POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION HomoDensityinfiltratio Heterogenous Centralperiph Silhouet n Wellill defined Zone eral Necrotic sign MEDIASTINAL Central deviasionwided COSTO-PHRENIC ANGEL Freeoblitern OTHER Bone soft tissuediaphragm
Case-1 A 35-year-oldmale presented with: 1. fever, 2. cough, 3. purulent sputumfor one week.
POSITION •PA CXRQUALITY •GOOD Technical Quality Lower lobe •Homogenous density in the right lowerLESION zone (with bronchogram) obscured hemidiaphragm •Central trachea? and mediasteinal.MEDIASTINAL •free left costo-phrenic angelsANGELS •NOOTHER
Case-2 This 75-year-oldfemale presented with: acute respiratory failure. She had been sick for two weeks with: 1. fever, 2. cough, 3. purulent sputum
POSITION •AP CXRQUALITY •Poor Technical Quality •(HIGH penetration). •Tow homogenous opacification in both lung: •in the left and right (middle,lower ) zoneLESION obscured aortic arc, and left border of heart extend to chest wall,(air bronchodram) •Central trachea and mediasteinalMEDIASTINAL •Free costo-phrenic angelsANGELS •NOOTHER
Case-3• A 30-year-old male presented with cough, shortness of breath• and loss of weight over four months
POSITION •AP? CXRQUALITY •Good Technical Quality •Bilateral infiltrate at lower zoneLESION •(air bronchogram??) •No kerley line. •No upper zone venous diversion •Central trachea and mediasteinalMEDIASTINAL •Free costo-phrenic angelsANGELS •NOOTHER
disscusion• The CXR shows bilateral infiltrates and air bronchograms with a perihilar distribution.• The heart size is normal.• There are no Kerley B lines or evidence of upper lobe venous diversion.• All these are typical features of PCP
Case-4• This middle-aged male had low- grade fever of one month’s duration• associated with productive cough and loss of weight.
POSITION •PA CXRQUALITY •POOR Technical Quality •rotation •Hetero-genous density at right lower zone (bronchogram) obscuredLESION hemidiaphragm •Central trachea and mediasteinalMEDIASTINAL •Free left costo-phrenic angelsANGELS •NOOTHER
Case-5• This patient presented with stridor due to thyroid goiter.• was intubated (Fig. 1).• Repeat CXR was done six hours later (Fig.2).• What is the main radiological abnormality?
POSITION •AP CXRQUALITY •ACCEPT Technical Quality •Bilateral perihilar patchy opaciteisLESION •Diffused but Most in middle zone . •Obscured aortic arc(bronchgram) •Central trachea and mediasteinalMEDIASTINAL •Free left costo-phrenic angelsANGELS •NOOTHER
discussion• The first CXR shows a normal cardiac shadow associated with bilateral perihilar alveolar infiltrates suggestive of acute pulmonary edema.• The development of pulmonary edema with a normal heart size is indicative of an acute event.• The rapid clearance of the pulmonary infiltrates here indicates that the process is rapidly corrected by positive pressure.• In this patient, an important consideration is negative pressure pulmonary edema due to upper airway obstruction from the thyroid Goiter