Radiology of Mediastinum, Pleural Disease

5. LEFT: A lung mass abuts the mediastinal surface
and creates acute angles with the lung.
RIGHT: A mediastinal mass will sit under the
surface of the mediastinum, creating obtuse
angles with the lung.

6. *Before you want to biopsy an
anterior mediastinal mass, do not
forget that some of these lesions
can be vascular in origin

7. Anterior mediastinal mass Lies adjacent to the heart. It may
efface a heart border or the margin
of the ascending aorta.
Middle mediastinal mass May splay the carina or efface a
normal hilar shadow. It will not
efface heart border nor widen a
paraspinal line.
Posterior mediastinal mass Will diplace either or both of the
paravertebral stripes laterally. It may
also widen the space between the
ribs and destroy a vertebra or rib.

13. Proceed with CT

26. Thymic cysts: these may be simple in nature ▶
they can occur within a normal gland, a
thymoma, or following thymic irradiation for
Hodgkin’s disease

29. Film findings:
• large,
inhomogeneous,
• solid, antero-left
mediastinal mass.
• No calcium.
• No fat.

37. fat
fluid
Soft tissue

40. ** haemorrhage or infection
can lead to a rapid size increase
** it can occasionally rupture
into the mediastinum or lung
(mimicking the
appearance of a malignant
lesion)

73. Lesion (arrows) is visible behind the heart on
radiograph.
Esophageal narrowing (arrows) is caused by
duplication.

76. + Vascular

82. PA chest radiograph demonstrates a
subcarinal abnormality with increased
opacity (*), splaying of the carina, and
abnormal convexity of the upper and
middle thirds of the azygoesophageal
line

83. PA CXR shows a mass obliterating the posterior junction line. Note that the mass
extends above the level of the clavicle and has a well-demarcated outline due to
the interface with adjacent lung

125. • LUNG MALIGNANCY
• SOLITARY PULMONARY NODULE (SPN)
Primary Lung Ca (Bronchogenic)
Lung metastases

147. Staging For NSCLC and SCLC
TNM 8th edition
Size of a solid lesion is defined as maximum diameter in
any of the three orthogonal planes in lung window.
In subsolid lesions T-classification is defined by the
diameter of the solid component and not the diameter of
the complete groundglass lesion.

148. Incidence: 2% of bronchogenic carcinoma
METABOLIC
Cushing syndrome (ACTH)
Inappropriate antidiuresis (SIADH)
Carcinoid syndrome (serotonin, other vasoactive substances)
Hypercalcemia (PTH, bone metastases)
Hypoglycaemia (Insulin-like factor)
MUSCULOSKELETAL
Neuromyopathies
HPOA (Hypertrophic osteoarthropathy)
CNS
Eaton–Lambert syndrome (myasthenialike syndrome)
Subacute cerebellar degeneration
Limbic encephalopathy
OTHERS
Acanthosis nigricans
Thrombophlebitis
Anaemia

153. Pulmonary nodules are frequently encountered incidentally on chest CT.
The role of the radiologist is to separate between benign and possibly malignant lesions, and advise on
follow-up imaging or additional invasive imaging techniques.

170. ATYPICAL PNEUMONIA

195. Opportunistics