Shifting granuloma sign

Case contributed by David McComiskey


Presents with weakness. History of lung cancer.

Patient Data

Age: 60 years
Gender: Female

There is right upper lobe collapse with shifting of the previously characterized right lower lobe mass superiorly, increased volume loss compared to prior examination (see below), and associated generalized increased density of the right hemisphere. This shifted mass and the nodule in the left upper lobe demonstrate interval increase in size compared to previous. There may be airspace disease or a third lesion in the left lower lobe adjacent to the cardiac silhouette.

Four months earlier


Right hilar enlargement with multiple rounded pulmonary densities. 

Case Discussion

The shifting granuloma sign refers to a shift in the location of a parenchymal lesion visible on prior films seen in the presence of atelectasis. In this case, right upper lobe collapse has shifted the previously characterized right lower lung mass superiorly with associated increased density of the right hemithorax.

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