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12.12.12 Chest radiographs

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Normal locations
  • Right diaphragm 1.5 cm higher than left
    • => Double-diaphragm sign on lateral film
  • Left hilum 1.5 cm higher

Anterior mediastinal mass
  • T - Thymoma
  • T - Thyroid
  • T - Teratoma
  • T - Terrible lymphoma

Atelectasis
  • Causes
    • Cancer
    • Mucous plug
    • Trauma
  • Appearance
    • VEIL-LIKE OPACITY
    • Diaphragm raised / tented
    • Hilum drawn up
  • Left upper lobe
    • Colapses anteriorly
    • Mediastinum shifted
    • Left hilum raised
    • Raised and tented left diaphragm, pulled up by pulmonary ligament
    • Luftsichel Sign
      • Lucency outlining the aortic arch on frontal view
      • Indicates Left upper lobe collapse
      • Occurs as a result of the superior segment of the left lower lobe migrating superiorly and abutting the aortic knob due to volume loss of the left upper lobe
  • Right upper lobe
    • Golden S sign
    • Seen in the right lung as a distorted minor fissure, whose lateral aspect is concave inferiorly and whose medial aspect is convex inferiorly
  • Right middle lobe
    • Silhouette sign - Can't distinguish right heart border
  • Right or left lower lobe
    • Sail sign

Interstitial vs Alveolar oedema
  • Quite difficult to distinguish!
  • Alveolar is "cotton-wool" / fluffy
  • Interstitial may be linear, nodular, reticulonodular
  • Causes of interstitial oedema
    • infectious causes, e.g.: non-tuberculous mycobacteria & certain fungal infections 
    • occupational causes, e.g.: asbestos & silica 
    • drug reactions, e.g.: methotrexate & amiodarone 
    • neoplastic causes, e.g.: metastatic cancer, bronchoalveolar cell carcinoma (a form of lung cancer) 
    • radiation pneumonitis 
    • hypersensitivity pneumonitis 
    • rheumatologic diseases
      • systemic lupus erythematosis 
      • rheumatoid arthritis 
      • scleroderma 
      • mixed connective tissue disease 
      • polymyositis 
    • Diseases of unknown cause, e.g.: sarcoidosis, Langerhan's cell granulomatosis (eosinophilic granuloma; histiocytosis X), lymphangioleiomyomatosis 
    • Idiopathic pulmonary fibrosis
  • Causes of alveolar oedema
    • Pneumonitis
    • Pulmonary contusion
    • Pulmonary oedema
    • Aspiration
  • http://www.wikiradiography.com/page/Interstitial+vs+Alveolar+Lung+Patterns

PE signs
  • Westermark’s sign - focal oligemia
  • Palla’s sign - a prominent right descending pulmonary artery

Pneumomediastinum
  • Oesophageal rupture, for example in Boerhaave syndrome
  • Asthma or other conditions leading to alveolar rupture
  • Bowel rupture, where air in the abdominal cavity tracts up into the chest.
  • Mycoplasma pneumoniae pneumonia
  • Obesity

Notes
  • Technically, consolidation refers to any fluid, not just from infection
  • Bullae/blebs bursting => pneumothorax
  • Cavitating lesion - Lucent border, opacity within
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