Chest > Diagnosis > Overview of Chest Imaging > Chest Radiographic and CT Signs

Air Crescent Sign

Santiago Martínez-Jiménez, MD

Selected Images Hide Images

Composite image with PA chest
radiograph (left) and axial NECT
(right) of a patient with sarcoidosis
shows a right upper lobe mycetoma
that developed in a preexisting
cavity and exhibits the air crescent
sign . infection. Note the nondependent
Composite image with axial NECT
obtained in the supine (left) and
prone (right) positions shows a
patient with a right lower lobe
mycetoma secondary to
nontuberculous mycobacterial
air crescent sign and migration of
the fungus ball to the dependent
portion of the cavity.
Composite image with PA chest Composite image with PA chest
radiograph (left) and axial NECT radiographs of 2 different patients
(right) of a patient with cavitary right shows a mycetoma in a cavity
upper lobe lung cancer shows a secondary to nontuberculous
mycetoma within the cavity and the mycobacterial infection (left) and a
air crescent sign . complicated hydatid cyst with
impending rupture . Both lesions
exhibit the air crescent sign.
(Courtesy P. Boiselle, MD.)

Additional Images

Composite image with PA chest Composite image with axial CECT in

radiograph (left) and axial NECT
(right) of a patient with
angioinvasive aspergillosis shows a
left upper lobe cavity with
internal heterogeneous soft tissue
that represents necrotic lung.
Note surrounding crescent of
intracavitary air that produces the
air crescent sign.
the supine (left) and prone (right)
positions of a patient with a left
upper mycetoma within a
preexistent cavity from
nontuberculous mycobacterial
infection is shown. Note the air
crescent configuration in the
nondependent aspect of the cavity
and migration of the fungus ball to
the dependent aspect of the cavity.
In clinical practice, the air crescent
sign is characteristically identified in
patients with mycetoma.

KEY FACTS

Terminology
Definition: Crescent-shaped or circumferential radiolucency surrounding a nodule or mass
Synonyms
Meniscus sign
Monod sign: Typically used for fungus ball or mycetoma
Imaging
Mass or nodule surrounded by peripheral crescent-shaped radiolucency
Mass or nodule within a lung cavity
Top Differential Diagnoses
 Abscess: Often completely air-filled or with air-fluid level
Infarct: May cavitate and exhibit air or air-fluid level
Infection: Tuberculosis, nocardiosis
Malignancy: Cavitary necrotic neoplasm
Pathology
Etiology: Angioinvasive aspergillosis, mycetoma within preexistent cavity (e.g., tuberculosis, sarcoidosis, bronchiectasis, lung
cancer), hydatid disease
Angioinvasive aspergillosis: Arterial thrombosis and lung infarction
Preexistent cavity: Saprophytic fungus/fungus ball
Hydatid disease: Airway erosion by hydatid cyst
Clinical Issues
Classically described in recovery phase of angioinvasive aspergillosis
Also described in mycetoma within preexistent cavity
Diagnostic Checklist
Most cases of air crescent sign seen in clinical practice are secondary to mycetoma within preexistent cavity

SELECTED REFERENCES

1. Chiarenza A et al: Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-
radiologists. Insights Imaging. 10(1):114, 2019
2. Sevilha JB et al: Infectious and non-infectious diseases causing the air crescent sign: a state-of-the-art review. Lung. 196(1):1-10,
2018
3. Kumaresh A et al: Back to basics - 'must know' classical signs in thoracic radiology. J Clin Imaging Sci. 5:43, 2015
4. Algın O et al: Signs in chest imaging. Diagn Interv Radiol. 17(1):18-29, 2011
5. Abramson S: The air crescent sign. Radiology. 218(1):230-2, 2001
6. Franquet T et al: Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 21(4):825-37,
2001
7. Mondo O et al: [Bronchiectatic aspergilloma.] Sem Hop. 33(61):3587-602, 1957
© 2022, Elsevier, Inc. AmirsysSupport@Elsevier.com