Correct!
4. The “Luftsichel” sign
Figures 1D and E: Frontal and lateral chest radiography shows progression of the hazy opacity projected over the left upper thorax, now with a rim of lucency projected over the aortic arch (arrowheads, D). The lateral study (E) shows increased attenuation anteriorly, marginated posteriorly by the left major fissure (arrows, E). While there is little evidence of shift or other features of volume loss, the appearance is typical of left upper lobe collapse.
The “Luftsichel” sign represents extension of the aerated superior segment of the left lower lobe extending superiorly, between the aortic arch and collapsed left upper lobe. This results in aerated lung contacting the aortic arch posteriorly, rendering the contour of the latter visible).
The patient also underwent thoracic CT (Figures 2A and 2B).
Click here for a movie of axial CT images
Click here for a movie of coronal CT images
What is the main finding on the thoracic CT? Among the following choices, which is the most useful next step for the management of this patient’s hemoptysis?
1. Surgical resection of the left lung
2. Bronchoscopy
3. 18FDG-PET-CT scanning
4. Bronchial artery arteriography and embolization
5. Transthoracic percutaneous CT-guided biopsy of the prevascular lymphadenopathy
