“Black hole sign”
The bronchus that appears in hour 2 leads to a cavity.
The light emitted by the endoscope is not refracted or reflected in the walls so the bronchus looks like a dark hole.
“Sign of the Bubble” positive
At hour 11: bubbles are observed in the lateral segmental of the middle lobe (RB4).
No bubbles in the medial (RB5), at hour 7 of the photograph: they report the distal obstruction of this bronchus.
It indicates that in segment RB5 the bronchoscopist must introduce the biopsy clamp to reach the tumor that obstructs it.
The bubble sign was described by Dr. Ricardo Isidoro in 2005, and published much later. (Rev. amer.respiratory med vol.12 no.4 CABA oct./Dec. 2012).
Inflammatory signs dominate the image, but here the light has been lost and the longitudinal folds meet giving this upper lobe a “funnel” aspect: “Bence sign”.
This indirect sign linked to bronchogenic carcinoma was described in Buenos Aires in 1942 by Dr. Alvaro Bence, in charge of the bronchoscopy service at the Guillermo Rawson hospital since 1938 and a disciple of Haslinguer in Vienna and of Chevalier Jackson in Philadelphia. (Fiorino, A. Historical evolution of bronchoscopy, Rev. Arg of tuberculosis, pulmonary diseases and public health 1987, 3:48)