignancy due to psychosocial circumstances.

Labs: No leucocytosis, CRP 127 mg/l.

Cavitation seen at newer chest CT more likely due to exuberant infection rather than cavitary carcinoma, since it exhibits a thin rim.

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Case Information

rID: 52474
Case created: 9th Apr 2017
Last edited: 21st Apr 2017
Systems: Chest, Oncology
Inclusion in quiz mode: Included

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