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Right middle lobe consolidation - silhouette sign

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Short history of cough and fever. Chest infection?

Patient Data

Age: 25 years
Gender: Male

The distinct silhouette of the right heart border is lost.   Consolidation in the right middle lobe.

Left lung clear.

Heart size normal.

Normal mediastinal contours.

The left image is a normal chest radiograph with the red line indicating the silhouette of the right heart border and right middle lobe.

The right image shows the same red line delineating where the silhouette should be, but is lost due to consolidation in the right middle lobe.

Case Discussion

A good side-by-side illustration of the concept of the silhouette sign of Benjamin Felson.

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