A 60-year-old male smoker has a chest radiograph showing volume loss and opacification of the right upper lobe. The minor fissure is displaced upward, but its medial portion bulges downward producing a reversed S shape. What is the underlying cause?
- A Right upper lobe tuberculosis with fibrosis
- B Right middle lobe syndrome
- C Central bronchogenic carcinoma obstructing the right upper lobe bronchus ✓
- D Compensatory emphysema of the right lower lobe
Correct answer: C. Central bronchogenic carcinoma obstructing the right upper lobe bronchus
Explanation
The Golden S sign (reverse S sign of Golden) is produced when a central mass, classically a bronchogenic carcinoma at the origin of the right upper lobe bronchus, prevents full upward retraction of the medial minor fissure while the lateral fissure retracts normally. Simple fibrosis or any other cause of uncomplicated right upper lobe collapse gives a straight or concave displaced fissure without the convex medial bulge.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.