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Images in thorax
The Harlequin sign
  1. Duneesha De Fonseka1,
  2. Adriana Lama-Lopez2,
  3. Tim Batchelor3,
  4. Anthony Edey4,
  5. Nicholas A Maskell5
  1. 1Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
  2. 2Department of Respiratory, North Bristol NHS Trust, Bristol, UK
  3. 3Department of Thoracic Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol UK
  4. 4Department of Radiology, North Bristol NHS Trust, Bristol, UK
  5. 5Academic Respiratory Unit, Department of Clinical Sciences, Bristol University, Bristol, UK
  1. Correspondence to Dr D De Fonseka, Academic Respiratory Unit, North Bristol NHS Trust, Bristol, BS10 5NB, UK; Duneesha{at}

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A 28-year-old woman was incidentally found to have a large right apical mass (figure 1) on a chest radiograph. She denied having any respiratory symptoms but had noted asymmetric flushing of her face following strenuous exercise (figure 2). On closer questioning she also described hypohydrosis affecting the right side of her face.

Figure 1

Chest radiograph showing a large right apical opacity and evidence of thinning of the right …

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