12.12.12 Chest radiographs

Website

• http://www.radiologyassistant.nl/en

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