POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION OPACI OPACITY Homo Heterogenous Wellill defined Zone Centralperiph Silhouet eral sign TY Necrotic PATCHY MEDIASTINAL NODULE Central deviasionwided MASS COSTO-PHRENIC ANGEL Freeoblitern CAVITARY OTHERINFILTIRATION Bone soft tissuediaphragm
Solitary Pulmonary Nodule(SPN) Appearance Margin Calcification cavitation Comparison with a Size previous x-ray to >8mm <8mm Assess growth over time. Location Upperhillar zone Lowerbasesup-pleural Associated abnormalitiesLymph node enlargement Rib destruction/erosion
Nodule Mass Nodule Mass• Well defined opacity it s • Well defined opacity more diameter up to 3cm. than 3cm.• The most common is: • The most common is: – Tuberculoma – Bronchgenic CA – Hamartoma – Hydatid cyst – Bronchogenic CA – metastases – Hydatid cyst – Metastases – AVM
Cavitary lesionAir-fluid level Air only Wall thicknessStraight Wavy Thick Thin site ruptured Irregular inner Regular innerAbscess Hydatid wall wall Peripheral Central cyst Cavitating Chronic Emphesematous pneumatocele neoplasm abscess bulla
Case-1• A 40-year-old man with a history of substance abuse and HIV infection is seen in the ER with complaints of: • fever, • weight loss, • production of foul-smelling sputum, • and shortness of breath for 2 wk.• On physical exam he is : • tachypneic • has clubbing of his digits.• Lung exam reveals: • diffuse rhonchi • and an area of egophony with whispering pectoriloquy in the right chest posteriorly.• ABGs reveal PaO2 of 59 mm Hg on room air.
CASE-1What is the most likelydiagnosis?a. Pneumococcalpneumoniab. PCP pneumoniac. Lung abscessd. Squamous cellcarcinoma
POSITION •PA CXRQUALITY •Good Technical Quality •Round opacitiy with air-fluid level •In right upper zone near hilumLESION •Ill-defined linear opacity surrond it •Central trachea and mediasteinal.MEDIASTINALANGELS •Free costo-phrenic angels.OTHER •No
Case-2• A 60-year-old man with a history of COPD and old TB is seen with• mild hemoptysis and chronic cough.• He is HIV negative and has been ill for about 2 wk.• Vital signs: pulse 110 bpm; temperature 101°F; respirations 24/min; blood pressure 108/70 mm Hg.• No skin lesions are noted.• Laboratory data: Hb 14 g/dL; HCA 42%; WBCs 8.7/μL; BUN 24 mg/dL; creatinine 0.8 mg/dL; sodium 131 mEq/L; potassium 4.3 mEq/L.• ABGs on RA: pH 7.37; PCO2 43 mm Hg; PO2 87 mm Hg.• Sputum tests reveal numerous AFB-positive organisms on smear.• Spirometry shows an obstructive ventilatory impairment with marginal reversibility.
POSITION •PA CXRQUALITY •Poor Technical Quality •Cavitary lesion •In right upper zoneLESION •Central trachea and mediasteinal.MEDIASTINALHilum •Right hilum pulled upwardANGELS •Disappear . •NoOTHER
Case-2• the most likely diagnosis is – a. Lung abscess – b. Non-TB mycobacteria – c. Actinomycosis – d. Aspiration pneumonia
Case-3• A 60-year-old man with a past history of smoking for 30 years (he stopped 3 years ago, prior to cardiac bypass surgery).• is admitted with cough and mild hemoptysis.• He is afebrile with no shortness on breath.• Physical exam is negative except that the lung exam reveals rhonchi in the left upper lung zone.
POSITION •PA CXRQUALITY •Poor Technical Quality •Well defined round density •(mass lesion)LESION •7*11cm. •In left para-hilar area. •Obscured aortic •Right deviated trachea.MEDIASTINALHilumANGELS •Disappear . •NoOTHER
Case-3• The finding/abnormality most likely to occur with the lesion seen on the CXR:• Serum calcium of 13.6 mg/dL.• b. Sputum positive for fungal elements• c. Increased D-dimer levels.• d. Koilonychia.
Case-4• A 38-year-old city worker presents with fever, chills, and cough with left-sided chest pain 2 days after the Mardi Gras festival.• She denies any hemoptysis, weight loss, or chronic illness.• Past history is unremarkable.• On physical exam, she has a BMI of 32; temperature is 101°F.• She was observed to have splinting of her right side during the inspiration.
POSITION •PA CXRQUALITY •Poor Technical Quality •Well defined round density •(mass lesion)LESION •3*2,5 cm. •In right middle zone. •Cardiomegaly .MEDIASTINALHilumANGELS •Hazy . •NoOTHER
Case-4• 1.The most likely diagnosis is:• a. Bronchogenic carcinoma• b. Round pneumonia• c. Alveolar sarcoidosis• d. Fungus ball• 2. Associated findings may include:• a. Hyponatremia• b. Increased ACE levels• c. Hypercalcemia• d. Clubbing
Case-5• A 62-year-old female smoker presents with a history of “pneumonia” 6 wk ago.• She has been on multiple antibiotics, and although she feels relatively better now,• her CXR remains unchanged.