tree in-bud sign golden s sign
DESCRIPTION
Tree-in-bud signGolden S signTRANSCRIPT
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Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
1. Tree-in-bud sign2. Golden S sign
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Topic Outline
1. Tree-in-bud sign2. Golden S sign
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Tree-in-bud sign
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Airways
Central
Peripheral
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Airways
Central Cartilage
Peripheral
Non cartilage
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Airways
Central Cartilage
>2mm of internal diameter
Peripheral Non cartilage
<2mm internal diameter
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Airways
Central Cartilage
>2mm of internal diameter
0-16
Peripheral Non cartilage
<2mm internal diameter
7 - 23
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Airways
Central
Conducting zone
Peripheral
Transitional and Respiratory
zone
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Dead Space The portion of each
breath that does not
participate in gas exchange
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Dead SpaceDS
Anatomic DS
Conducting zone150 ml
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Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
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Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
Conducting zone
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Dead SpaceDS
Anatomic DS
Conducting zone150 ml
Physiologic DS
Conducting zone
Alveoli that are well-ventilated but poorly perfused
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Quiz
• Asthma always attacks:A. Lung parenchymaB. Central airwaysC. Peripheral airwaysD. B + C
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Quiz
• Asthma always attacks:A. Lung parenchyma
B. Central airwaysC. Peripheral airwaysD. B + C
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Quiz
• COPD always attacks:A. Central airwaysB. Peripheral airwaysC. Lung parenchymaD. B + C
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Quiz
• COPD always attacks:A. Central airwaysB. Peripheral airwaysC. Lung parenchyma
D. B + C
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Volume-rendered images demonstrate normal central and peripheral airways / Axial image
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Volume-rendered images demonstrate normal central and peripheral airways / Coronal image
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Volume-rendered images demonstrate normal central and peripheral airways / Sagittal image
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Peripheral airways
TB: Terminal BronchioleRB1: Respiratory
Bronchiole 1RB2: Respiratory
Bronchiole 2RB3: Respiratory
Bronchiole 3AD: Alveolar DuctAS: Alveolar sac
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Tree-in-bud sign
Inflammatory material filling:TBRBAD
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Quiz / Tree-in-bud sign
This sign could be seen in :
A. HRCT scanner of thorax
B. CT scanner of thorax
C. PA chest x rayD. Left profile chest x
ray
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Tree-in-bud sign
This sign could be seen in :A. HRCT scanner of
thoraxB. CT scanner of
thoraxC. PA chest x rayD. Left profile chest x
ray
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Tree-in-bud sign could be seen
• In:A. Endobronchial
TuberculosisB. AsthmaC. Bronchoalveolar
carcinoma
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Tree-in-bud sign could be seen
• In:A. Endobronchial
TuberculosisB. AsthmaC. Bronchoalveolar
carcinoma
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Case 1
• A 29-year-old man• Acute myeloid leukemia after bone marrow
transplantation• The patient had a history of fever and cough
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Case 1
HRCT in RLL
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Case 1
• Multiple, small, centrolobular nodules of soft-tissue attenuation connected to linear branching opacities (arrows)
• Tree-in-bud sign
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Case 1At serologic examination, an infection with
A. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
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Case 1At serologic examination, an infection with
A. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
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Tree-in-bud sign associated with bronchiolar infection
• Transverse thin-section CT scan through right lower lobe in a patient with airways disease and bacterial infection related to AIDS (acquired immunodeficiency syndrome)
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Tree-in-bud sign associated with bronchiolar infection
• Multiple impacted centrilobular bronchioles result in tree-in-bud appearance (arrowheads).
• Bronchiectasis is also present
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Lung slice from patient with bronchopneumonia
• Impacted mucus- and pus-filled bronchioles (arrows) are visible throughout the lung
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Golden S sign
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Concave
Convex
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Golden S sign
Refers to a reverse S shaped shadow
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Golden S sign
Caused by right upper lobe collapse
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Golden S sign
The upper curve of the reverse S
(concave infero-laterally)
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Golden S sign
A central mass causing the collapse forming the lower curve (convex infero-medially)
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• When a lobe collapses around a large central mass, the peripheral lung collapses and the central portion of lung is prevented from collapsing by the presence of the mass.
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• The relevant fissure is concave toward the lung peripherally but convex centrally, and the shape of the fissure resembles an S or a reverse S .
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Conclusion
• Golden S sign - indicates lobar collapse with a central mass, suggesting an obstructing bronchogenic carcinoma in an adult
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