Chest > Diagnosis > Overview of Chest Imaging > Chest Radiographic and CT Signs
Luftsichel Sign
Selected Images
PA chest radiograph of a patient
with a centrally obstructing left
upper lobe squamous cell lung
cancer shows complete left upper
lobe atelectasis and the Luftsichel
sign. The former manifests as a
vague left mid and upper lung zone
opacity and the latter as a
sickle-shaped lucency
(hyperexpanded left lower lobe) that
outlines the aortic arch .
Additional Images
AP chest radiograph of a patient
with complete left upper lobe
atelectasis secondary to
endobronchial metastases from
clear cell renal carcinoma shows a
vague opacity of the left mid-
and upper lung zones that obscures
the adjacent left mediastinal
contours. The aerated lung seen in
the upper lung zone represents the
cranially displaced left lower lobe
superior segment.
PA chest radiograph of a patient
with left upper lobe lung cancer
Lateral chest radiograph of the
same patient shows complete left
upper lobe atelectasis outlined
posteriorly by the anteriorly
displaced left major fissure . proximal left upper lobe bronchus
Axial CECT of the same patient
shows complete left upper lobe
atelectasis and an intrinsic
heterogeneously enhancing mass
with an irregular endoluminal
component that completely
obstructs the left upper lobe
bronchus.
Lateral chest radiograph of the
same patient shows the anteriorly
Axial NECT of the same patient
shows complete atelectasis of the
left upper lobe secondary to a
central mass that obstructs the
. The Luftsichel sign is typically
associated with centrally obstructing
primary lung cancers.
PA chest radiograph of a patient
who underwent endobronchial valve
placement shows complete
atelectasis of the left upper lobe and
the Luftsichel sign. There is a subtle
opacity in the left mid- and upper
lung zones and a sickle-
shaped lucency that outlines the
aortic arch . Note the left
upper lobe endobronchial valves
.
Axial CECT of the same patient
shows opacification of the left upper
Santiago Martínez-Jiménez, MD
Hide Images
Axial fused FDG PET/CT of the same
patient shows a large central FDG-
avid mass within the completely
atelectatic left upper lobe. Note
diffuse centrilobular emphysema in
the aerated lung in this patient with
primary lung cancer.
Axial NECT of the same patient
shows complete left upper lobe
atelectasis, marked anterior
displacement of the left major or
oblique fissure , and a left
upper lobe endobronchial valve
.
PA chest radiograph of a patient
with a left upper lobe lung cancer
shows postobstructive left upper located opaque left upper lobe. The lobe and the aerated left lower lobe that produced complete left upper
lobe atelectasis manifesting with a left lower lobe superior segment is superior segment that abuts lobe atelectasis shows a sickle-
nearly opaque left hemithorax. A unusually high , abuts the the upper descending thoracic aorta shaped lucency outlining the
crescentic lucency outlines the aortic aortic arch , and forms the and accounts for the Luftsichel seen aortic arch, the so-called Luftsichel
arch and produces the so- "Luftsichel" or air sickle seen on PA on radiography. sign.
called Luftsichel sign. The lucency radiography.
represents the aerated and
hyperexpanded left lower lobe
superior segment.

Composite image with axial NECT
shows a lung cancer that produces
left upper lobe atelectasis secondary
to complete obstruction of the left
upper lobe bronchus . Note
anterior displacement of the left
major fissure and the V-shaped
posterior contour of the atelectatic
left upper lobe .
Sagittal CECT shows a left hilar lung
cancer that produces complete
left upper lobe atelectasis. The
aerated superior segment of the left
lower lobe occupies the
expected anatomic position of the
left upper lobe.
PA chest radiograph of a patient
with a centrally obstructing lung
cancer that resulted in right upper
and middle lobe atelectasis shows a
right apical lucency produced by
the aerated right lower lobe
superior segment, sometimes
referred to as the "right Luftsichel."

KEY FACTS

Terminology
Luftsichel sign: Crescentic lucency outlining aortic arch on frontal radiography secondary to left upper lobe atelectasis
"Luftsichel" from German, air sickle or air crescent
Imaging
PA chest radiography
Left paraaortic crescentic lucency that extends from left apex to left superior pulmonary vein; represents aerated left
lower lobe superior segment adjacent to aortic arch (outlined by hyperexpanded left lower lobe)
Hazy perihilar opacity that fades superiorly, laterally, and inferiorly and represents atelectatic left upper lobe
Lateral chest radiography
Anterior displacement of left major fissure
CT
Atelectatic lobe extends toward anterior chest wall and exhibits V-shaped posterior margin toward hilum
Visualization of obstructing endobronchial lesion
PET/CT: Identification of FDG-avid central neoplasm within atelectatic lobe
Top Differential Diagnoses
Anterior herniation of hyperinflated right lung across midline with leftward displacement of anterior junction line
Medial pneumothorax: Not necessarily associated with other signs of volume loss
Bullous disease adjacent to aortic arch: No other signs of volume loss
Pathology
Hyperexpanded and displaced left lower lobe superior segment interposed between aortic arch and atelectatic left upper lobe
Etiology
Endobronchial obstructing lesion: Typically lung cancer, endobronchial metastasis, pulmonary lymphoma (rare)
Non-neoplastic bronchial stenosis: Complication of pulmonary vein ablation, endobronchial valves

SELECTED REFERENCES

1. Von Ende E et al: Primary pulmonary anaplastic large cell lymphoma: a rare malignancy and rare cause of the Luftsichel sign. Case
Rep Radiol. 2018:8574642, 2018
2. Neelakantan S et al: Luftsichel sign. BMJ Case Rep. 2016, 2016
3. Sriram PS et al: Luftsichel sign and juxtaphrenic peak sign. BMJ Case Rep. 2015, 2015
4. Algın O et al: Signs in chest imaging. Diagn Interv Radiol. 17(1):18-29, 2011
5. Marshall GB et al: Signs in thoracic imaging. J Thorac Imaging. 21(1):76-90, 2006
6. Yiu MW et al: Focal area of hyperlucency on a chest radiograph. Respiration. 68(5):545-7, 2001
7. Blankenbaker DG: The luftsichel sign. Radiology. 208(2):319-20, 1998
 8. Mohammed JR et al: Stimulation of the nucleus raphe obscurus produces marked serotonin release into the dorsal medulla of fed
but not fasted rats--glutamatergic dependence. Brain Res. 695(1):100-3, 1995
9. Webber M et al: The Luftsichel: an old sign in upper lobe collapse. Clin Radiol. 32(3):271-5, 1981
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