A frontal chest radiograph shows opacification of the right upper zone with a concave inferior margin laterally but a convex downward bulge medially, forming a reverse S shape. What does this appearance indicate?

• A Right apical pleural thickening from old tuberculosis
• B Right middle lobe collapse secondary to broncholithiasis
• C Left atrial enlargement elevating the right hilum
• D Right upper lobe collapse caused by an underlying central hilar mass ✓

Explanation

The Golden S (reverse S) sign combines right upper lobe collapse with a convexity formed by a mass at the right hilum displacing the ascending major fissure. The lateral part of the fissure moves up and medially with volume loss while the central part is held down by the mass, producing the S configuration. It signals a central bronchogenic carcinoma obstructing the upper lobe bronchus rather than simple collapse.

Reference: Grainger and Allison Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.