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Golden S sign with rib and clavicle metastases

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Right-sided chest pain, dyspnea and hemoptysis. Lifelong heavy smoker.

Patient Data

Age: 65 years
Gender: Male

Right upper zone opacification contiguous with a right hilar mass. Loss of the right mediastinal contour. The horizontal fissure is retracted superiorly. Elevation of the right hemidiaphragm and rightward mediastinal shift. 

Distal right clavicle and right 10th rib lytic lesions. Right lateral 5th rib subtle expansion suspicious of a lesion.

Case Discussion

This case is a classic example of the Golden S sign, indicating RUL collapse secondary to an obstructing right hilar mass.

Staging CT confirmed a large right hilar mass, collapse of the right upper lobe and several osseous metastases. Biopsy confirmed NSCLC.

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