3. POSITION
PA AP
QUALITY
ROTATION PENETRATION INSPIRATION
LESION
OPACIT
OPACITY
Homo
Heterogenous Wellill defined Zone
Centralperipher
Silhouet sign
al
Y Necrotic
PATCHY
HILUMMEDIASTINAL
NODULE Central deviasionwided
MASS
COSTO-PHRENIC ANGEL
Freeoblitern
CAVITARY
OTHER
INFILTIRATION
Bone soft tissuediaphragm
5. Solitary Pulmonary Nodule(SPN)
Appearance
Margin Calcification cavitation
Comparison with a
Size
previous x-ray to >8mm
<8mm
Assess growth over
time. Location
Upperhillar zone Lowerbasesup-pleural
Associated abnormalities
Lymph node enlargement Rib destruction/erosion
6. Cavitary lesion
Air +
Air-fluid level Air only
tissue
Wall thickness
Straight Wavy Thick Thin
1. Fungal ball.
2. Rupture hydatid cyct site
3. Necrotic tumor
ruptured
4. Blood glot Hydatid
Abscess Irregular Regular
Peripheral Central
inner wall inner wall
cyst
Emphesemato
Cavitating Chronic us pneumatoc
neoplasm abscess ele
bulla
7. LINEAR PATTERN
LINEAR PATTERN
LEFT VENTRICULAR FAILURE Perihilar and peripheral basal septal lines,
changes acutely and resolves with diuretics
Normal ageing Coarsening of lung markings in lower zones, no
change on review of recent films
Lymphangitis Coarse nodular and linear thickening of
markings, known malignancy, often associated
with pleural effusion, rapid clinical
deterioration of patient
8. LINEAR PATTERN
LINEAR PATTERN
Atelectasis Short thin lines, often basal, new on review of
previous films
Subsegmental Longer thicker bands, often perihilar or basal,
collapse suggest recent infection or infarction
Scarring Any length, persist over time unchanged
Fibrosis Volume loss is key, persists over time
9. Causes of fibrosis
Mid zone lung Lower zone lung Upper zone lung
tuberculosis Drug indused fibrosis sarcoidosis
(most common)
Chronic extrinsic allergic UIP
alveolitis
Radio-therapy Asbestose-related fibrosis
Ankylosing spondylitis
Progressive massive
fibrosis
histoplasmosis
19. INTRODUCTION
• The mediastinum extends from the
thoracic inlet to the diaphragm
• contains many vital structures:
» The heart and great vessels
» Pulmonary hila
» Esophagus
20. INTRODUCTION
• The mediastinum extends from the
thoracic inlet to the diaphragm
• contains many vital structures:
» The heart and great vessels
» Pulmonary hila
» Esophagus
21. INTRODUCTION
• The mediastinum extends from the
thoracic inlet to the diaphragm
• contains many vital structures:
» The heart and great vessels
» Pulmonary hila
» Esophagus
26. The Middle compartment
• The pericardium
anteriorly
• The posterior
• The middle pericardial reflection
compartment is
bounded by • Inferior : the
diaphragm
• Superior: the thoracic
inlet
27. The middle compartment
• This compartment includes:
» the heart
» intrapericardial great vessels
» Pericardium
» trachea
28. The posterior compartment
• Extends from the
posterior pericardial
reflection to the
posterior border of the
vertebral bodies and
from the first rib to the
diaphragm
29. The posterior compartment
• It includes the:
» Esophagus
» Vagus Nerves
» Thoracic Duct
» Sympathetic Chain
» Azygous Venous
System.
30. The posterior compartment
"visceral compartment"
• Visceral
compartment: the
area from the
posterior pericardial
reflection to the
anterior border of the
vertebral bodies in the
middle compartment
has "Paravertebral
sulcus"
31. The posterior compartment
• In this classification,
the cardiopericardial
structures, the
trachea and the
esophagus, are part
of the visceral
compartment
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. Case-1
• A 71-year-old man is seen with low-grade fever, generalized malaise, and a run-
down feeling.
• He has lost weight and shows stigmata of chronic illness.
• There is no history of occupational exposure.
• On physical examination, vital signs are as follows:
– pulse 110 bpm;
– temperature 99°F;
– respirations19/min;
– blood pressure 90/60 mm Hg.
• On exam, the man is frail and appears cachectic with temporal wasting.
• Other aspects of his physical exam are unremarkable.
• Laboratory data:
– Hb 10 g/dL; Hct 30%; MCV 90;
– WBCs 3000/μL; differential normal;
– BUN 19 mg/dL; creatinine 1.0 mg/dL;
– sodium 129 mEq/L; potassium 5.0 mEq/L;
• ABGs (RA): pH 7.42, PCO2 35mm Hg, PO2 58 mm Hg.
• Spirometry: FVC 60% of predicted; FEV1 60% of predicted.
• PPD skin test is negative (0 mm); induced sputum for AFB smear is negative.
46. POSITION •PA CXR
QUALITY •Poor Technical Quality
•Bilateral nodular opacity apperance.
LESION
MEDIASTINALHilum •Central trachea and mediasteinal.
ANGELS •Disappear .
•No
OTHER
47. Case-1
• 1. What is the most likely diagnosis?
• a. Silicosis
• b. Miliary TB
• c. Metastatic thyroid carcinoma
• d. Sarcoidosis
• 2. What is the next step in the workup of this
patient that would most likely yield the diagnosis?
• a. CT scan of the chest
• b. Thyroid function tests
• c. Bone marrow aspiration for culture
• d. Thoracoscopic lung biopsy
49. POSITION •PA CXR
QUALITY •Poor Technical Quality
•Bilateral nodular opacity apperance.
LESION •At middle,upper zone.
MEDIASTINALHilum •Central trachea and mediasteinal.
ANGELS •Hazy left angle .
•No
OTHER
50. Case-2
• 1. Based on the CXR shown, all of the following may be
helpful in the diagnosis except:
• a. Occupational history
• b. Sputum for AFB
• c. Sputum for fungus
• d. History of rheumatic fever
• 2. This patient’s occupational history reveals exposure to
iron ore, asphalt, and dust related to working on loading
docks for 10 years. The CXR is most consistent with:
• a. Silicosis
• b. Asbestosis
• c. Bagassosis
• d. Chlorine gas exposure
51. Case-3
• A 70-year-old man with a history of
emphysema and progressive dyspnea is
admitted with mild hemoptysis.
• On exam, he is afebrile; he has a left-sided
chest wall scar from a previous thoracotomy
with decreased breath sounds in the left lung
field.
• There are wheezes and rhonchi heard in the
right lung field.
53. POSITION •PA CXR
QUALITY •Poor Technical Quality
•Left hemithorax homogenous opacity
•Patchy consolidation in right lung
LESION •CUTT OFF SIGN
MEDIASTINALHilum •Left trachea and mediasteinal
deviation
ANGELS •obscured left angle .
OTHER •No
54. Case-3
• Based on the CXR and clinical history, the
most likely diagnosis is:
• a. Left lung atelectasis with mucus plug
• b. Metastatic lung disease from lung primary
• c. Multiple pulmonary infarcts
• d. Septic emboli
55. Case-4
• A 53-year-old male smoker, unemployed with no
occupational exposure,
• is admitted with progressive shortness of breath.
• He has been unwell for some time and has received
multiple courses of antibiotics for “bronchitis.”
• During the prior 4 mo, he has not had any medical
follow-up.
• On exam, he is a-febrile but looks ill.
• Lung exams reveal diffuse rhonchi and crackles with no
localizing signs.
• ABGs on room air show PaO2 of 68 mm Hg with mild
compensated respiratory alkalosis.
• Sputum for AFB is negative.
57. POSITION •PA CXR
QUALITY •Poor Technical Quality
•Bilateral multiple nodular opacity
•Masslike lesion at left middle zone
LESION
•Wided superior mediastinum
MEDIASTINALHilum •Round opacity at upper right hilum
ANGELS •Right angle is disappered .
•May be opacity at left axila
OTHER
58. Case-4
• 1. The most likely diagnosis is:
• a. TB
• b. Hypersensitivity pneumonitis
• c. Metastatic disease
• d. Acute interstitial pneumonitis
• 2. Associated with this diagnosis is:
• a. Clubbing
• b. Increased IgE
• c. Hypocalcemia
• d. Eosinophilia
