“Bulging fissure sign” on chest radiograph: Strong predictor of central airway malignancy

Abstract

A bulging fissure sign in a chest radiograph is usually associated with right upper lobe lung collapse with horizontal fissural effusion or collection. Etiology and pathophysiology traced to infective and noninfective causes. Commonly bulging fissure sign is described with lung malignancy in old age. Infective etiologies are infective types in children and adults with comorbid conditions. In this case report, we have reported a 54-year-old male presented with cough and hemoptysis with progressive worsening of shortness of breath. Clinically tubular breath sounds in the right infraclavicular region with egophony were heard. Chest X-ray documented right lung consolidation or mass lesion with bulging fissures. Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right mainstem bronchus causing near-complete occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and forceps-guided (forcep biopsy) histopathology suggestive of “squamous cell” type of lung malignancy for bulging fissure sign in our case. A high index of suspicion is must to rule out underlying malignancy and bronchoscopy is “gold-standard” test in cases with bulging fissure sign to confirm a diagnosis.