Current Medical Issues

CME QUIZ
Year
: 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
India




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
Available from: https://www.cmijournal.org/text.asp?2020/18/1/72/277517


Full Text

 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?

 View Answer

 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}

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

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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