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Chest x ray pathology
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Chest x ray pathology

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  • 1. Pathology of lung
  • 2. NORMAL CHEST X-RAY
    • L- Lung
    • T- Trachea
    • AK- Aortic Knob
    • A- Ascending Aorta
    • H- Heart
    • R- Ribs
    • P- Pulmonary Artery
    • S- Spleen
  • 3. CONSOLIDATION
    • Lobar or Segmental Density  
    • Air Bronchogram
    • No Loss of Lung Volume
  • 4. CONSOLIDATION
    • Density in left lower lung field
    • Loss of left heart silhouette
    • Diaphragmatic silhouette intact
    • No shift of mediastinum
    • Blunting of costophrenic angle
  • 5. CONSOLIDATION
    • Density in right upper lung field
    • Lobar density
    • Loss of ascending aorta silhouette
    • No shift of mediastinum
    • Transverse fissure not significantly shifted
    • Air bronchogram
  • 6. PLEURAL EFFUSION
    • Fluid accumulates in the pleural space.
    • Radiological criteria are:
    • Increased Density
    • In dependent portion
      • Costophrenic angle in PA view
      • Along sides in lateral decubitus position
      • Along posteriorly in supine position, giving diffuse haziness on the side of effusion
    • Blunting of costophrenic angle 
    • Lack of identifiable diaphragm  (silhouette sign principle).
  • 7. The silhouette sign
    • loss of an interface by adjacent disease and permits localization of a lesion on a film by studying the diaphragm, cardiac and aortic outlines.
    • if the border is retained -the abnormality is superimposed, the lesion must he lying either anterior or posterior.
  • 8. PLEURAL EFFUSION
    • Homogenous density
    • Meniscus maximum in axilla
    • Loss of cardiophrenic angle
    • Loss of diaphragmatic and right cardiac silhouette
  • 9. MASSIVE PLEURAL EFFUSION
    • Massive
    • Shift of mediastinum
  • 10. LOCULATED PLEURAL EFFUSION
    • Homogenous density
    • Loculated
    • Loss of cardiophrenic angle
    • Loss of lateral portion of  diaphragmatic  silhouette
  • 11. ATELECTASIS
    • loss of air in the alveoli; alveoli devoid of air
    • Increased density, Signs indicating loss of lung volume
    • Types of Atelectasis:
      • Resorptive Atelectasis
      • Relaxation Atelectasis
      • Adhesive Atelectasis
      • Cicatricial Atelectasis
      • Round Atelectasis
  • 12. SIGNS OF ATELECTASIS
    • Generalized 
    • Shift of mediastinum
    • Elevation of diaphragm
    • Drooping of shoulder.
    • Crowding of ribs
    • Movement of Fissures
      • movement of oblique fissures.
      • Forward movement - LUL atelectasis.
      • Backward movement - lower lobe atelectasis.
      • Movement of transverse fissure on PA film.
    • Movement of Hilum
  • 13. Cont…
    • Compensatory Hyperinflation
    • Alterations in Proportion of Left and Right Lung
    • Hemithorax Asymmetry 
  • 14. ATELECTASIS RIGHT LUNG
    • Homogenous density right hemithorax
    • Mediastinal shift to right
    • Right hemithorax smaller
    • Right heart and diaphragmatic silhouette are not identifiable
    •  
  • 15. LEFT LOWER LOBE ATELECTASIS
    • Inhomogeneous cardiac density
    • Left hilum pulled down
    • Non-visualization of left diaphragm
    • Triangular retrocardiac atelectatic LLL
  • 16. Rt UL COLLAPSE
  • 17. RT MID LOBE
  • 18. FIBROSIS
    • Diffuse haziness
    • Apical cap thickening
    • Blunting of costophrenic angle
    • No shift of fluid in lateral decubitus
    • Loss of lung volume
    • Lines not corresponding to fissures
  • 19. PLEURAL FIROSIS
    • Small right hemithorax
    • Diffuse haziness
    • Tracheal shift to right
    • Blunted costophrenic angle
    • Lines not corresponding to fissures
  • 20. TUBERCULOSIS
    • LUL cavities
    • RUL infiltrate 
    • Bilateral upper lobe disease
  • 21. TUERCULOSIS
    • LUL cavity
    • Cavity behind clavicle - note increased density of clavicle in the region over lying cavity
    • Pleural effusion on right
  • 22.  
  • 23. Fungal ball
  • 24. MILIARY TUBERCULOSIS
    • Interstitial nodules
      • Uniform size
      • Sharper edges
  • 25. PNEUMOTHORAX
    • Air (black) in pleural space. With No lung markings
    • Recognition of atelectatic lung (lung margin).
    • Shift of mediastinum to the opposite side.
    • Larger hemithorax.
    • Opposite lung - vascular markings prominent.
  • 26. PNEUMOTHORAX
    • No vascular markings on right
    • No shift of mediastinum to left
    • Deep sulcus
    • Atelectatic right lung
    • Increased haziness on left: Diversion of entire cardiac output
    • Small fluid level near costophrenic angle: Hydro pneumothorax
  • 27. TENSION PNEUMOTHORAX
    • No vascular markings on right
    • Shift of mediastinum to left
    • Deep sulcus
    • Atelectatic right lung
    • Increased haziness on left: Diversion of entire cardiac output
  • 28. HYDROPNEUMOTHORAX
    • Air in pleural cavity
    • Lung margin visible
    • Bilateral fluid level: Any time you see a horizontal fluid level, it means that there is air and fluid in the pleural space
  • 29. LUNG CANCER
    • Squamous cell
      • Large mass
        • Cavitation
      • Atelectasis with hilar mass
      • Lympadenopathy
    • Large cell
      • Large mass
    • Adenocarcinoma
      • Solitary pulmonary nodule
  • 30.
    • Small cell
      • Insignificant lung lesion
      • Massive mediastinal adenopathy
    • Alveolar cell
      • Solitary pulmonary nodule
      • Pneumonic
      • Multicentric
    • Pancoast tumor
      • Apical shadow
      • Posterior rib destruction
      • Drooping of shoulder / Brachial plexus
  • 31. ALVEOLAR CELL CARCINOMA
    • Alveolar Cell Carcinoma / Solitary Pulmonary Nodule
    • LUL anterior segment lesion
    • Round with irregular margins
    • Air bronchogram
  • 32. PANCOAST TUMOUR
    • Right apical mass
    • Cavitating mass
    • Para tracheal nodes
    • 2nd rib destruction
    • Calcified nodes (silicosis)
  • 33. LARGE CELL CANCER
    • Large Cell Cancer
    • Mass RUL
  • 34. LUNG MASS
    • Mass
    • Round or oval
    • Sharp margin
    • Homogenous
    • No respect for anatomy
    • Lung Cancer: Large cell
    •  
  • 35. LUNG ABSCESS
    • Lung Abscess
    • Bilateral
    • Multiple
    • Fluid level
  • 36. LUNG ABSCESS
    • Lung Abscess
    • Anterior segment of LUL
    • Atypical location for aspiration lung abscess
    • Thick wall
    • Fluid level
  • 37. PULMOARY EDEMA
    • Pulmonary Edema Acute Diffuse Alveolar
    • Bilateral
    • Diffuse
    • Butterfly pattern
    • Soft fluffy lesions
    • Coalescing
    • Air bronchogram
  • 38. EMPHYSEMA
    • Alpha 1 Anti-Trypsin Deficiency
    • Hyperinflation
    • Hyperlucency
    • Low set flat diaphragm
    • Vertical heart
    • Pre and infra cardiac lungs
    • Barrel shape
    • Emphysema
    • Avascular zones
    • Cephalization of upper lung fields is not evident
    • Predominant basal involvement (not evident)
  • 39.
    • SOME D/D
  • 40. MULTIPLE NODULES OR MASS >3 CM
    • M ets/Carcinoma/Lymphoma
    • T B/granuloma
    • W egeners
    • R heumatoid nodules/Round pneumonia
    • F ungal
    • S arcoid
    • S eptic pulmonary emboli
  • 41.  
  • 42. COIN LESION <3 CM
    • C arcinoma/Congenital
    • H amartoma/Hematoma
    • A VM/Abscess
    • N eoplasm–mets
    • G ranuoma
    • TB pneumonia
  • 43.  
  • 44.  
  • 45. CAVITY
    • C arcinoma-SCC
    • A bscess-fungal/bacterial/TB
    • V ascular-septic emboli
    • I nflammatory-rheumatoid nodule
    • T rauma-resolving contusion
    • Y oung-bronchogenic cyst
  • 46.  
  • 47. UNILATERAL HYPERLUCENT LUNG
    • P oland syndrome/Pneumothorax
    • O ligemia/Obstruction (PE)
    • E mphysema
    • M astectomy
    • S wyer James
  • 48. E mphysema
  • 49. Anterior Mediastinal Masses
    • 1. Thymoma
    • 2. Teratoma
    • 3. Substernal thyroid
    • 4. Lymphoma
  • 50. Opacified Hemithorax
    • 1. Atelectasis
    • 2. Pleural effusion
    • 3. Pneumonia
    • 4. Post-pneumonectomy/ agenesis
  • 51.  
  • 52. Large Cavitary Lung Lesions
    • 1. Abscess
    • 2. Carcinoma
    • 3. TB
  • 53. Bronchogenic Carcinoma
  • 54. Upper Lobe Disease
    • 1. TB (2° TB)
    • 2. Silicosis
    • 3. Eosinophilic granuloma
  • 55.
    • Micronodular Lung Disease
    • 1. Mets
    • 2. Sarcoid
    • 3. Pneumoconiosis
    • 4. Miliary TB
  • 56. Micronodular Lung Disease- Sarcoid
  • 57.
    • Small Cavitary Lung Lesions
    • 1. Septic emboli
    • 2. Rheumatoid nodules
    • 3. Squamous or transitional cell mets
    • 4. Wegener’s Granulomatosis
  • 58.  
  • 59.
    • Multiple Lung Nodules
    • 1. Mets
    • 2. Wegener’s granulomatosis
    • 3. Rheumatoid nodules
    • 4. AVMs
    • 5. Septic emboli
  • 60.  
  • 61.
    • Pulmonary Interstitial Edema
    • 1. CHF
    • 2. Lymphangitic spread
    • 3. Allergic reaction
  • 62. CHF
  • 63.
    • Unilateral Hyperlucent Lung
    • 1. Mcleod’s syndrome
    • 2. Pulmonary embolism
    • 3. Pneumothorax
    • 4. Obstructive/ compensatory emphysema
  • 64. p/o FB
  • 65.
    • Cavitating Pneumonia
    • 1. Staph
    • 2. Strep
    • 3. TB
    • 4. Gram negative (Klebsiella)
  • 66. Staph
  • 67.
    • Middle Mediastinal Masses
    • 1. Lymphadenopathy
    • 2. Aneurysms
    • 3. Esophageal duplication
    • 4. Bronchogenic cysts
  • 68. Bronchogenic cysts
  • 69.
    • Hilar Adenopathy
    • 1. Sarcoid
    • 2. TB
    • 3. Lymphoma
    • 4. Bronchogenic ca
    • 5. Mets
  • 70. Sarcoid
  • 71.
    • Cavities Containing Masses
    • 1. Aspergillosis
    • 2. Cavitating bronchogenic ca
    • 3 Tuberculosis
    • 4 Hydatid cyst
  • 72. Aspergillosis
  • 73.
    • Solitary Pulmonary Nodule
    • 1. Bronchogenic ca
    • 2. Hamartoma
    • 3. Histoplasmoma
    • 4. TB granuloma
    • 5. Bronchial adenoma
    • 6. Solitary met
    • 7. Round pneumonia
    • 8. Rounded atelectasis
  • 74. Hamartoma
  • 75. Pleural Effusion 1. CHF 2. Mets 3. Pancreatitis 4. Pulmonary embolism 5. Trauma 6. Empyema 7. Collagen vascular 8. Ovarian tumor (Meig’s Syndrome) 9. Chylothorax
  • 76. CCF
  • 77.
    • Left-sided Pleural Effusion
    • 1. Dissecting aortic aneurysm
    • 2. Pancreatitis
    • 3. Distal thoracic duct rupture
    • 4. Esophageal pathology
  • 78. Dissecting aortic aneurysm
  • 79.
    • Posterior Mediastinal Masses
    • 1. Neurogenic tumors
    • 2. Lymphadenopathy
    • 3. Extramedullary hematopoesis
    • 4. SPINAL PATHOLOGY
    • 5. DIAPHRAGMATIC HERNIA
  • 80.  
  • 81.
    • Lung Disease & Rib Destruction
    • 1. Bronchogenic ca, i.e Pancoast tumor
    • 2. Actinomycosis
    • 3. Blastomycosis
    • 4. Multiple myeloma
  • 82.  
  • 83.
    • Unilateral Pulmonary Edema
    • 1. Aspiration
    • 2. Disease in other lung, e.g. COPD
    • 3. Postural
    • 4. Rapid expansion of PTX
  • 84. Unilateral Pulmonary Edema
  • 85.
    • Reverse “Pulmonary Edema”
    • 1. Eosinophilic lung disease, e.g. Loeffler’s
    • 2. Sarcoid
    • 3. Pulmonary contusions
  • 86.
    • DIAGNOSIS PLEASE
  • 87.  
  • 88.
    • RT ML CONSOLIDATION
  • 89.  
  • 90.
    • CANNON BALL METZ
  • 91.  
  • 92.
    • ABSCESS
  • 93.  
  • 94.
    • LT UL CONSLIDATION
  • 95.  
  • 96.
    • BRONCHIECTASIS
  • 97.  
  • 98.
    • OS METZ
  • 99.
    • Thank you