Shënjat Radiologjike Pulmonare

1
Sllavko K. Kallfa

SHNJAT
RADIOLOGJIKE
PULMONARE
(Prmbledhje Artikujsh nga Radiopaedia.org)

2

X-Ray Pulmonary signs
big rib sign f. 3
Chang's sign f. 4
coin lesion. f. 5
dense hilum sign f.12
double contour sign f.16
extrapleural sign f.21
hilum overlay sign f.22
hilum convergence sign f.33
holly leaf sign f.36
finger in glove sign f.41
flat waist sign f.47
Fleishner's sign f.48
ginkgo leaf sign f.50
Golden S sign f.53
incomplete border sign f.60
juxtaphrenic peak sign f.62
medial stripe sign f.66
more black sign f.69
Naclerio's V sign f.80
Shmoo sign f.81
silhouette sign f.82
o cervicothoracic sign f.84
o thoraco-abdominal sign f.85
steeple sign f.86
spinnaker sign f.90
3

water bottle sign f.96
wave sign f.100
Westermark's sign f.103

Big rib sign
Dr Henry Knipe and Dr M Venkatesh et al.
The big rib sign is a sign to differentiate right and left ribs on lateral chest radiographs.
It exploits a technique of magnification differences on lateral projections between right and left
ribs. For example, on right lateral projections the left ribs appear larger than right ribs.
This sign can be useful but may be difficult to appreciate as the difference in size between ribs is
~10% and is not applicable when the posterior ribs are superimposed.

References
1. Kurihara Y, Yakushiji YK, Matsumoto J et-al. The ribs: anatomic and radiologic considerations.
Radiographics. 1999;19 (1): 105-19. Radiographics (full text) - Pubmed citation

4

Chang's sign
Dr Yuranga Weerakkody and Dr Henry Knipe et al.
Changs sign refers to a dilatation and abrupt change in calibre of a main pulmonary artery due
to pulmonary embolism
1
.

References References
1. Plain Film Signs in Pulmonary Embolism (with CT correlate), Kirwadi A, Bickle IC.
http://www.eurorad.org/eurorad/case.php?id=7735 Eurorad case 7735

Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Chang sign
Changs sign

5

Coin lesion
Dr Henry Knipe et al.
Coin lesion refers to a round or oval, well-circumscribed solitary pulmonary lesion. It is
typically 1-5 cm in diameter and calcification may or may not be present
1,3
. Typically but not
always the patient is asymptomatic
1
.
Differential diagnosis
The differential diagnosis for such lesions is
1-3
:
primary lung malignancy - e.g. squamous cell carcinoma
metastases
infection
o pulmonary tuberculosis;
o Streptococcus sp., Staphlycoccus sp., or Klebisialla sp. infection
o hydatid cyst
o abscess
benign disease processes
o Wegener's granulomatosis
o pulmonary hamartoma
o pulmonary arteriovenous malformation
o rheumatoid nodule
o bronchogenic cyst
o bronchial adenoma
Take care not to call a "pseudo-coin lesion", which are caused by artifacts (e.g. button on
patient's clothing, unilateral nipple shadow, etc).
See also
solitary pulmonary nodule

6

References
Coin lesions
Pulmonary coin lesion

From the case: Pulmonary coin lesion
Modality: X-ray
7

From the case: Coin lesion (lung adenocarcinoma)
8

Modality: X-ray
From the case: Coin lesion - breast cancer metastasis
Modality: X-ray

9

From the case: Coin lesion - colorectal carcinoma metastasis
Modality: X-ray

10

Imaging Differential Diagnosis
From the
case: Pseudo-coin lesion due to button
Modality: X-ray
11

From the case: Pseudo-
coin lesion due to button
Modality: X-ray

12

Dense hilum sign
Dr Henry Knipe and Dr Paresh K Desai et al.
The dense hilum sign suggests a pathological process at the hilum - hilar malignancy or
bronchogenic carcinoma should be suspected.
On a well-centred chest PA radiograph the density of the hilum is comparable on both sides. In
absence of calcification or adenopathy, the hila should appear of equal density and be symmetric.

References
1. Khan MIG. On Call Cardiology: On Call Series. Saunders. ISBN:1416025375. Read it at Google
Books - Find it at Amazon
2. Armstrong P, Wilson AG, Dee P et-al. Imaging of diseases of the chest. Mosby-Year Book.
ISBN:0815100116. Read it at Google Books - Find it at Amazon
3. Desai SR, Copley SJ, Aziz ZA et-al. Thoracic Imaging (Oxford Specialist Handbooks in
Radiology). Oxford University Press, USA. ISBN:0199560471. Read it at Google Books - Find it at
Amazon
13

Dense
right hilum
From the case: Lung carcinoma with vertebral metastasis
Modality: X-ray

14

left psoas bulge From the case:
Lung carcinoma with vertebral metastasis
Modality: X-ray
15

Necrotic mass in the right
hilum

16

Double density sign of left atrial enlargement
Dr Jeremy Jones and Dr Frank Gaillard et al.
A double-density sign is seen on frontal chest radiographs in the presence of left atrial
enlargement, and occurs when the right side of the left atrium pushes behind the right cardiac
shadow, indenting the adjacent lung and forming its own distinct silhouette
1-3
.
If large enough it can actually reach beyond the border of the right atrium; this is known as atrial
escape.
3
The right superior pulmonary vein can lead to a similar appearance
1

See also
double density sign of osteoid osteomas
double density sign of berry aneurysms

Synonyms
or
Alternativ
e Spelling
Include in Listings?
Double
contour
sign

Double
contour
sign of left
atrial
enlargeme
nt

17

Synonyms
or
Alternativ
e Spelling
Include in Listings?
Right
retrocardia
c double
density

From the case: Left atrial enlargement
18

Modality: X-ray
Modality: Annotated imag
19

20

Modality: Annotated imag

21

Extrapleural sign
Dr Henry Knipe and Dr Matt Skalski et al.
The extrapleural sign, described by Felson in 1973
1
, refers to the appearance of a pulmonary
opacity with oblique margins that taper slowly to the chest wall when the lesion is viewed
tangentially to the x-ray beam. This appearance suggests that the lesion is extrapleural in nature,
as opposed to intrapulmonary where an acute angle would be expected as the lesion meets the
lung periphery. This term may be confused with extrapleural air sign which refers to a different
finding.

References
1. Felson B. Chest roentgenology. W.B. Saunders Company. ISBN:0721635911. Read it at Google
Books - Find it at Amazon
2. Principles and Interpretation of Chest X-rays. Orient Longman Limited. (2007)
3. Shields TW, LoCicero J, Reed CE et-al. General Thoracic Surgery. Lippincott Williams & Wilkins.
(2011) ISBN:1451152787. Read it at Google Books - Find it at Amazon

22

Hilum overlay sign
Dr Henry Knipe and Dr Frank Gaillard et al.
The hilum overlay sign refers to an appearance on frontal chest radiographs of patients with a
mass projected at the level of the hilum which is in fact either anterior or posterior to the hilum.
When a mass arises from the hilum, the pulmonary vessels are in contact with the mass and as
such their silhouette is obliterated. The ability to see the edges of the vessels through the mass
implies that the mass is not contacting the hilum, and is therefore either anterior or posterior to it.
Most of these masses are found to be in the anterior mediastinum.
The sign was first described by Benjamin Felson
2
.

References
1. Coche EE, Ghaye B, Mey JD. Comparative Interpretation of CT and Standard Radiography of
the Chest. Springer Verlag. (2010) ISBN:3540799419. Read it at Google Books - Find it at Amazon
2. George PP, Irodi A, Nidugala Keshava S et-al. 'Felson Signs' revisited. J Med Imaging Radiat
Oncol. 2014;58 (1): 64-74. doi:10.1111/1754-9485.12031 - Pubmed citation
23

From the case: Lymphoma - mediastinal
Modality: Annotated image
24

From the case: Mediastinal lipoma
25

26

From the case: Mediastinal lipoma

27

From the case: Mediastinal lymphoma
Modality: X-ray
28

From the case: Ascending aortic aneurysm
Modality: X-ray
29

From the case: Lung hilar mass - unknown histology
Modality: X-ray
30

31

From the case: Lung hilar mass - unknown histology
Modality: X-ray
32

From the case: Hilum overlay and loss of more black signs - colorectal carcinoma metastases
Modality: X-ray

33

Hilum convergence sign
Dr Henry Knipe and Dr Andrew Dixon et al.
The hilum convergence sign is a useful chest radiograph sign to help distinguish a bulky hilum
due to pulmonary artery dilatation from a mass/nodal enlargement. In the former, pulmonary
vessels can be seen to converge and join a dilated pulmonary artery.
The sign was first described by Benjamin Felson
2
.

References
1. Parker MS, Chasen MH, Paul N. Radiologic signs in thoracic imaging: case-based review and
self-assessment module. AJR Am J Roentgenol. 2009;192 (3): S34-48. doi:10.2214/AJR.07.7081 -
Pubmed citation
2. George PP, Irodi A, Nidugala Keshava S et-al. 'Felson Signs' revisited. J Med Imaging Radiat
Oncol. 2014;58 (1): 64-74. doi:10.1111/1754-9485.12031 - Pubmed citation
34

From the case: Pulmonary arterial hypertension - primary
Modality: X-ray
35

From the case: Pulmonary arterial hypertension - primary
Modality: X-ray

36

Holly leaf sign
The holly leaf sign refers to the appearance of pleural plaques on chest x-rays. Their irregular
thickened nodular edges are likened to the appearance of a holly leaf.

Holly leaf appearance

37

From the case: Holly leaf
Modality: Photo
38

From the case: Pleural plaques
Modality: X-ray
39

From the case: Calcified pleural plaques
40

Modality: X-ray
From the case: Calcified pleural plaques
Modality: X-ray

41

Finger in glove sign
Dr Henry Knipe and Dr Jeremy Jones et al.
The finger in glove sign seen on CXR and CT chest and refers to the characteristic sign of a
bronchocoele. The same appearance has also been referred to as:
rabbit ear appearance
mickey mouse appearance
toothpaste shaped opacities
Y-shaped opacities
V-shaped opacities
Pathology
Aetiology
Obstructive
In bronchial obstruction, the portion of the bronchus distal to the obstruction is dilated with the
presence of mucous secretions. Causes of bronchial obstruction include :
hamartoma
lipoma
carcinoid
carcinoma
congenital bronchial atresia (rarely)
Non obstructive
Causes include :
asthma
allergic bronchopulmonary aspergillosis (ABPA)
cystic fibrosis

Finger in glove appearance
42

Finger-in-glove sign
Rabbit ear appearance
Y-shaped opacities
V-shaped opacities
Gloved finger sign

43

From the case: Allergic bronchopulmonary aspergillosis (ABPA)
44

Modality: X-ray
Glove Image courtesy of Werneuchen. Please see case description page for licence and original file
information.

45

Finger in glove appearance of
ABPA
46

Finger in glove appearance of ABPAFrom the case: Allergic bronchopulmonary aspergillosis (ABPA) From
the case: Allergic bronchopulmonary aspergillosis (ABPA)
Modality: CT

47

Flat waist sign
Dr Henry Knipe and Dr Vinod G Maller et al.
The flat waist sign refers to flattening of the contours of the aortic arch and adjacent main
pulmonary artery. It is seen in severe left lower lobe collapse and is caused by leftward
displacement and rotation of the heart.

48

Fleishner's sign
Dr Yuranga Weerakkody and Dr Ian Bickle et al.
Fleishner's sign is a prominent central artery that can be caused either by pulmonary
hypertension that develops or by distension of the vessel by a large pulmonary embolus.
Radiographic appearance
Plain film
Fleishner's sign is a description given to appearances on plain chest x-ray along with
Westermark's sign and Hampton's hump. These are all rarely seen, and usually in the context of a
large pulmonary embolism.

Fleishner sign
49

From the case: Pulmonary embolism with right atrial thrombus

50

Ginkgo leaf sign
Dr Henry Knipe and Dr Bita Abbasi et al.
The ginkgo leaf sign is a chest plain radiography appearance which is seen at extensive
subcutaneous emphysema of the chest wall. Air outlines the fibers of the pectoralis major muscle
and creates a branching pattern that resembles the branching pattern in the veins of a ginkgo leaf.

Ginkgo leaf appearance

Ginkgo leaf
51

Emphizema 3 day after pneumonectomyFrom the case: Subcutaneous emphysema
Modality: X-ray
52

From the case: Subcutaneous emphysema (ginkgo leaf sign)
Modality: X-ray

53

Golden S sign
Dr Frank Gaillard et al.
The Golden S sign is seen on both PA chest radiographs and on CT scans. It is named because
this sign resembles a reverse S shape, and is therefore sometimes referred to as the reverse S
sign of Golden.
Although typically seen with right upper lobe collapse, the S sign can also be seen with the
collapse of other lobes. It is created by a central mass obstructing the upper lobe bronchus and
should raise suspicion of a primary bronchogenic carcinoma. It can also be caused by other
central masses, such as: metastasis, primary mediastinal tumour, or enlarged lymph nodes.
Radiographic features
Chest radiographs
The Golden S sign is seen on frontal radiographs. In the most common situation, the appearance
is that of right upper lobar collapse (the right upper lobe appearing dense and shifting medially
and upwards) with a central mass expanding the hilum. These two changes together form a
reverse S shape.
Etymology
The sign was first described by R Golden in 1925
3
.

Reverse S sign of Golden
S sign of Golden

54

From the case: Golden S sign
55

Modality: X-ray
56

Modality: X-ray
57

From the case:
S sign of Golden
58

From the case: S sign of
Golden
59

From the case: Pleural effusion with right lower lobe atelectasis
Modality: X-ray Case 4: inverted Golden S sign

60

Incomplete border sign
Dr Yuranga Weerakkody and Dr Charlie Chia-Tsong Hsu et al.
The incomplete border sign is useful to depict an extrapulmonary mass on chest radiograph.
An extrapulmonary mass will often have a inner well defined border and an ill-defined outer
margin
1-3
. This can be attributed to the inner margin being tangential to the x-ray beam and has
good inherent contrast with the adjacent lung. On the other hand, the outer margin is enface or
partially enface with the x-ray beam and merges with the pleural or chest wall thus the border is
obscured.
Differential diagnosis for extrapulmonary mass can be further divided into pleural or
extrapleural.
Common pleural masses include:
loculated pleural collection
haematoma
pleural plaques
fibrous tumour of pleura
Extrapleural causes can arises from component of chest wall, bone/cartilage, nerve, vascular,
fat, muscle and skin. If there is sign of rib/bone involvement on chest radiograph the lesion is
most likely to be extrapleural. In adults, skeletal metastases are the most common malignant
chest wall neoplasm while chondrosarcoma is the most common primary malignant tumor.

Incomplete border sign on a chest x ray
Incomplete border sign on a chest radiograph

61

From the case: Pleural metastases with the 'incomplete border sign'

62

Juxtaphrenic peak sign
Dr Henry Knipe and Dr Andrew Dixon et al.
The juxtaphrenic peak sign refers to the peaked or tented appearance of a hemidiaphragm
which can occur in the setting of lobar collapse. It is caused by retraction of the lower end of
diaphragm at an inferior accessory fissure (most common
1
), major fissure or inferior pulmonary
ligament. It is commonly seen in upper lobe collapse but may also be seen in middle lobe
collapse.

Juxtaphrenic peak
Juxtaphrenic peak (JP)
Juxta-phrenic peak sign

63

From the case: Luftsichel sign Case 1: in left upper collapse
Modality: X-ray
64

From the case: Luftsichel sign Case 1: in left upper collapse
Modality: X-ray
65

From the case: Juxtaphrenic peak sign Case 2 : on right
Modality: X-ray

66

Medial stripe sign
Dr Henry Knipe and Dr Aditya Shetty et al.
Medial stripe sign refers to an area of increased lucency at the interface of the medial lung and
the mediastinum in case of medial pneumothorax. A small volume of pneumothorax generally
accumulates anteriorly or medially which can be difficult to detect hence this sign holds a certain
significance.
Related pathology
neonatal pneumothorax

Medial pneumothorax sign
Medial stripe sign in a pneumothorax

67

From the case: Pneumothorax
Modality: X-ray
68

Post chest tube

69

More black sign
The more black sign is a normal finding in lateral chest x-ray, and refers to the gradual
increased apparent radiolucency (blackness) of the vertebral bodies, when proceeding from upper
to lower chest. This is due to the increased proportion of the chest comprised of air containing
lungs over distal dorsal spine compared to the upper parts.
When the air is displaced by higher attenuation material, such as consolidation, fluid or a mass
(e.g. bronchogenic carcinoma, paraspinal neurogenic tumour) then the lower dorsal vertebral
bodies become more radio-dense; this is referred to as the loss of the more back sign.

Loss of more black sign

70

Normal pulmonary artery
71

Normal chest x-ray
72

Normal chest x-ray
73

Left lower lobe consolidation
74

Left lower lobe consolidation
75

From the case: Small pleural effusion
Modality: X-ray
76

From the case: Small pleural effusion
Modality: X-ray
77

From the case:
Hilum overlay and loss of more black signs - colorectal carcinoma metastases
78

From the case:
Hiatus and Bochdalek hernias
Modality: X-ray
79

From the
case: Hiatus and Bochdalek hernias
Modality: X-ray

80

Naclerio's V sign
The Naclerio's V sign is a sign described on the plain film in patients with
a pneumomediastinum occurring often secondary to an oesophageal rupture.
It is seen as a V-shaped air collection. One limb of the V is produced by mediastinal air outlining
the left lower lateral mediastinal border. The other limb is produced by air between the parietal
pleura and medial left hemidiaphragm.
Although Naclerios V sign was originally described in patients with oesophageal
rupture, it is not entirely specific to that condition.

Naclerio v sign
Naclerios v sign

81

Shmoo sign
Dr Henry Knipe and Dr Sahith Reddy et al.
Shmoo sign refers to appearance of prominent, rounded left ventricle and dilated aorta on a plain AP
radiograph of chest giving the appearance of Shmoo, a fictional cartoon character in the comic strip Li'l
Abner in the 1940s. This signs indicates left ventricular hypertrophy

82

Silhouette sign
Dr Henry Knipe and Dr Ayush Goel et al.
Silhouette sign was first described by Drs Benjamin Felson and Henry Felson in 1950
1
. The
name is somewhat of a misnomer and in the true sense actually denotes the loss of a silhouette,
thus it is sometimes also known as loss of silhouette sign or loss of outline sign
4
.
The differential attenuation of x-ray photons by two adjacent structures defines the silhouette,
e.g. heart borders against the adjacent lung segments and it is the pathological loss of this
differentiation, which the silhouette sign refers to.
Radiographic appearance
Plain film
Recognition of this sign is useful in localising areas of airspace opacities, atelectasis or
mass within the lung, with the loss of these normal silhouettes on frontal chest radiographs being
generally indicative of the site of pathology
3, 4
:
right paratracheal stripe - right upper lobe
right heart border - right middle lobe or medial right lower lobe
right hemidiaphragm - right lower lobe
aortic knuckle - left upper lobe
left heart border - lingula segments of the left upper lobe
left hemidiaphragm or descending aorta - left lower lobe
Sites of silhouette sign on the lateral chest radiograph include
3
:
posterior border of the heart +/- posterior left hemidiaphragm - left lower lobe
anterior right hemidiaphragm - right middle lobe
posterior right hemidiaphragm - right lower lobe
The silhouette sign forms the basis of the hilum overlay sign, cerviothoracic sign and thoraco-
abdominal sign
2
.
The presence of a silhouette sign may not be due to intra-pulmonary disease. For example
3, 4
:
right heart border - pectus excavatum
posterior border of heart (lateral projection) - hiatus hernia

83

Silhouette sign of Felson
Loss of silhouette sign
Loss of outline sign

84

Cervico-thoracic sign
Dr Yuranga Weerakkody and Dr Omar Bashir et al.
The cervico-thoracic sign, a variant of the silhouette sign, believed to have been coined by
Benjamin Felson. It helps to discern the anterior or posterior location of mass in the superior
mediastinum on frontal chest radiographs.
As the anterior mediastinum ends at the level of the clavicles and as such the upper border an
anterior mediastinal lesions cannot be visualised extending above the clavicles. Any lesions with
a discernible upper border above that level must be located posteriorly in the chest; i.e apical
segments of upper lobes, pleura, or posterior mediastinum
3
.

Cervicothoracic sign

85

Thoracoabdominal sign
Dr Henry Knipe and Dr Ayush Goel et al.
Thoracoabdominal sign is a chest x-ray sign probably coined by Benjamin Felson. It defines
the location of a thoracic lesion based on the fact that the posterior costophrenic sulcus extends
caudally than the anterior lung.
Thus a thoracic lesion which has its caudal end visible below the dome of diaphragm must be in
the posterior part.

Thoraco abdominal sign
Abdomino thoracic sign
Thoraco-abdominal sign

86

Steeple sign
The steeple sign (also called wine bottle sign) refers to tapering of the upper trachea on a frontal
chest radiograph reminiscent of a church steeple. The appearance is suggestive of croup, which
should be obvious clinically. A corresponding lateral x-ray would show narrowing of the
subglottic trachea and ballooning of the hypopharynx.

Wine bottle sign

Steeple of Salisbury Cathedral
This cropped image of the steeple of Salisbury Cathedral, Wiltshire, England, is from the original
photgraph by Andrew Dunn, available at
http://commons.wikimedia.org/wiki/File:Salisbury_Cathedral.jpg which is published under the
following license: This file is licensed under Creative Commons Attribution ShareAlike 2.0 License
87

From the case: Croup - steeple sign
Modality: X-ray
88

From the case: Croup - steeple sign
Modality: X-ray
89

From the case: Steeple sign- croup
Modality: X-ray

90

Spinnaker sign
The spinnaker sign (also known as the angel wing sign) is a sign of pneumomediastinum seen
on neonatal chest radiographs. It refers to the thymus being outlined by air with each lobe
displaced laterally and appearing like spinnaker sails. This is distinct from the sail sign
appearance of the normal thymus.
See also
sail sign (elbow)
sail sign (lower lobe collapse)

Angel wing sign
Spinnaker sail sign

91

From the case: Pneumomediastum (neonate)
Modality: X-ray
92

From the case: Pneumomediastum (neonate)
Modality: X-ray
93

From the case: Pneumomediastinum
94

95

From the case: Pneumomediastinum

96

Water bottle sign
The water bottle sign or configuration refers to the shape of the cardiac silhouette on erect
frontal chest x-rays in patients who have a very large pericardial effusion. Typically the effusion
has accumulated over many weeks to months (e.g. in patients with malignancy) and the
pericardium has gradually stretched. The fluid, often measuring a litre or more, causes the
pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

References
Water bottle configuration
Water bottle heart

97

From the case: Pericardial effusion - water bottle sign
Modality: X-ray
98

From the case: Pericardial effusion
Modality: X-ray
99

From the
case: Pericardial effusion
Modality: X-ray

100

Wave sign
Dr Henry Knipe and Radswiki et al.
The wave sign refers to the indentation of the normal thymus in young children by the ribs,
resulting in a wavy border.

References
1. Textbook of radiology and imaging. Churchill Livingstone. ISBN:0443071098. Read it
at Google Books - Find it at Amazon
From the case: Normal thymus

101

From the case: Wavy thymus
102

Modality: X-ray
From the case: Prominent thymus - wavy border
Modality: X-ray

103

Westermark's sign
Westermark's sign is a sign of pulmonary embolus (PE) seen on chest radiographs.
Pathology
In one study (PIOPED) this sign was present on ~10% of chest x-rays of patients with confirmed
PE
2
.
The theory behind the sign is either obstruction of the pulmonary artery or distal vasoconstriction
in hypoxic lung
3
.
Radiographic features
Plain film
focal peripheral hyperlucency secondary to oligaemia
2, 3, 4

central pulmonary vessels may also be dilated
3

emphysema
2

References
1. Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark's
and Palla's signs in acute pulmonary embolism. Circulation. 2007;115 (8): e211.
doi:10.1161/CIRCULATIONAHA.106.665422 - Pubmed citation
2. Osborn A, Blaser S, Salzman K. Encyclopedia of Diagnostic Imaging. AMIRSYS.
(2008) ISBN:0721629059. Read it at Google Books - Find it at Amazon
3. Webb WR, Higgins CB. Thoracic Imaging. Lippincott Williams & Wilkins. (2010)
4. E.Brant MW, A.Helms MC. The Brant and Helms Solution. Lippincott Williams
&Wilkins. (2007) ISBN:B0011ZYZR2. Read it at Google Books - Find it at Amazon
104

From the case: Saddle pulmonary embolus with Westermark's sign
Modality: X-ray

105

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