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- ArticleFrancis JB, Francis PB.South Med J. 1978 Nov;71(11):1452-3.A bulging fissure sign was noticed on chest roentgenogram in a patient with H influenzae pneumonia. This sign is usually associated with Klebsiella pneumonia and has also been seen in pneumococcal and plague pneumonia, tuberculosis, mass lesions of the lung, and large lung abscesses. This is thought to be the first report of a bulging fissure sign associated with pneumonia due to H influenzae.