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. 2015 May 14;2015:bcr2015210302. doi: 10.1136/bcr-2015-210302

Luftsichel sign and juxtaphrenic peak sign

P S Sriram 1, Abhishek Biswas 1
PMCID: PMC4434329  PMID: 25976205

Description

A 56-year-old man presented with a 1-week history of cough, dyspnoea and left-sided chest pain. A chest radiograph revealed left mid lung infiltrates (figures 1 and 2). He was treated as an outpatient with an antibiotic for community-acquired pneumonia. His symptoms resolved and a chest X-ray 2 months later showed an elevated left hemidiaphragm with a characteristic Luftsichel sign (figures 3 and 4). A lateral view X-ray showed left upper lobe collapse with anterior displacement of the oblique fissure and elevation of the left hemidiaphragm (figure 5). A CT of the chest confirmed left upper lobe collapse due to an endobronchial lesion (figure 6). In addition, chest X-ray showed presence of a juxtaphrenic peak sign that had become more prominent compared to prior chest X-ray (figure 3) and was confirmed on CT of the chest (figure 7).

Figure 1.

Figure 1

Chest X-ray posteroanterior showing left mid lung infiltrates.

Figure 2.

Figure 2

Chest X-ray lateral view showing left mid lung infiltrates.

Figure 3.

Figure 3

Chest X-ray showing a characteristic Luftsichel sign (arrow: air crescent around the aortic arch) with elevated left hemidiaphragm and a prominent left hilum. Chest X-ray also shows a peaked or tented appearing left hemidiaphragm representing the juxtaphrenic peak sign (block arrow).

Figure 4.

Figure 4

A CT scan showing an aerated left lower lobe juxtaposed between the aorta and a collapsed left upper lobe that results in the Luftsichel sign on chest X-ray (arrow).

Figure 5.

Figure 5

Lateral view X-ray showing collapse of the left upper lobe with anterior displacement of the oblique fissure (arrow) and elevation of the left hemidiaphragm (block arrow).

Figure 6.

Figure 6

A CT of the chest confirms left upper lobe collapse due to an endobronchial lesion (arrow).

Figure 7.

Figure 7

CT of the chest showing a prominent inferior accessory fissure responsible for the juxtaphrenic peak sign (arrow).

Luftsichel sign (in German: Luft: air and sichel: crescent) was first described in 1942.1 This sign is seen in left upper lobe collapse. When the left upper lobe collapses, the superior segment of the left lower lobe shifts upwards and anteriorly, interspersing between the aortic arch and the collapsed left upper lobe. The ensuing air crescent around the aortic arch is the Luftsichel sign.2

Juxtaphrenic peak sign has been well described in chest X-rays following upper lobe volume loss (for eg, lobectomy, tuberculosis or radiation). A prominent inferior accessory fissure is the main reason for this sign. This sign is noted to appear in 70% of patients after right upper lobectomy and in 50% after left upper lobectomy. Presence of this sign is suggestive of upper lobe volume loss and is never seen after lower lobe lobectomy.3

Learning points.

  • Luftsichel (air crescent) sign is suggestive of left upper lobe collapse.

  • Juxtaphrenic peak sign is seen in chest X-rays following upper lobe volume loss.

Footnotes

Competing interests: None declared.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

References

  • 1.Webber M, Davies P. The Luftsichel: an old sign in upper lobe collapse. Clin Radiol 1981;32:271–5. 10.1016/S0009-9260(81)80036-0 [DOI] [PubMed] [Google Scholar]
  • 2.Algin O, Gokalp G, Topal U. Signs in chest imaging. Diagn Interv Radiol 2011;17:18–29. 10.4261/1305-3825.DIR.2901-09.1 [DOI] [PubMed] [Google Scholar]
  • 3.Konen E, Rozenman J, Simansky DA et al. Prevalence of the juxtaphrenic peak after upper lobectomy. AJR 2001;177:869–73. 10.2214/ajr.177.4.1770869 [DOI] [PubMed] [Google Scholar]

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