3. Cavitary lung lesions
Loculated empyema
Hydropneumothorax
Esophageal obstruction
Mediastinal abscess
Hydropneumopericardium
Hiatal hernia
Chest wall abscess
Air Fluid Levels
in the following conditions:
4. • A mediastinal lesion should have a sharp
margin convex towards the lungs and its base
abutting the mediastinum .
Most disease processes will either increase
or decrease the density of the lung
parenchyma
5. • A pleural lesion should be seen as a homogenously
dense opacity abutting the pleural surface, without
air bronchogram.
• If the pleural lesion is free fluid, it will gravitate to
the dependant lung parts first to form a miniscus
(concavity) along its upper surface.
6. • An extra pleural lesion demonstrates a homogenous
density which makes obtuse angles with the chest
wall, or may appear similar to pleural disease.
7. • A lung opacity may be due to a mass or lung-
parenchymal opacification.
• Identification of clear margins vs indistinct or
diffuse opacification is important in making
the differentiation.
• If the diffuse opacification demonstrates
lucencies or air bronchogram within it, it is
most likely air space disease (consolidation).
8. Signs of lobar collapse
• Local increase in density due to non-aerated
lung.
• Decreased lung volume.
• Displacement of pulmonary fissures.
• Elevation of hemidiaphragm.
• Displacement of hila.
10. left upper lobe atelectasis following right upper lobectomy.
The left lung lacks a middle lobe and therefore a minor fissure, so left upper
lobe atelectasis presents a different picture from that of the right upper lobe
collapse.
The result is predominantly anterior shift of the upper lobe in left upper lobe
collapse, with loss of the left upper cardiac border. The expanded lower lobe
will migrate to a location both superior and posterior to the upper lobe in
order to occupy the vacated space.
As the lower lobe expands, the lower lobe artery shifts superiorly. The left
mainstem bronchus also rotates to a nearly horizontal position.
17. Lung mass
• of more than Clinical history and patient’s age .
• Mass borders .
• Comparison with previous examinations.
• Presence of calcifications.
• Associated adjacent rib erosions, pleural effusion,
hilar or mediastinal nodal enlargement.
• Presence of more than one mass.
18. Distribution of opacities
• Unifocal or multifocal.
• Lobar.
• Segmental.
• Perihilar.
• Peripheral.
• Upper, middle or lower zones.
19. Lung fields appear dark because of air.
Ninety-nine percent of the lung is air.
The pulmonary vasculature,
interstitium constitute 1% and give the
lacy lung pattern.
20. Normal Female . older, young
Note breast shadows
Look for asymmetry or missing breast (surgery)
Be aware of basal lung changes due to breast tissue.
Review lateral to evaluate basal changes.
21. Which lung is larger?
Which diaphragm is higher and why?
What is the normal size of the heart?
What is the normal size and shape of
the aorta?
24. Silouhette Adjacent lobe/segment
Right Diaphragm RLL/Basal segments
Right Heart margin RML/Medial segment
Ascending Aorta RUL/Anterior segment
Aortic knob LUL/Posterior segemnt
Left Heart margin Lingula/Inferior segment
Descending Aorta LLL/Superior and medial segments
Left Diaphragm LLL/Basal segments
25. Consolidation / Lingula
Density in left lower lung field
Loss of left heart silhouette
Diaphragmatic silhouette intact
No shift of mediastinum
Blunting of costophrenic angle
35. Unilateral Hyperlucent Lung
Peanut in Left Bronchus
Partial Airway Obstruction Left lung hyperlucent
Left lung stays hyperlucent on expiration
Mediastinal shift with respiration
38. Honeycombing
• Seen in end stage lung disease
• Indicative of diffuse interstitial fibrosis
• Due to bronchiolectasia
• Most of the time in bases
• Upper lobe distribution seen in eosinophilic
granuloma
43. Aspergilloma. Bilateral upper lobe disease
Long standing cavity due to sarcoidosis
Cavity containing round density
Crescent sign - semilunar air space above mass density
44. Aspergillosis
Solitary Pulmonary Nodule
Patient on steroids. Develops solitary pulmonary nodule with air bronchogram.
Short doubling time indicating inflammatory process. Air bronchogram indicating
that it is an alveolar process.
- On steroids (film below)
- Develops solitary pulmonary nodule within one month
- Air bronchogram in the density
FNAB: Aspergillus
Resolved with discontinuation of steroids
49. Tension Pneumothorax No vascular markings on
right
Shift of mediastinum to left
Deep sulcus
Atelectatic right lung
Increased haziness on left: Diversion of entire
cardiac output
52. Hilar Nodes
Note bilateral symmetrical hilar nodes and
para tracheal nodes.
A clear space between the nodes and heart,
identifies the nodes as hilar.
60. Aneurysm Arch of Aorta
Leaking Blood into Pleural Space
Mediastinal mass
Calcification of periphery evident along upper margin
Loss of silhouettes of
aortic knob
left heart margin
left diaphragm
Left pleural effusion
Tracheal indentation Old and New x rays
61. Aneurysm Arch of Aorta
"Mass" density
Extrapleural
Middle mediastinal mass
62. Aneurysm of Descending Aorta- Inhomogeneous cardiac density
Retrocardiac density
Extrapleural
63. Dissecting Aneurysm
Mediastinal widening
Inlet to outlet shadow on left side
Retrocardiac: Intact silhouette of left heart margin
Pulmonary artery overlay sign: Density behind left lower
lobe
Wavy margin
Lat view demonstrates increased density over spine
65. Bronchiectasis
• Normal appearing CXR in most
• Tubular shadows
• Tram line
• Gloved fingers
• Mucocele
• Ring shadows with thickened bronchial walls
• Air fluid levels
• Watch for dextrocardia
– Immotile cilia syndrome
• Diffuse lung fibrosis
– Due to recurrent infections
72. Right Sided Aortic Arch
Aortic knob missing on left and seen on right
Descending aorta missing on left and seen on right
Paravertebral line on right
73. Right Sided Aortic Arch
Aortic knob on right
Descending aorta on right
Paravertebral line
Right Sided Aortic Arch
Aortic knob on right
Descending aorta on right
Paravertebral line
75. Anterior Mediastinal Mass
Widened mediastinum
Loss of cardiac silhouette
Intact silouhette of descending aorta
Lateral view below.
This is a case of anaplastic carcinomaRetrosternal area is filled with mass density.
77. Pulmonary Embolism
. The primary purpose of a chest film
in suspected PE is to rule out other
diagnoses as a cause of dyspnea or
hypoxia. Most CXRs in patients with
PE are normal.
78. These are two PA fiilms demonstrating Hampton's
hump (rounded opacities) in patients with pulmonary
embolism