Practice cases to go with the first CXR lecture, with cases relating to the lung parenchyma

1. Med Home Unit
Chest 1: Respiratory Cases
RAH Radiology

2. Review: Chest Xray interpretation
“In-to-out” approach -
cardiomediastinum -> hilar -> lung fields -> pleura -> bones + soft tissues
Density of the abnormality -
air < fat < fluid/soft tissue < bone < metal
Increased density -
interstitial (lines) vs alveolar (clouds) vs mass lesion
Reduced density -
lung markings vs no lung markings
connective tissue boundary: mediastinum, diaphragm etc.

3. WARM UP CASES

4. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

5. Diagnosis: NGT coiled up in the mid to lower oesophagus.

6. Add in foreign body or gunshot etc

7. INCREASED DENSITY

8. Start with collapse/consolidation
Then do interstitial
Then do masses

9. Diagnosis: Right lower lobe collapse/consolidation

10. Diagnosis: Right middle lobe collapse/consolidation

11. Diagnosis: Right upper lobe collapse (volume loss, hilar elevation)

12. Diagnosis: Left lower lobe collapse (sail sign)

13. Diagnosis: Bilateral pneumonia (air bronchograms)

14. Diagnosis: Interstitial pulmonary oedema

15. Diagnosis: Alveolar (and insterstitial!) pulmonary oedema

16. Diagnosis: Upper lobe diversion (“pre-APO”, “fluid overload”)

17. Diagnosis: Fibrosis. Coarse interstitial opacity

18. Diagnosis: Large right hilar mass lesion with RUL collapse. Highly likely malignant.

19. Diagnosis: Left perihilar lung mass. Suspicious due to size. Malignant pathology.

20. Diagnosis: Left retrocardiac mass, suspicious due to size. Benign pathology.

21. Diagnosis: Cannonball mets. Malignant.

22. Diagnosis: Cavitating lesion with air-fluid level. Abscess vs malignancy.

23. LATERAL XRAYS
What will it look like on the frontal view?

24. Left lower lobe collapse

25. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

26. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

27. Diagnosis: add in lateral cancer

28. Diagnosis: lateral effusion

29. DECREASED DENSITY

30. Diagnosis: Right sided pneumothorax with rib fractures and subcut emphysema

31. Diagnosis: Subtle left apical pneumothorax. No lung markings.

32. Diagnosis: Supine pneumothorax. Lucent right side with “deep sulcus”.

33. Diagnosis: Left sided tension pneumothorax.

34. Diagnosis: COPD. Hyper-expansion, coarsening of markings.

35. Diagnosis: Bullous emphysema. No lung markings right mid zone.

36. Diagnosis: Emphysema. Barrel chest, flattened diaphragm, enlarged clear space.

37. TRICKY CASES