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Golden S-sign

German: Golden-S-Zeichen

1 Definition

The golden S-sign is a feature that can be seen on X-ray images of the thorax. It is ideal for X-rays with an anterior-posterior-beam path (AP-beam path), as well as CT images to be recognisable.

2 Background

The first to identify this feature, and at the same time the namesake of this phenomenon, is R. Golden (1925), in connection with lung cancer. Moreover, it can also detect a collapse of the upper right lung.

3 Appearance

The name "Golden S-sign" refers to the form of an inverted S on the CT and can also be seen on the AP x-ray. This can, for example, be a collapse of the right lung or a neoplasia in this area.

4 Explanation

The reason for the recognisable inverted S-shape is a distortion of the fissures which separate the lobes of the right lung from each other. An enhanced developed convexity of the median inferior section and at the same time enhanced concavity of the lateral inferior section of the horizontal fissure creates the appearance of a reverse S-shape.

The fissura obliqua is separated on both sides of the upper lung lobes from the lower lung lobes. In the right lung, in the 3 lobes, the fissura horizontalis separates the upper lobe from another middle lobe. Thus the upper lobe of the lung borders the anterior of the fissura obliqua and the posterior of the fissura horizontalis The appearance of the golden S-sign can be explained by the collapse of the right upper lobe, a volume loss in the fissura horizontalis and fissura obliqua in the superior and medial sections. Another effect of the collapse is the increase in the density of the collapsed lung tissue. Both situations: the relative increase of the density and the deformation of the fissures, to explain the appearance of the reverse S-shape.

Another reason for the occurrence of this feature is neoplasia or other space-occupying lesions in the right upper lobe, which can collapse the lung tissue. In this case, although the lung tissue may collapse, the tissue does not degenerate so a convexity would be detected at this point. The finding of a golden S-sign is always an indication of a neoplasia or other central lesions.

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