Abnormal chest radiograph part 1

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Abnormal chest radiograph part 1

  1. 1. Abnormal Chest Radiograph– part 1B WidajaAwesomemedicalnotes.wordpress.com
  2. 2. Describe the abnormality
  3. 3. Collapse Compare with previous films if available (new or long standing?) Lung fields – right lung should be larger than left. If not, suspect area of right sided collapse Diaphragms – right diaphragm should be higher than left. Distortion may suggest left sided collapse Horizonal fissure in right lung – If pulled up, suspect right upper lobe collapse. If pulled down, suspect right lower lobe collapse Trachea – pulled towards area of collapse Heart – deviated towards side of collape Borders (diaphragm, heart or mediastinum) – blurred if lung adjacent to it is collapsed (silhouette sign)
  4. 4. Case 1
  5. 5. Case 1  Right upper lobe collapse ◦ Shadowing in upper zone of right lung (1) ◦ Horizontal fissure is elevated ◦ Tracheal deviation towards the right (2) ◦ Ribs over shadowing are closer together than normal
  6. 6. Case 2
  7. 7. Case 2  Right middle lobe collapse ◦ Right diaphragm may be slightly raised (1) ◦ Horizontal fissure may be slightly lower than usual (2) ◦ Upper part of lower zone may have hazy shadowing (3) ◦ Right heart border may be indistinct
  8. 8. Case 3
  9. 9. Case 3  Right lower lobe collapse ◦ Whiteness immediately above the diaphragm (1) causing loss of its outline ◦ Right heart border maintained
  10. 10. Case 3
  11. 11. Case 3  Left upper lobe collapse ◦ Most left upper lobe lies in front of lower lobe ◦ Collapse of upper lobe causes a haze to appear over the whole left lung field
  12. 12. Case 4
  13. 13. Case 4  Left lower lobe collapse ◦ Left lower lobe collapses behind heart ◦ Heart shadow appears whiter ◦ Double left heart border (sail sign) ◦ Left hemidiaphragm border can’t be followed to spine
  14. 14. Describe the abnormality
  15. 15. Volume loss -pneumonectomy Mediastinum ◦ tracheal deviation towards side of pneumonectomy. ◦ Heart border not visible Contralateral lung field ◦ Hyperinflation of contralateral lung due to mediastinal shift. ◦ Appears darker (unaffected lung over-inflate, causing vessels to become more spread out, hence reduced vascular markings) Diaphragm ◦ Upper border obliterated Ribs ◦ Pneumonectomy usually involve cutting or removing ribs during operation. Look for rib deformity or absence of rib. Usually 5th rib Note extensive hypoplasia or congenital absence of one lung may cause similar appearance
  16. 16. Case 5  Left sided pneumonectomy ◦ Left hemithorax white ◦ Left mediastinal shift ◦ Lft ribs crowded together ◦ Slight curvature of spine ◦ Right lung hyperinflated + crosses over midline
  17. 17. Case 6
  18. 18. Case 6  Right upper lobe lobectomy ◦ Volume loss of right lung ◦ Right tracheal deviation ◦ Remaining right lung hyperinflated, appea rs darker ◦ Right diaphragm – diagphragmatic tenting
  19. 19. Case 7
  20. 20. Case 7  Mass lesion in mediastinum ?enlarged thyroid gland ◦ Tracheal deviation caused by mass ◦ Long volume, ribs and diaphragms are normal

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