Upper lobe diversion


  • A 50 years old man
  • Long standing poorly controlled hypertension
  • Presented with shortness of breath
  • No fever and no cough
Chest radiograph PA erect view

Radiographic findings:

  • There is cardiomegaly evidenced by increased cardiothoracic ratio
  • Presence of upper lobe diversion, more prominent on the left side (red arrow)
  • Increased artery (yellow arrows) to bronchus (blue arrows) ratio¬† are also seen at both upper and mid zones
  • Presence of peripheral septal thickenings (Kerley B) lines (black arrows)
  • Minimal consolidation at right perihilar region
  • No pleural effusion

Diagnosis: Congestive cardiac failure.

Discussion (Upper lobe diversion):

  • Upper lobe diversion is a sign seen on upright chest radiograph.
  • It is also known as upper zone redistribution or cephalisation
  • In these patients, minimal early perivascular oedema develops first in the lower zone, leading to contraction of the lower zone arteries and veins and a relative increase in the upper zones.
  • The comparison vessels should be equidistant from the hilar point done on upright chest radiograph.
  • ¬†This sign produces dilated branching and branching upper zone pulmonary veins resembling the antlers of a stag, thus another name for this sign is stag-antler’s sign
Author: radhianahassan