Tomas C. Franquet MD, Presenter: Nothing to Disclose

Sanjeev Bhalla MD, Abstract Co-Author: Nothing to Disclose

Marvin H. Chasen MD, Abstract Co-Author: Nothing to Disclose

Ana M. Gimenez MD, Abstract Co-Author: Nothing to Disclose

Alberto Hidalgo MD, Abstract Co-Author: Nothing to Disclose

1. To recognize the morphologic characteristics of Pomegranate sign. 2. To understand the physical basis that may form a wavy line interface in intrathoracic exudates. 3. To illustrate this sign in different intrathoracic exudates related to infections, malignancies, congenital malformations, iatrogenic disorders and trauma.  

The "Pomegranate sign" is a useful CT finding based on the appearance of intrathoracic pathologic gas–fluid levels. This sign  consist on  the presence of a wavy air-fluid interface occurring after the complication of a cavity or space containing fluid (exudate). When the imaging plane is parallel to the wavy gas-fluid interface, a pomegranate-like appearance will be visible. We discuss and illustrate this previously non-described CT finding in diverse complicated intrathoracic disorders (Table 1). Table 1. Gas-Fluid Levels in Complicated Intrathoracic Exudates (Pomegranate Sign) A) Infectious processes with parenchymal, pleural or mixed involvement such as bronchopleural fistula, empyema, and lung abscess. B) Congenital disorders: Bronchogenic cyst; Bronchial atresia; Congenital pulmonary airway malformation (CPAM). C) Malignant: Malignant pleural effusion D) Iatrogenic disorders E) Traumatic thoracic injuries: Hydropneumothorax, Lung contusion  

http://abstract.rsna.org/uploads/2014/14008666/14008666_qhc3.pdf

Franquet, T, Bhalla, S, Chasen, M, Gimenez, A, Hidalgo, A, "The Pomegranate Sign: A Useful CT Finding for Diagnosing Intrathoracic Exudates".  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008666.html