38 Complicated Right Upper Lobe Atelectasis: Reverse “S” Sign of Golden

Clinical Presentation

27-year-old woman complains of non-productive cough and weight loss over the last several months

Radiologic Findings

PA (Fig. 38.1A) and lateral (Fig. 38.1B) chest X-rays reveal reduction in volume of the right hemithorax, right hemidiaphragm elevation, and a “peaked” appearance (i.e., juxtaphrenic peak) of the superomedial hemidiaphragm. The trachea is minimally displaced to the right. On the frontal exam (Fig. 38.1A), the horizontal fissure is displaced cephalad. A mass-like convex-appearing bulge is present in the inferior and medial portion of the fissure. The lateral aspect of the fissure is concave superiorly. The configuration creates a “reverse S-shaped” morphology to the fissure. The lateral exam (Fig. 38.1B) reveals displacement of both the horizontal and oblique fissures and an indistinct wedge-shaped triangular mediastinal opacity with its apex directed toward the hilum and its base contiguous with the parietal pleura posterior to the apex of the hemithorax.