Presentation
Fever, respiratory distress, moist cough.
Patient Data
Within the retrocardiac left lower zone there is a small region of airspace opacification. This silhouettes the left hemidiaphragm, anatomically localizing this to the left lower lobe. There is also associated volume loss in the left lung. The remainder of the lungs are clear. No pleural effusion. In the context of fever and cough, this is consistent with left lower lobe pneumonia.
The left lower lobe consolidation is outlined in blue. The right hemidiaphram (pink) is well seen, however the medial aspect of the left hemidiaphram (green) is obscured, silhouetted by the consolidation. The hilar points (yellow) are at different levels, with the left lower than the right.
Case Discussion
The silhouette sign helps localize the pathology to the left lower lobe. The right hemidiaphragm, the right and left heart borders and the mediastinal contours are clearly seen. The associated volume loss is best appreciated as slight depression of the left hilar point compared with the right.
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