|Year : 2020 | Volume
| Issue : 1 | Page : 72-73
Bulging fissure sign
Darpanarayan Hazra, Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, CMC, Vellore, Tamil Nadu, India
|Date of Submission||22-Jul-2019|
|Date of Decision||05-Sep-2019|
|Date of Acceptance||07-Sep-2019|
|Date of Web Publication||03-Feb-2020|
Dr. Darpanarayan Hazra
Department of Emergency Medicine, CMC, Vellore - 632 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hazra D, Abhilash KP. Bulging fissure sign. Curr Med Issues 2020;18:72-3
| Question|| |
Presenting a 75-year-old woman, with chronic obstructive pulmonary disease, with a lobar pneumonia suggestive of Klebsiella.
Shown here is her chest radiograph, what is the radiological finding?
| Answer|| |
Right upper lobe consolidation causing inferior bulging of major fissure (black arrow) is suggestive of Klebsiella pneumoniae
In 1882, Carl Friedlander isolated a Gram-negative encapsulated rod from the lungs. K. pneumoniae
is now known to be an infrequent cause of community-acquired pneumonia occurring in alcoholics, diabetics, or severe chronic obstructive pulmonary disease.
Radiologically, K. pneumoniae
pneumonia typically follows three patterns: lobar consolidation, lobular consolidation, and a chronic form with lung abscesses. The “bulging fissure” sign of K. pneumoniae
pneumonia refers to the lobar consolidation where the affected portion of the lung is expanded causing displacement of the adjacent fissure, resulting in a “bulge” in the minor fissure on frontal radiographs and major fissure on lateral films. Although this finding is classical for K. pneumoniae
, it can also be seen in any lobar pneumonia. The bulging fissure sign is a result of the development of small areas of necrosis within larger areas of consolidative lung, subsequent parenchymal destruction, and loss of elastic recoil of the lung parenchyma.
Chest radiograph [Figure 1]
showed right upper lobe consolidation causing inferior bulging of major fissure (black arrow).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Can AD, Alsharif A, Muthiah MP. University of Tennessee Health Science Center, Memphis. Am J Respir Crit Care Med 191;2015:A1819.