A previously healthy 49-year-old woman had hemoptysis of one month's duration. She had no chest pain, shortness of breath, or weight loss. She had a history of cigarette smoking for more than 20 years and denied any exposure to tuberculosis or other infectious pulmonary diseases. The patient was afebrile, and examination of the chest disclosed decreased breath sounds in the right upper chest anteriorly. There was no cyanosis or clubbing, and the rest of her physical examination was within normal limits. Routine laboratory data were unremarkable.Figures 1 and 2 are posteroanterior and lateral roentgenograms taken on admission.
Bronchogenic carcinoma with collapse of the right upper lobe exhibiting the S sign of Golden.
The posteroanterior chest film (Fig 1) shows the reverse S-shaped curve often seen with collapse of the right upper lobe1,2 (Fig 3, retouched). The lateral view (Fig 2) confirms the upper lobe collapse.