Golden's S sign

Radiological sign indicating a right upper lobe collapse

Golden's S sign
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Causes	Right upper lobe collapse
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Diagnosis	Chest X-ray
Differential diagnosis
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Golden's S sign is a radiological sign seen on a chest X-ray that indicates the presence of a right upper lobe collapse, often due to an obstructing mass such as a lung cancer. The sign is named after Dr. Ross Golden, who first described it.

Description

Golden's S sign is characterized by a distinctive S-shaped curve on the right side of the mediastinum on a frontal chest X-ray. This appearance is due to the combination of a right upper lobe collapse and a central obstructing mass, which causes the minor fissure to be displaced inferiorly and medially, while the major fissure is displaced superiorly and laterally.

Pathophysiology

The S-shaped curve is formed when there is a mass in the right hilum, such as a bronchogenic carcinoma, that causes obstruction of the right upper lobe bronchus. This leads to atelectasis (collapse) of the right upper lobe. The collapsed lobe pulls the minor fissure downward, while the mass itself pushes the major fissure upward, creating the characteristic S shape.

Clinical Significance

Golden's S sign is an important radiological finding because it suggests the presence of an obstructing lesion, often a malignancy, in the right upper lobe bronchus. Identifying this sign can prompt further investigation, such as a CT scan or bronchoscopy, to determine the nature of the obstruction and guide management.

Diagnosis

Golden's S sign is diagnosed through a frontal chest X-ray. The radiologist looks for the characteristic S-shaped curve on the right side of the mediastinum. Further imaging, such as a CT scan, may be used to confirm the presence of a mass and assess its extent.

Management

The management of a patient with Golden's S sign depends on the underlying cause of the obstruction. If a malignancy is present, treatment may involve surgical resection, chemotherapy, or radiation therapy, depending on the stage and type of cancer.

Also see

• Atelectasis
• Bronchogenic carcinoma
• Chest X-ray
• Lung cancer