X ray images of lung disease

1. X-RAY IMAGES OF LUNG DISEASES
(PNEUMONIA, TUBERCULOSIS, AND
TUMORS).
M.KURTANIDZE

2. THE THORACIC CAGE

3. STERNUM RIBS
• Manubrium true ribs 1-7
false ribs 8-12
• Body
• Xiphoid process floating ribs 11,12

4. RIBS
• true ribs: the first seven pairs of ribs are true ribs as they are attached to the sternum
directly by costal cartilages anteriorly
• false ribs: the 8th to 10th ribs converge anteriorly to each other via costal cartilages
and eventually to the seventh rib, therefore, their connection to the sternum is indirect
• floating ribs: the 11th and 12th ribs have no anterior direct or indirect sternal
attachments and therefore are classified as floating ribs; these ribs are often of

5. BONES ARE THE DENSEST STRUCTURES VISIBLE ON A NORMAL CHEST X-RAY. DESPITE THIS IT IS EASY TO OVERLOOK IMPORTANT
ABNORMALITIES OF THE BONES WHICH MAY BE VERY SUBTLE.
The bones visible on a chest X-ray include the clavicles, the ribs, the scapulae, the spine, and the
proximal humeri (upper arms). The sternum is also included on a frontal view but it overlies other
midline structures and so is obscured.
The bones are used as useful markers of chest radiograph quality. They are used to assess
patient rotation, adequacy of inspiration and X-ray penetration.

7. CLAVICLES / SPINOUS PROCESSES / RIBS
• The spinous processes of the vertebrae (posterior structures) and the medial ends of the
clavicles (anterior structures) are landmarks to assess rotation
• The ribs should be checked on every chest X-ray
• The right 5th rib is highlighted

8. • Clavicle / Scapula / Humerus
• The clavicles, scapulae, and humeri are often clearly seen on a chest X-ray
• Occasionally you will see evidence of important disease such as metastases in these bones

9. CLAVICLE / RIBS
• The clavicle and ribs act as landmarks when assessing the adequacy of inspiration taken by the patient
• The anterior end of approximately 5-7 ribs should be visible above the point at which the mid-clavicular line
intersects the diaphragm
• Less than 5 ribs indicates incomplete inspiration
• More than 7 ribs suggests lung hyper-expansion
• On this normal X-ray the anterior end of the 7th rib intersects the diaphragm at the mid-clavicular line
• The subcostal grooves are visible on the underside of the ribs
• These grooves contain the subcostal nerves and vessels that accompany each rib
• Note: To avoid damaging the subcostal nerves or vessels the superior edge of a rib is used as the landmark
during procedures such as chest drain insertion
• The spine can be seen through the heart indicating adequate X-ray penetration

10. BIFID RIB
• Bifid ribs are usually asymptomatic, and are often discovered incidentally by chest X-ray.
Effects of this neuroskeletal anomaly can
include respiratory difficulties, neurological difficulties, The sternal end of the rib is cleaved into
two. It is usually unilateral.

13. PECTUS EXCAVATUM
• is a congenital deformity of the chest wall that causes several ribs and the breastbone
(sternum) to grow in an inward direction. Usually, the ribs and sternum go outward at the front
of the chest. With pectus excavatum, the sternum goes inward to form a depression in the
chest.

14. FRONTAL RADIOGRAPH SHOWS BILATERAL CERVICAL RIBS (ARROWS), WHICH
ARE AN EXAMPLE OF SUPERNUMERARY RIBS.

15. • Volume-rendered CT image in a trauma patient shows bridging between the 10th and 11th ribs in the
posterior aspect that forms a synostosis (arrow). This finding may be symptomatic.

17. PNEUMONIA
• Pneumonia is a general term in widespread use, defined as infection within the lung. It is due to
material, usually purulent, filling the alveoli.
• The term consolidation is often used as a synonym for pneumonia- It is one of the many patterns of
lung opacification and is equivalent to the pathological diagnosis of pulmonary consolidation..

18. Left lower lobe consolidation

19. Pulmonary consolidation with air
bronchograms

20. • Classification
• Pneumonias can be classified by:
• etiology
• infective agent
• bacterial (pyogenic) pneumonia
• cavitating bacterial pneumonia
• fungal pneumonia
• pneumocystis pneumonia (PCP)
• mycobacterial pneumonia
• viral pneumonia
• coronavirus
• COVID-19

21. • setting of infection
• community-acquired pneumonia
• hospital-acquired pneumonia (HAP)
• ventilator-associated pneumonia (VAP)
• healthcare-acquired pneumonia (HCAP)
• aspiration pneumonia
• lipid: lipoid pneumonia

22. • method of spread (a pathological description)
• bronchopneumonia
• lobar pneumonia
• multilobar pneumonia
• radiographic appearance
• atypical pneumonia
• round pneumonia
• cavitating pneumonia
• hemorrhagic pneumonia

23. ATYPICAL PNEUMONIA
• most commonly associated with atypical bacterial etiologies such as Mycoplasma
pneumoniae, Chlamydophila pneumoniae and Legionella pneumophilia. Viral and fungal pathogens may
also create the radiological and clinical picture of atypical pneumonia.
• Plain radiograph
• Because the inflammation is often limited to the pulmonary interstitium and the interlobular septa,
atypical pneumonia has the radiographic features of patchy reticular or reticulonodular opacities. These
opacities are especially seen in the perihilar lung . Subsegmental and sometimes segmental atelectasis
from small airway obstruction may occur.

24. Chlamydia pneumonia

25. ROUND PNEUMONIA
• Round pneumonia is a type of pneumonia usually only seen in pediatric patients. They are well
defined, rounded opacities that represent regions of infected consolidation.
• Round pneumonias are round-ish and while they are well-circumscribed parenchymal opacities, they
tend to have irregular margins.

27. CAVITATING PNEUMONIA
• Cavitating pneumonia is a complication that can occur with severe necrotizing pneumonia. It is a rare
complication in both children and adults.

29. HEMORRHAGIC PNEUMONIA
• Hemorrhagic pneumonia refers to a descriptive term for pneumonia(infective - inflammatory
consolidation of the lung) that is complicated by pulmonary hemorrhage. It can be localized or diffuse.

31. TUBERCULOSIS (PULMONARY MANIFESTATIONS)
• Pulmonary manifestations of tuberculosis are varied and depend in part whether the infection is
primary or post-primary
• In primary pulmonary tuberculosis, the initial focus of infection can be located anywhere within the
lung and has non-specific appearances ranging from too small to be detectable, to patchy areas of
consolidation or even lobar consolidation
• In most cases, the infection becomes localized and a caseating granuloma forms (tuberculoma)
• Hilar nodal enlargement is seen in only approximately a third of cases

33. Hilar nodal enlargment

34. MILIARY TUBERCULOSIS
• Miliary tuberculosis is an uncommon pulmonary manifestation of tuberculosis. It represents
hematogenous dissemination of uncontrolled tuberculous infection and carries a relatively poor
prognosis.
Plain radiograph
• Miliary deposits appear as 1-3 mm diameter nodules, which are uniform in size and uniformly
distributed.

37. LUNG CANCER
Each subtype has different radiographic appearances, demographics, and prognoses:
• squamous-cell carcinoma of the lung
• adenocarcinoma of the lung
• large cell carcinoma of the lung
• small cell carcinoma of the lung

38. SQUAMOUS-CELL CARCINOMA OF THE LUNG
• The appearance depends on the location of the lesion.
• Lobar collapse may be seen due to obstruction of a bronchus
• When the right upper lobe is collapsed and a hilar mass is present, this is known as the Golden S sign
• A more peripherally located mass may appear as a rounded or spiculated mass
• Cavitation may be seen as an air-fluid level.
• Chest wall invasion is difficult to identify on plain films unless there is destruction of an adjacent rib or
evidence of soft tissue growing into the chest wall.
• Pleural effusion may also be seen, and although it is associated with a poor prognosis,

39. Golden S sign

40. Upper lobe collapse

41. ADENOCARCINOMA OF THE LUNG
• is the most common histologic type of lung cancer
• A lung nodule is a rounded or irregular region of increased attenuation.
• adenocarcinoma are often seen as a ground-glass nodule

43. EMERGENCY CONDITIONS OF RESPIRATORY SYSTEM
Pneumothorax
-refers to the presence of gas (often air) in the pleural space
-visible visceral pleural edge is seen as a very thin, sharp white line
-no lung markings are seen peripheral to this line
-peripheral space is radiolucent compared to the adjacent lung
-lung may completely collapse