Transcript 7.decubitus film CXR of adult male PA and lateral views, it shows

Various Chest disease & their XR
findings & appearance
important note>>> density of the upper spine is
more than density of the lower spine
7.decubitus film
CXR of adult male PA and lateral views, it shows :
Normal both lung fields ,Central cardiac shadow, Central trachea, central
mediastinum, No boney lesions, no soft tissue abnormalities
normal radiologic anatomy of the chest
Look carefully on both diaphragmatic cruse costo & cardio
phrenic angles. Useful in detection of pleural effusion
10.normal chest anatomy
Upper zone>>>> 1st and 2nd ribs
Middle zone>>>> 3rd and 4th ribs
Lower zone>>>> 5th and 6th ribs
How to asses cardiac size
We take 2 lines the between borders of cardiac shadow and 2 lines
between the inner surface of thoracic cage and the ribs
Cardiothoracic ratio (CTR) =
Cardiac Width : Thoracic Width
A CTR of greater than 1:2 (50%) is considered abnormal.
Cardiac borders in AP view
Mitral valve disease
CXR of adult male , PA view shows: Enlargement of the cardiac shadow (cardiomegaly),
Enlargement of left atrium Double density sign: the right side of the enlarged left atrium
pushes into the adjacent lung and creates an addition contour superimposed over the right
heart.
Mitral valve disease (double density RT cardiac border)
CXR of adult , PA view shows: Cardiomegally Double density sign
of right cardiac border Enlargement of left atrium, permenant left
atrial appendage and relaced mitral valve (prosthesis)
Pericardial effusion Globe shape
CXR of adult, PA view shows:
Globular enlargement of the heart
giving a water bottle configuration (globe heart,
pumpkin shape heart)
boot shape (wooden boot) heart (TOF)
CXR of a child, PA view shows:
"boot shaped" heart with an upturned cardiac apex due to right ventricular
hypertrophy and concave pulmonary arterial segment .
Pulmonary oligaemia due to decreased pulmonary arterial flow.
TGO
19.Egg on side heart y(Transposition f great vessels )
CXR of a child PA view shows:
cardiomegaly with a cardiac contours classically described as
appearing like an "egg on a string "
apparent narrowing of the superior mediastinum as result of the
aortic and pulmonary arterial configuration.
Ebstain anomaly box shape heart
CXR of a child , PA view shows:
Huge cardiomegaly ( box shaped heart)
Dextro cardia
CXR of adult female , PA view shows:
Cardiac shadow is seen on the right side
Diagnosis= dextrocardia
22.Retrophyrengeal
abscess
CT scan (scanogram) ,lateral
view of the neck shows:
Widening of retropharyngeal
space with air fluid level
Orange arrow pharynx pushed
anteriorly
thymus gland in neonate
CXR of a neonate ,PA view shows thymus gland (normal finding not a disease ) with indentations
UL: Thymus Indentation sign. UR: Thymic wave sign, Lower: Thymic Sail sign
normal chest XR of the infant( normal thymus gland) Sail sign
25.retrosternal Goiter
CXR , PA view shows:
Widening of the superior mediastinum by soft tissue mass with deviation of the trachea
to the opposite side
Retrosternal Goiter
Lymphoma of middle mediastinum
CXR of adult male, PA and lateral views show:
Widening of the middle mediastinu
bilateral hilar lymph adenopathy
CXR of adult male, PA view shows: Bilateral hilar and paratracheal
regions are enlarged and Prominent
DDX Infection>>> TB ,sarcoidosis. Metastasis of bronchogenic
carcinoma. Lymphoma.
Bilateral hilar LAP
CXR of adult male, PA view shows:
Hilar lymph nodes are enlarged (bilaterally)
RT upper lobe consolidation (pneumonia)
CXR of adult male, PA view shows:
-photo on the right: homogenus opacity occuies right upper lobe
-photo on the left: Homogenus opacity occupies right upper lobe with translucent
area within the opacity called air bronchogram , the fissure is normal
RT UL consolidation(bulging fissure sign ) klebsiella pneumonia
CXR of adult male, PA view shows:
Bulging fissure sign with homogenus opacity of right upper lobe
No deviation of the trachea
32.RT ML consolidation (pneumonia) ( PA & lat. view )
CXR of adult , PA view on the left and lateral view on the right shows:
Triangular Homogenus opacity in the right lower zone (left photo) while in the right
photo the opacity occupies middle lobe of the lung.
Indistinct right cardiac border
Loss of the medial aspect of right hemidiphram
Fissures are at normal position
No deviation of the trachea
RT ML consolidation (Pneumonai) (Lat. view )
CXR of adult female , lateral view shows:
Homogenus opacity of middle lobe with normal fissures
34.LUL consolidation (pneumonia) (PA & Lat. View )
CXR of adult , PA and lateral views show:
Complete haziness of the left hemithorax
Homogenus opacification of the left upper lobe
Fissure is normal
No deviation of the trachea
35.LT.lower lobe consolidation (pneumonia) ( PA & Lat. view )
CXR of adult , PA and lateral views show:
Homogenus opacity of the left lower zone with normal fissure
Lobular consolidation ( broncho or lobular pneumonia
CXR of adult ,PA and lateral views show:
Patchy consolidation in both lung fields (diffuse) mainly in the
lower zones
Normal heart size
Very important to consider that pulmonary edema in normal sized
heart have close similar appearance to broncho pneumonia
The important Golden Key differentiation is the cardiac size being
enlarged in pulmonary edema .
‫من المحاضرة‬
 Septal lines, also known as Kerley lines, are seen when the
interlobular septa in the pulmonary interstitium become
prominent. This may be because of lymphatic engorgement or
edema of the connective tissues of the interlobular septa. They
usually occur when pulmonary capillary wedge pressures reach 2025 mmHg
 Classification
 Kerley A lines
 These are 2-6 cm long oblique lines that are <1 mm thick and
course towards the hila. They represent thickening of the
interlobular septa
 Kerley B lines
 These are 1-2 cm thin lines in the peripheries of the lung. They are
perpendicular to and extend out to the pleural surface . They
represent thickened sub pleural interlobular septa and are usually
seen at the lung bases.
Interstitial pulmonary edema
CXR of adult , PA view shows:Bilatral patchy opacity involving
mainly lower lung fields with enlargement of cardiac shadow
Pulmonary edema ( alveolar pulmonary edema)
CXR of ault ,PA view shows:
Bilateral patchy opacity mainly in the middle zones of the lungs
(Bat wing sign )
Cardiomegaly
Bat wing sign ( alveolar pulmonary edema)
CXR of adult male, PA view shows:
Bat wing sign, Cardiomegaly
41.RT UL collapse
CXR of adult , PA view shows: Homogenus opacity of right upper lobe
Elevation of the the horizontal fissure.The trachea is slightly devited to the right
Elevation of ipsilateral hemidiahram, Crowding of the ipsilateral ribs.
42.RT UL collapse (collapse consolidation)
CXR of adult female, PA view shows:
Homogenus opacity of right upper lobe (consolidation with air bronchogram)
Elevation of horizontal fissure
Elevation of the right hemidiaphram
Crowding of the ribs on the right side
RU collapse (Golden S sign)
CXR of adult, PA view shows:
Homogenus oppacity in right upper lobe+ hilar mass lead to
bulging of the horizontal fissure with golden S sign
Shifting of the trachea to the right
What is the main difference between 2 films ??? What is the shape of each one ???
A.
B.
44.A.RT middle lobe consolidation
Homogenus opacity of right middle
lobe triangular in shape, the fissures
are normal
B.RT middle lobe collapse
Homogenus opacity of right middle
lobe tongue like with elevation of the
fissure
45.LT lower lobe collapse
CXR of adult male, PA view shows:
Triangular opacity in the posteromedial aspeect of the left lung
Left hilum is depressed
Loss of the normal left hemidiaphram outline
Elevation of the left hemidiaphram
Crowding of the ribs on the left side
Shifting of the mediastinum to the left
45.LT lower lobe collapse
CXR of adult male ,PA and lateral views show:
Homogenus opacity in the left lower lobe triangular in shape
In the lateral view the density of the lower vertebrae is more than the upper vetebrae
(abnormal)
Emphysema
CXR of adult female ,PA view shows:
Flattening of the hemidiaphrams
Widely spaced ribs
Tenting of the diaphram
Abnormal shape of the heart (tubular)
Increased and irregular radiolucency of the lungs
Vascular changes, paucity of blood vessels (absent pulmonary markings in the outer 1l3
of the lung fields
There is an emphysmatous bulla (area devoid of lung markings more than 1 cm) in the
hilar area of the right lung .
48.opasified hemi thorax Total collapse
48.opasified hemi thorax Total
Homogenus opacity of the right hemithorax consolidation
with shifting of the trachea to the same side Homogenus opacity of the left hemithorax
with central trachea
Total collapse
Homogenus opacity of the left hemithorax with shifting of the trachea to the
same side
Homogenus opacity of the right hemithorax
Oblitration of cardiophrenic and costophrenic
angles
Shifting of the trachea to the opposite side
Homogenus opacity of right lower zone with
meniscus sign
Oblitration of right cardiophrenic and
costophrenic angles
Pleural effusion
Pleural effusion
Homogenus opacity of right lower lobe with Oblitration of right
cardiophrenic and costophrenic angles.
Meniscus sign
Encysted pleural effusion
Homogenus opacity in the right lung with obtuse angle and
obliteration of right costophrenic angle, normal cardiophrenic
angle
Note: this x ray has 2 ddx>>> empyema and encysted pleural
effusion
Radiolucent area devoid of lung
markings in the upper left lung
Visible viseral pleural edge as very
thin sharp white line
Radiolucent area devoid of lung
markings in the upper left lung
Visible viseral pleural edge as very
thin sharp white line
Pneumothorax
Radiolucent area devoid of lung
markings in the periphry of the
right lung with visible viseral
pleural edge
The mediastinum is pushed to the
opposite side
Tension pneumothorax
Right pneumothorax
Radiolucent area devoid of lung markings in the
area of the left lung with visible viseral pleural
edge.
Tension Pneumothorax
Radiolucent area devoid of lung markings in the area of the right lung
with visible viseral pleural edge. The mediastinum is pushed to the
opposite side
Hydro pneumothorax
CXR of adult male in errect position ,PA view shows:
Homogenus opacity in the right lower zone with
Horizontal air fluid level .
Bronchiectasis
Many curvilinear opacities in right lung with multiple air fluid levels
Honey comb shadow, Increase in bronchoalveolar markings
Pulmonary vasculature appears ill defined
Post primary TB broncho pneumonia cotton wool sign
Bilateral patchy opacities of the upper lobes of the
lungs, cotton wool sign.
61.post primary TB notice upper
apical Broncho pneumonic
shadow
Bilateral Patchy opacification of
the lungs involving upper zones,
a cavity can be seen in the right
uper lobe( 3rd photo)
bronchopnemonia
Bilateral patchy opacity
mainly involving lower lung
zones
primary TB bronchopnemonia
Bilateral patchy opacity mainly
involving upper lung zones
Both of them have similar appearance of broncho
pneumonic shadow
??????
What is being the pit fall in such films ???
Who can you differentiate ???
Answer the Q in the KEY
After discussion with the students
& get their ideas about each films .
Miliary TB
Bilateral diffuse tiney nodules1-3 mm in diameter
uniform in size and uniformly distributed involve
whole lung fields.
miliary TB
CT scan show cavity with air fluid
level inside it in the upper lobe of
the right lung.
Cavity with air fluid level inside in the uper
lobe of the right lung
TB lung abscess
Aspergilloma
Cavity in the upper lobe of the right lung with Well defined
rounded opacity in side it
Hydatid cyst simple
Well defined rounded opacity in the middle
zone of the right lung, transparent( can see
the ribs through it)
Hydatid cyst rupture ( water Lilly )
The right upper zone show cavity with
wavy air fluid level (water lilly sign)
radioopaque mass with
speculated margine can be seen
in the upper zone right lung
2 Radioopaque lesions can be seen in the
right lung one is hilar(central) and the
other is periphral both of them have
speculated margins( sun ray appearance)
70.Bronchogenic CA
Large radioopaque mass in the left
middle zone with sun ray
apearance and evidence of
invasion to the chest wall
Note: the film is rotated
Hilar radioopaque mass in the left
lung with speculater margin, air
fluid level can also be seen
(pleural effusion).
70.Bronchogenic CA
bronchogenic carcinoma caused lung collapse
CXR of adult ,PA view shows:
Hilar mass +homogenus opacity in the upper right
lobe with elevation of the horizontal fissure
Golden S sign
Shifting of the trachea to the same side
Bronchogenic CA
‫غير مطلوب‬CT
Pancosts tumor
Radioopaque shadoe in the right upper zone
Deviation of the horizontal fissure upward
Deviation of the trachea to the same side
Invasion of the ribs
Note: (lung collapse produce similar picture but there is no rib destruction
Metastisis to Lung (canon ball appearance)
CXR of adult, PA view shows Bilateral rounded radioopaque nodules of
multiple sizes distributed all over both lung fields( Cannon ball appearance)
DDX of coin shadow
coin shadow :Well defined rounded
radioopaque lesion 3-5 cm in diameter
Ddx= -simple hydatid cyst
-bronchogenic carcinoma
-TB -metastasis
Lung abscess
CXR of adult male, PA and lateral views show:
Well defined rounded cavitatory lesion in the middle zone of the
right lung with air fluid level inside
Lung abscess
Well defined rounded lesion in the
upper zone of the right lung with
air fluid level inside
Well defined rounded
lesion in the middle
zone of the right lung
with air fluid level inside
DDX of soap bubble appearance of the hemi thorax
79.Diaphragmatic hernia
congenital cystic adenomatous malformation
Soap bubble appearance in the left hemithorax
Soap bubble appearance in the left hemithorax
with shifting of mediastinum to the right
with air fluid level
Left hemidiaphram cannot be seen
Shifting of mediastinum to opposite side
Presence of nasogasric tube