The silhouette sign Described by I'elson & l elson (1950), the 'silhouette sign' is the l oss of an interface by adjacent

disease and permits localisation of a l esion on a film by .studying the diaphragm, cardiac and aortic outlines. These structures are normally seen because the adjacent lung i s aerated and the dilIerence in radiodensity is demonstrated. When air in the alveolar spaces is replaced by fluid or soft tissue. there isno longer a difference in radioden.sity between that part of the 11.11 1 2 t he adjacent struetures.'I'herefore the silhoutte is lost and the silhoette sign' is present. Conversely if the border is retained and the abnormality is superimposed, the lesion must he lying either anterior or posterior. In 8-IUr4 of people a short segment of the right heart border is obliterated by the bit pad or pulmonary vessels. Obliteration of these borders may occur with pleural or mediastinal lesions as well as pulmonary pathology. The right middle l obe and lingula lie adjacent to the right and left cardiac borders, the apicoposterior ,segment of the Icfl upper lobe lies adjacent to the aortic knuckle, the anterior segment of the right upper lobe and the middle lobe lie against the right aortic border, and the basal segments of the lower lobes lie adjacent to the hemidiaphragills. Pulntonarv disease in these lobes and segments cam obliterate the borders (Figs 1.23- 1.25). Using the same principle. a well-delned mass seen ahem the clavicles is always posterior whereas an anterior mass, being in contact ss ith soft tissues rather than aerated Iung. is ill defined. This i s the cerricolltnrat is sigtr. The hi/um ot e rluv sign helps distinguish a large heart from a media.stinal mass. With the latter the hilum is seen through the mass whereas ssith the former the hilunr is displaced so that orals its l ateral border is visible. The air bronchogram Originally described by I'Ieischner ( 1941 ), and named by Fclson 11973). the air hronchoggram is an important sign shoss ing that an opacity is intrapulmonary. The bronchus, if air filled but not Iluid l illed, becomes visible when air rs displaced from the surrounding parenchyma. Frequently the air bronchogran is seen as scattered linear transluceneies rather than continuous branching structures. It i s most commonly seen within pneumonic consolidation and pulmonary oedema. An air hronchogram is not seen within pleural fluid and rarely within a tumour, with the exception of alveolar cell distal to a malignancy if the bronchus remains patent (Fig. 1.26). carcinoma and rarely lymphoma. It may he seen in consolidation An air bronchogram is usually a feature of air-space filling but is described accompanying severe interstitial fibrosis such as may develop with sarcoidosis (Box 1.4). Air-space (acinar/alveolar) pattern (Box 1.5) Few disease processes truly only involve the jnterstitium or

acinus on histological examination, but air-space shadowing on t he chest radiograph has distinctive features . When the distal airways and alveoli are filled with fluid, whether it is trmsudate, exudate or blood, the acinus forms a nodular 4-f; mm shadow. These shadows coalesce into ITulTy ill-dclincd round or irregular cotton-wool shadows, non-segmental, homogeneous or patchy. but frequently well defined adjacent to the fissures (Fig. I.28). The