3. Missing Right Breast"Hyperlucent" right base secondaryto missing breast.Silicone Breast Implantation
4. Cancer BreastLarger right breastInverted nippleRadiation Fibrosis ofLungRight lung smallerRight hemithorax smallerParamediastinal fibrosis
5. Cervical Rib
6. Pleural Effusion / Lytic Lesions in Clavicle and Scapula
7. Cervical rib
9. Rib Fracture / Hematoma
10. Extra Pleural SignCancer LungDensity in peripherySharp inner marginIndistinct outer marginAngle of contact with chest wallExpanding destructive rib lesionParatracheal wideningThis is an example of an RUL lesion
12. Sprengels DeformityHigh set scapulaVertebral anomalyRib anomaly
13. Subcutaneous EmphysemaAir outlining pectoral musclesAir along chest wallPneumomediastinum
14. Lateral ChestThere is valuable information that can be obtained by a chestlateral view. A few of them are listed below:SternumVertebral columnRetrosternal spaceLocalization of lung lesionsLobes of lungsOblique fissuresPulmonary arteryHeartAortaMediastinal massesDiaphragmVolume measurementsSPNRadiologic TLCTracheoesophageal stripe
15. Tuberculosis of SpineLoss of intervertebral spaceVertebral collapseCold abscess is not present in this case. PA view is not diagnostic.
17. RML AtelectasisVague density in right lower lung field, almost normalRML atelectasis in lateral view, not evident in PA view
18. Atelectasis Left UpperLobeHazy density over leftupper lung fieldLoss of left heartsilhouetteTracheal shift to leftA: Forward movement of obliquefissureC: Atelectatic LULB: Herniated right lung
19. LocalizationWhen a lesion is not contiguous to asilhouette, it is not possible to localize itwithout a lateral view. This is a case of asolitary pulmonary nodule with popcorncalcification: Hamartoma.
20. Air Bronchogram• In a normal chest x-ray, the tracheobronchial tree is notvisible beyond the 4th order. As the bronchial treebranches, the cartilaginous rings become thinner, andeventually disappear in respiratory bronchioles. Thelumen of the bronchus contains air and the surroundingalveoli contain air. Thus, there is no contrast to visualizethe bronchi.• The air column in the bronchi beyond the 4th orderbecomes recognizable if the surrounding alveoli is filled,providing a contrast or if the bronchi get thickened• The term air bronchogram is used for the former stateand signifies alveolar disease.
21. Silhouette SignAdjacent Lobe/SegmentSilhouetteRLL/Basal segmentsRight diaphragmRML/Medial segmentRight heart marginRUL/Anterior segmentAscending aortaLUL/Posterior segmentAortic knobLingula/Inferior segmentLeft heart marginLLL/Superior and basal segmentsDescending aortaLLL/Basal segmentsLeft diaphragmCardiac margins are clearly seen because there is contrast between the fluiddensity of the heart and the adjacent air filled alveoli. Both being of fluid density,you cannot visualize the partition of the right and left ventricle because there is nocontrast between them. If the adjacent lung is devoid of air, the clarity of thesilhouette will be lost. The silhouette sign is extremely useful in localizing lunglesions.
22. Atelectasis Right LungHomogenous density right hemithoraxMediastinal shift to rightRight hemithorax smallerRight heart and diaphragmatic silhouette are not identifiable
23. Atelectasis Left LungHomogenous density left hemithoraxMediastinal shift to leftLeft hemithorax smallerDiaphragm and heart silhouette are not identifiable
24. LateralMovement of oblique and transversefissuresAtelectasis Right Upper LobeHomogenous density right upper lungfieldMediastinal shift to rightLoss of silhouette of ascending aorta
25. Atelectasis Left UpperLobeHazy density over leftupper lung fieldLoss of left heartsilhouetteTracheal shift to leftLateralA: Forward movement ofoblique fissureB: Herniated right lungC: Atelectatic LUL
26. Consolidation RightUpper Lobe /Density in right upper lungfieldLobar densityLoss of ascending aortasilhouetteNo shift of mediastinumTransverse fissure notsignificantly shiftedAir bronchogram
27. Consolidation Left Lower LobeDensity in left lower lung fieldLeft heart silhouette intactLoss of diaphragmatic silhouetteNo shift of mediastinumPneumatoceleOne diaphragm only visibleLobar densityOblique fissure not significantlyshifted
28. Left Upper Lobe ConsolidationDensity in the left upper lung fieldLoss of silhouette of left heart marginDensity in the projection of LUL in lateral viewAir bronchogram in PA viewNo significant loss of lung volume
29. Vague density right lower lung fieldIndistinct right cardiac silhouetteIntact diaphragmatic silhouetteDensity corresponding to RMLNo loss of lung volumeRML pneumonia
30. S Curve of GoldenWhen there is a massadjacent to a fissure, thefissure takes the shapeof an "S". The proximalconvexity is due to a mass,and the distal concavity isdue to atelectasis. Note theshape of the transversefissure.This example represents aRUL mass with atelectasis
31. Tracheal ShiftTrachea is index of upper mediastinal position. The pleural pressures on eitherside determine the position of the mediastinum. The mediastinum will shifttowards the side with relatively higher negative pressure compared to theopposite side. Tracheal deviation can occur under the following conditions:• Deviated towards diseased side– Atelectasis– Agenesis of lung– Pneumonectomy– Pleural fibrosis• Deviated away from diseased side– Pneumothorax– Pleural effusion– Large mass• Mediastinal masses• Tracheal masses• Kyphoscoliosis
32. Atelectasis Right Lung• Homogenous densityright hemithorax• Mediastinal shift to right• Right hemithorax smaller• Right heart anddiaphragmatic silhouetteare not identifiable•
33. Pleural Effusion Massive• Unilateral homogenousdensity• Mediastinal shift to right• Left diaphragmatic andleft heart silhouettes lost• Left hemithorax larger
34. Pneumonectomy• Opacity lefthemithorax• Tracheal shift to left• Cardiac and leftdiaphragmaticsilhouettes missing• Crowding of ribs
35. Air Bronchogram• In a normal chest x-ray, the tracheobronchial tree is notvisible beyond the 4th order. As the bronchial treebranches, the cartilaginous rings become thinner, andeventually disappear in respiratory bronchioles. Thelumen of the bronchus contains air and the surroundingalveoli contain air. Thus, there is no contrast to visualizethe bronchi.• The air column in the bronchi beyond the 4th orderbecomes recognizable if the surrounding alveoli is filled,providing a contrast or if the bronchi get thickened• The term air bronchogram is used for the former stateand signifies alveolar disease.
36. Bowing Sign• In LUL atelectasis orfollowing resection, as inthis case, the obliquefissure bows forwards(lateral view). Bowingsign refers to this feature.The arrow points to theforward movement of theleft oblique fissure.
37. Doubling Time• Time to double in volume (not diameter)• Useful in determining the etiology of solitarypulmonary nodule• Utility– Less than 30 days: Inflammatory process– Greater than 450 days: Benign tumor– Malignancy falls in between
38. Eccentric Location of Cavity in aMass• Thick wall and irregular lumen can beseen in both malignancy andinflammatory lesions.• However eccentric location of cavity isdiagnostic of malignancy.
39. • This is an example ofsquamous cellcarcinoma lung.• LUL mass• Thick walled cavity• Eccentric location ofcavity• Fluid level• This is diagnostic ofmalignancy.
40. Cortical Distribution• Mirror image of pulmonary edema• Alveolar disease of outer portion of lung• Encountered in:– Eosinophilic pneumonia– Bronchiolitis obliterans with pneumonia
41. Medullary Distribution• It is also called "butterfly pattern"• Note the sparing of lung periphery both inthe CT, PA and lateral views• This is one of the radiologic signsindicative of diffuse alveolar disease• This is an example of alveolar proteinosis.
42. Note the sparing of lung periphery both in the CT, and PA viewThis is one of the radiologic signs indicative of diffuse alveolar diseaseThis is an example of alveolar proteinosis.
43. Diffuse Alveolar DiseaseRadiological Signs• Butterfly distribution / Medullary distribution• Lobar or segmental distribution• Air bronchogram• Alveologram• Confluent shadows• Soft fluffy edges• Acinar nodules• Rapid changes• No significant loss of lung volume• Ground glass appearance on HRCT
46. Acinar NodulesInterstitialAcinarSame sizeSharp edgessmallerVarying in sizeIndistinct edgesLarger than interstitial nodulesAcinar nodules are difficult to distinguish from interstitialnodules. Some distinguishing characteristics are as follows:
47. Cut Off Sign• When you see an abrupt ending of visualizedbronchus, it is called a "cut off sign". It indicatesan intrabronchial lesion. This is useful to identifythe etiology of atelectasis . Be careful as thetracheobronchial tree is three dimensional andthe finding need to be confirmed with tomogram.In the modern era, a CT scan will take care ofthis.
48. Air Fluid LevelCauses• Cavities• Pleural space: Hydropneumothorax• Bowel: Hiatal hernia• Esophagus: Obstruction• Mediastinum: Abscess• Chest wall• Normal stomach• Dilated biliary tract• Sub diaphragmatic abscess
49. Wedge Shaped DensityThe wedges base is pleuraland the apex is towards thehilum, giving a triangularshape. You can encountereither of the following:Vascular wedges :InfarctInvasive aspergillosisBronchial wedges :ConsolidationAtelectasis
50. Polycyclic MarginThe wavy shape ofthe mediastinal massmargin indicates thatit is made up ofmultiple masses,usually lymph nodes.This is a case oflymphoma.
51. Open Bronchus Sign / Alveolar AtelectasisThe right lung is atelectatic. You can see air bronchogram, which indicatesthat the airways are patent .This case is an example of adhesive alveolaratelectasis.
52. Pulmonary Artery OverlaySignThis is the same concept asa silhouette sign. If you canrecognize the interlobarpulmonary artery, it meansthat the mass seen is eitherin front of or behind it.This is an example of adissecting aneurysm.
53. S Curve of GoldenWhen there is a massadjacent to a fissure, thefissure takes the shapeof an "S". The proximalconvexity is due to a mass,and the distal concavity isdue to atelectasis. Note theshape of the transversefissure.This example represents aRUL mass with atelectasis
54. Tracheoesophageal StripeThe posterior wall of the trachea (T)and the anterior wall of the esophagus(E) are in close contact and form thetracheoesophageal stripe in the lateralview (arrow).It is considered abnormal when it iswider than __ mm.Common causes for thickening oftracheoesophageal stripe are:Esophageal diseaseNodal enlargement
55. AV FistulaOsler-Weber-RenduSyndrome"Pulmonary nodule"Multiple lesionsFeeding vesselCardiomegalyPatient presented withsevere congestive heartfailure and severe irondeficiency anemia. Hadmultiple telangiectasia oftongue, lips andconjunctivae.
56. PneumonectomyDiffuse hazinessSmaller right hemithoraxMediastinal shift to rightSurgical clips
57. The definition of atelectasis is loss of air in the alveoli;alveoli devoid of air (not replaced).A diagnosis of atelectasis requires the following:1-A density, representing lung devoid of air2-Signs indicating loss of lung volumeAtelectasis
58. 1-Absorption AtelectasisWhen airways are obstructed there is no furtherventilation to the lungs and beyond. In the earlystages, blood flow continues and gradually theoxygen and nitrogen get absorbed, resulting inatelectasis.Types of Atelectasis:
59. 2-Relaxation AtelectasisThe lung is held close to the chest wall because of thenegative pressure in the pleural space. Once thenegative pressure is lost the lung tends to recoil dueto elastic properties and becomes atelectatic. Thisoccurs in patients with pneumothorax and pleuraleffusion. In this instance, the loss of negativepressure in the pleura permits the lung to relax, dueto elastic recoil. There is common misconception thatatelectasis is due to compression.Types of Atelectasis:
60. 3-Adhesive Atelectasis :Surfactant reduces surface tension and keeps thealveoli open. In conditions where there is loss ofsurfactant, the alveoli collapse and becomeatelectatic. In ARDS this occurs diffusely to bothlungs. In pulmonary embolism due to loss of bloodflow and lack of CO2, the integrity of surfactantgets impaired.Types of Atelectasis:
61. Types of Atelectasis:4-Cicatricial Atelectasis–Alveoli gets trapped in scar andbecomes atelectatic in fibroticdisorders
62. .5-Round AtelectasisAn instance where the lung gets trapped bypleural disease and is devoid of air.Classically encountered in asbestosis.Types of Atelectasis:
63. Generalized1-Shift of mediastinum: The trachea and heart gets shiftedtowards the atelectatic lung.2-Elevation of diaphragm: The diaphragm moves up andthe normal relationship between left and right side getsaltered.3-Drooping of shoulder.4-Crowding of ribs: The interspace between the ribs isnarrower compared to the opposite side.Signs of Loss of Lung Volume:
64. Movement of FissuresYou need a lateral view to appreciate the movement ofoblique fissures. Forward movement of oblique fissure inLUL atelectasis. Backward movement in lower lobeatelectasis.Movement of transverse fissure can be recognized in thePA film.Signs of Loss of Lung Volume:
65. Movement of HilumThe right hilum is normally slightly lower than the left.This relationship will change with lobar atelectasis.Signs of Loss of Lung Volume:
66. Compensatory HyperinflationCompensatory hyperinflation as evidenced by increasedradiolucency and splaying of vessels can be seen with thenormal lobe or opposite lung.Signs of Loss of Lung Volume:
67. Alterations in Proportion of Left andRight LungThe right lung is approximately 55% and left lung 45%. Inatelectasis this apportionment will change and can be aclue to recognition of atelectasis. .Signs of Loss of Lung Volume:
68. Hemithorax AsymmetryIn normals, the right and left hemithorax are equal in size.The size of the hemithorax will be asymmetrical andsmaller on the side of atelectasisSigns of Loss of Lung Volume:
69. Signs of Loss of Lung Volume:GeneralizedShift of mediastinum: The trachea and heart gets shifted towards the atelectatic lung.Elevation of diaphragm: The diaphragm moves up and the normal relationship between leftand right side gets altered.Drooping of shoulder.Crowding of ribs: The interspace between the ribs is narrower compared to the opposite side.Movement of FissuresYou need a lateral view to appreciate the movement of oblique fissures. Forward movement ofoblique fissure in LUL atelectasis. Backward movement in lower lobe atelectasis.Movement of transverse fissure can be recognized in the PA film.Movement of HilumThe right hilum is normally slightly lower than the left. This relationship will change with lobaratelectasis.Compensatory HyperinflationCompensatory hyperinflation as evidenced by increased radiolucency and splaying of vesselscan be seen with the normal lobe or opposite lung.Alterations in Proportion of Left and Right LungThe right lung is approximately 55% and left lung 45%. In atelectasis this apportionment willchange and can be a clue to recognition of atelectasis.Hemithorax AsymmetryIn normals, the right and left hemithorax are equal in size. The size of the hemithorax will beasymmetrical and smaller on the side of atelectasis
70. Atelectasis Right LungHomogenous density right hemithoraxMediastinal shift to rightRight hemithorax smallerRight heart and diaphragmatic silhouette are not identifiable
71. Atelectasis Left LungHomogenous density left hemithoraxMediastinal shift to leftLeft hemithorax smallerDiaphragm and heart silhouette are not identifiable
72. Left Lower Lobe Atelectasis• Inhomogeneous cardiac density• Left hilum pulled down• Non-visualization of left diaphragm• Triangular retrocardiac atelectatic LLL
73. Atelectasis Left Lower LobeDouble density over heartInhomogenous cardiac density Triangular retrocardiac densityLeft hilum pulled downOther findings include:Pneumomediastinum
74. Atelectasis LeftUpper LobeMediastinal shift to leftDensity left upper lung fieldLoss of aortic knob and left hilarsilhouettesHerniation of right lungAtelectatic left upper lobeForward movement of leftoblique fissure "Bowing sign"
75. Atelectasis Left UpperLobeHazy density over leftupper lung fieldLoss of left heartsilhouetteTracheal shift to leftLateralA: Forward movement ofoblique fissureB: Herniated right lungC: Atelectatic LUL
76. LateralMovement of oblique and transversefissuresAtelectasis Right Upper LobeHomogenous density right upper lungfieldMediastinal shift to rightLoss of silhouette of ascending aorta
77. LateralMovement of oblique and transversefissuresAtelectasis Right Upper LobeHomogenous density right upper lung fieldMediastinal shift to rightLoss of silhouette of ascending aorta
78. RML AtelectasisVague density in right lower lung field, almost normalRML atelectasis in lateral view, not evident in PA view
79. Vague density in right lower lung field (almost a normal film).Dramatic RML atelectasis in lateral view, not evident in PA view. Movement oftransverse fissure.Other findings include: Azygous lobe
80. Atelectasis Right Lower LobeDensity in right lower lung fieldIndistinct right diaphragmRight heart silhouette retainedTransverse fissure moved downRight hilum moved down
81. Adhesive AtelectasisAlveoli are kept open by the integrity of surfactant. When there is lossof surfactant, alveoli collapse. ARDS is an example of diffuse alveolaratelectasis.Plate-like atelectasis is an example of focal loss of surfactant.
82. Relaxation AtelectasisThe lung is held in apposition to the chest wall because of negative pressurein the pleura. When the negative pressure is lost, as in pneumothorax orpleural effusion, the lung relaxes to its atelectatic position. The atelectasis isa secondary event. The pleural problem is primary and dictates otherradiological findings.
83. Round AtelectasisMass like densityPleural basedBase of lungsBlunting of costophrenic anglePleural thickeningPulmonary vasculature curvinginto the densityEsophageal surgical clips
84. Round AtelectasisMass like densityPleural basedBase of lungsBlunting of costophrenic angle, pleural thickeningPulmonary vasculature curving into the density
85. RML Lateral Segment Atelectasis
86. Sub-segmental Atelectasis
87. AtelectasisSegmentalAnterior sub-segment of RUL"Bronchial wedge"
88. Hilar Displacement
89. BronchiectasisLeft lung atelectasis due to mucus pluggingMucus plugs suctioned with bronchoscopyBronchogram done after bronchoscopySaccular bronchiectasis in bronchogram below
90. BronchogramBronchograms are rarely done nowadays. The need for itdisappeared with the invention of the fiberopticbronchoscopy and high resolution CT scan. View theseimages to get a greater understanding of a threedimensional view of a bronchial tree..
91. BronchogramBronchograms are rarely done nowadays. The need for it disappeared with theinvention of the fiberoptic bronchoscopy and high resolution CT scan.
96. SilicosisEgg shell calcification of lymph nodesOther findings include:Diaphragmatic pleural calcificationMultiple cavities with fluid levels
97. HistoplasmosisCalcified nodesClumpy calcification Calcified nodules in lungs
98. HamartomaPopcorn calcification
99. Pleural CalcificationVisceral pleuralcalcificationParietal pleura appearsblack because it issandwiched betweenbony densities
100. Pleural CalcificationVisceral pleuraOld TB
101. Visceral pleural calcificationOpen drainage with air fluid levels in pleural space
102. Subcutaneous calcification
103. Cavitary Lung Lesions
104. Number:Multiple bilateral cavities would raisesuspicion for either bronchiogenous orhematogenous process. You should consider:Aspiration lung abscessSeptic emboliMetastatic lesionsVasculitis (Wegeners)Coccidioidomycosis, tuberculosis
105. Location:• Classical locations for aspiration lung abscessare superior segment of the lower lobesposterior segments of upper lobes.• Tuberculous cavities are common in superiorsegments of upper and lower lobes or posteriorsegments of upper lobes.• When a cavity in anterior segment isencountered, a strong suspicion for lung cancershould be raised. TB and aspiration lungabscess are rare in anterior segments. Cancerlung can occur in any segment.
106. Wall Thickness:• Thick walls are seen in:– Lung abscess– Necrotizing squamous cell lung cancer– Wegeners granulomatosis– Blastomycosis
107. Wall Thickness:• Thin walled cavities are seen in:• Coccidioidomycosis• Metastatic cavitating squamous cellcarcinoma from the cervix• M. Kansasii infection• Congenital or acquired bullae• Post-traumatic cysts• Open negative TB
108. Contents:• The most common cause for air fluid level islung abscess. Air fluid levels can rarely beseen in malignancy and in tuberculouscavities from rupture of Rasmussensaneurysm.• A fungous ball should make you consideraspergillosis. A blood clot and fibrin ball willhave the same appearance.• Floating Water Lily: The collapsed membraneof a ruptured echinococcal cyst, floats givingthis appearance.
109. Lining of Wall:The wall lining is irregular and nodular inlung cancer or shaggy in lung abscess
110. Evolution of Lesion:Many times review of old films to assess theevolution of the radiological appearance ofthe lesion extremely helpful. Examples• Infected bullae• Aspergilloma• Sub acute necrotizing aspergillosis• Bleeding from Rasmussens aneurysm in atuberculous cavity
111. Associated Features:Ipsilateral lymph nodes or lyticlesions of the bone is seenwith malignancy
113. BullaDefinition•Thin-walled–less than 1 mm•Air-filled space•In the lung> 1 cm in size and up to 75% of lung•Walls may be formed by pleura, septa,or compressed lung tissue.•Results from destruction, dilatation andconfluence of airspaces distal to terminalbronchioles.
114. •Bullous disease may be primary or associatedwith emphysema or interstitial lung disease.• Primary bullous lung disease may be familialand has been associated with Marfans, EhlersDanlos, IV drug users, HIV infection, andvanishing lung syndrome.•Bullae may occasionally become very largeand compromise respiratory function. Thushas been referred as vanishing lung syndrome,and may be seen in young men.
118. Pneumatocele is a benign air containing cyst of lung, withthin wall < 1mm as bulla but with different mechanism Infection with staph aureus is the commonest cause ( lesscommon causes are, trauma, barotrauma) lead to necrosisand liquefaction followed by air leak and subpleuraldissection forming a thin walled cyst.
119. •Honeycombing is defined as multiple cysts < 1cm in diameter,withwell defined walls, in a background of fibrosis, tend to formclusters and is considered as end stage lung .•It is formed by extensive interstitial fibrosis of lung with residualcystic areas.
120. A cyst is a ringshadow > 1 cm indiameter and up to10 cm with wallthickness from 1-3mm.
121. Thin walled cysts of LAM
122. A cavity is > 1cmin diameter, and itswall thickness ismore than 3 mm.
123. •A central portion necrosis and communicate to bronchus.•The draining bronchus is visible (arrow). CT (2 mm slice thickness)shows discrete air bronchograms in the consolidated area.Mechanism
124. 1. Site
125. A cavity in apicoposterior segment of left upper lobe
144. Radiation PneumoniaPost Mediastinal RadiationAir space disease (air bronchogram)Over radiation port (vertical and paramediastinal)BilateralProgression to fibrosis
145. Round PneumoniaRound densityShorter doubling timeAir bronchogramThe most common causes for round pneumonia are:FungalTuberculosis
146. Consolidation / LingulaDensity in left lower lung fieldLoss of left heart silhouetteDiaphragmatic silhouette intactNo shift of mediastinumBlunting of costophrenic angleLateralLobar densityOblique fissure notsignificantly shiftedAir bronchogram
147. Consolidation Left Lower LobeDensity in left lower lung fieldLeft heart silhouette intactLoss of diaphragmatic silhouetteNo shift of mediastinumPneumatoceleOne diaphragm only visibleLobar densityOblique fissure not significantlyshifted
148. Left Upper Lobe ConsolidationDensity in the left upper lung fieldLoss of silhouette of left heart marginDensity in the projection of LUL in lateral viewAir bronchogram in PA viewNo significant loss of lung volume
149. Vague density right lower lung fieldIndistinct right cardiac silhouetteIntact diaphragmatic silhouetteDensity corresponding to RMLNo loss of lung volumeRML pneumonia
150. Consolidation Right Upper Lobe /Air BronchogramDensity in right upper lung fieldLobar densityLoss of ascending aorta silhouetteNo shift of mediastinumTransverse fissure not significantly shiftedAir bronchogram
151. PneumoperitoneumAir under diaphragm
152. Elevated Diaphragm"Note pneumoperitoneumSupradiaphragmatic massCan be mistaken for elevated diaphragmPellets
153. Alveolar Cell Carcinoma - ProgressionOld film on leftSolitary pulmonary nodule resectedOnset of diaphragmatic paralysisProgression to multicentric acinar nodules
154. Hyperlucent LungFactorsVasculature: DecreaseAir: ExcessTissue : DecreaseBilateral diffuseEmphysemaAsthmaUnilateralSwyer James syndromeAgenesis of pulmonary arteryAbsent breast or pectoral musclePartial airway obstructionCompensatory hyperinflationLocalizedBullaeWestermarks sign : Pulmonary embolus
155. Agenesis of Left Pulmonary ArteryMissing vascular markings in left lungLeft hilum not seenEntire cardiac output to right lung
156. Missing Right Breast"Hyperlucent" right base secondary to missing breast.
163. Achalasia ofesophagus• Inhomogeneouscardiac density:Right half moredense than left• Density crossingmidline (right blackarrow)• Right sided inlet tooutlet shadow• Right para spinal line(left black arrow)• Barium swallowbelow: Dilatedesophagus
164. Aortic Aneurysms• Location– Ascending / Anterior mediastinum– Arch / Middle mediastinum– Descending / Posterior mediastinum• Characteristics– Mediastinal "mass" density– Extrapleural– Calcification of wall• Dissecting– Inward displacement of calcified intima– Wavy margin– Inlet to outlet shadow– Left pleural effusion
165. Dissecting AneurysmMediastinal wideningInlet to outlet shadowon left sideRetrocardiac: Intactsilhouette of left heartmarginPulmonary arteryoverlay sign: Densitybehind left lower lobeWavy margin
166. Pulmonary Metastsis
167. Colon in front of liver
168. Lymph Nodes
169. Thrombotic Pulmonary Embolism
170. Thrombotic Pulmonary Embolism
171. Thrombotic Pulmonary Embolism
172. Embolism Nonthrombotic Pulmonary
173. Embolism Nonthrombotic Pulmonary
174. Embolism Nonthrombotic Pulmonary
175. Embolism Nonthrombotic Pulmonary
176. Embolism Nonthrombotic Pulmonary
177. of PE Diagnostic Algorithm1. Patients with normal chest radiographic findingsare evaluated with a perfusion scan and, ifnecessary, an aerosol ventilation scan. Patientswith normal or very low probability scintigraphicfindings are presumed not to have pulmonaryemboli .2-Patients with a high-probability scan usuallyundergo anticoagulation therapy. All other patientsshould be evaluated with helical CT pulmonaryangiography, conventional pulmonaryangiography, or lower-extremity US, depending onthe clinical situation
178. of PE Diagnostic Algorithm3-Patients with abnormal chest radiographic findings, areunlikely to have definitive scintigraphic findings. Thesepatients undergo helical CT pulmonary angiography as wellas axial CT of the inferior vena cava and the iliac, femoral,and popliteal veins. If the findings at helical CT pulmonaryangiography are equivocal or technically inadequate (5%–10% of cases) or clinical suspicion remains high despitenegative findings, additional imaging is required.4-Patients who have symptoms of deep venous thrombosisbut not of pulmonary embolism initially undergo US, whichis a less expensive alternative. If the findings are negative,imaging is usually discontinued; if they are positive, thepatient is evaluated for pulmonary embolism at thediscretion of the referring physician.
179. Developmental Anomalies
180. Developmental Anomalies
181. Developmental Anomalies
182. Developmental Anomalies
183. Developmental Anomalies
184. Pulmonary A-V Malformations
185. Pulmonary Edema
186. Pulmonary Artery Aneurysms
187. Pulmonary Artery Aneurysms
188. Pulmonary –Systemic Communications
189. Pulmonary –Systemic Communications
190. Pulmonary –Systemic ommunications
191. Abnormal Systemic Arteries
192. Pulmonary Hypertension
193. Pulmonary Hemorrhage
195. Potential Sources of Mediastinal AirIntrathoracicTrachea and major bronchiEsophagusLungPleural spaceExtrathoracicHead and neckIntraperitoneum and retroperitoneum
196. Radiographic Signs of PneumomediastinumSubcutaneous emphysemaThymic sail signPneumoprecardiumRing around the artery signTubular artery signDouble bronchial wall signContinuous diaphragm signExtrapleural signAir in the pulmonary ligament
197. Mediastinal Cysts
198. The CT features of benignmediastinal cyst are(a) a smooth, oval or tubular mass with a well-defined thin wall that usually enhances afterintravascular administration of contrastmaterial,(b) homogeneous attenuation, usually in therange of water attenuation (0–20 HU),(c) no enhancement of cyst contents, and(d) no infiltration of adjacent mediastinalstructures.
199. Cysts that contain serous fluid typically havelong T1 and T2 relaxation values, whichproduce low signal intensity on T1-weightedMR images and high signal intensity on T2-weighted images.
200. Because cysts containing nonserousfluid can have high attenuation at CT,they may be mistaken for solidlesions. MR imaging can be useful inshowing the cystic nature of thesemasses because these cysts continueto have characteristically high signalintensity when imaged with T2-weighted sequences regardless of thenature of the cyst contents
201. Radionuclide imaging can be helpful indetecting functioning thyroid tissue(iodine-123 or I-131) or parathyroidtissue (technetium-99m sestamibi) inthe mediastinal cystic mass . gallium-67 scintigraphy may show increasedradiotracer uptake in the cysticmalignancy owing to necrosis such aslymphoma or metastatic carcinoma.
202. Ultrasonography (US) can be useful inevaluating a mass adjacent to thepleural surface or cardiophrenic angle.At US, the benign cysts typicallyappear as anechoic thin-walledmasses with increased throughtransmission