Current Medical Issues

: 2020  |  Volume : 18  |  Issue : 1  |  Page : 72--73

Bulging fissure sign

Darpanarayan Hazra, Kundavaram Paul Prabhakar Abhilash 
 Department of Emergency Medicine, CMC, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Darpanarayan Hazra
Department of Emergency Medicine, CMC, Vellore - 632 004, Tamil Nadu

How to cite this article:
Hazra D, Abhilash KP. Bulging fissure sign.Curr Med Issues 2020;18:72-73

How to cite this URL:
Hazra D, Abhilash KP. Bulging fissure sign. Curr Med Issues [serial online] 2020 [cited 2021 Oct 27 ];18:72-73
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Full Text


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?

 View Answer


Right upper lobe consolidation causing inferior bulging of major fissure (black arrow) is suggestive of Klebsiella pneumoniae pneumonia.

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.[1] 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).{Figure 1}

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Conflicts of interest

There are no conflicts of interest.


1Can AD, Alsharif A, Muthiah MP. University of Tennessee Health Science Center, Memphis. Am J Respir Crit Care Med 191;2015:A1819.