Hi there i'm doctor andrew dixon from radiopaedia.org and in this video we are going to
look at the Golden S sign which can be seen on chest radiographs when there is
right upper lobe collapse due to an obstructing hilar region mass
instead of having a straight line the margin of the collapsed lobe forms
an S shape or more correctly it forms a back to front S shape which is why
many people often refer to this as the reverse S sign of Golden
as the right upper lobe collapses it moves
medially and towards the superior mediastinum but due to the presence of
the hilar region mass the lower margin of collapsed portion bulges out
forming the distinctive reverse S shape. The most common cause of the S sign of Golden is of
course primary lung cancer however it can occasionally be caused by lymph
node enlargement or due to metastases and as such the S sign of Golden is a sinister chest xray
abnormality and should always prompt further evaluation with a chest CT
and yes for those who are wondering this patient has had quite an ectatic thoracic
aorta which is probably a sign of their old age
and down here in the right lower zone and across the other side in the left
lower zone there are nipple shadows
so there you have it, the S sign of Golden, right upper lobe collapse due
to an obstructing central mass
you can find out more on the radiopaedia.org website
