• Prominent main pulmonary artery segment (MPA), which appears to be
• Right pulmonary artery (RPA) is also enlarged.
• Enlargement of right pulmonary artery differentiates it from the post
stenotic dilatation of main pulmonary artery in pulmonary stenosis.
• In post stenotic dilatation, even though the left pulmonary artery which is
in line with the main pulmonary artery may be dilated, the right pulmonary
artery which does not have the effect of the jet and eddy currents, is not
• This X-ray also shows a prominent right atrial contour, indicating right
atrial dilatation as a consequence of pulmonary hypertension and right
• The end on views of blood vessels seen through the right pulmonary
artery shadow are tiny, indicating that the RPA dilatation is unlikely to be
due to increased pulmonary blood flow. Large end on vessels are a
feature of pulmonary hypertension due to excessive left to right shunt
causing increased pulmonary blood flow. In this case, the absence of
them would make one think that the severe pulmonary hypertension is
• The right ventricular systolic pressure and hence the pulmonary artery
systolic pressure estimated by continuous wave Doppler interrogation of
the tricuspid regurgitation jet was over 110 mm Hg.
Criteria of 2ry pneumonia:
1. Consolidation collapse.
2. Consolidation with no air bronchogram.
3. Consolidation with hilar mass.
4. Consolidation confined to one lobe for
more than 2 weeks without resolution or
spread to other lobes.
5. Unresolved pneumonia (for more than 8
weeks after proper antibiotic therapy).
Mediastinal LN enlargement
Convexity of the SVC interface.
Thickening of the right paratracheal strip.
Enlargement of the azygos arch.
Convexity of the left subclavian artery
Convexity of the aorto-pulmonary window.
Subcarinal LN: Convexity of the superior extent of azygo-
Widening of the carina.
Thickening of the posterior tracheal band on
Bronchogenic carcinoma with invasion of the
intrapericardial portion of the left pulmonary
• Direct spread.
• Lymphatic obstruction.
• 2ry pneumonia.
Pleural effusion without mediastinal shift due
to underlying obstructive collapse
Chest wall invasion
Focal chest pain.
Chest wall mass.
Area of contact >
• Parietal tumoral signal intensity on T1 (T2 WIs has no value)
• Parietal enhancement.
• Interruption of the extrapleural fat.
In superior sulcus tumor:
• Invasion of the subclavian vessels.
• Invasion of the brachial plexus.
Direct bone invasion.
• Rib or vertebral body destruction.
• Usually osteolytic metastases.
• Involving the wrist, hand, ankle & foot.
• The involved bone show solid periosteal
LLBB: Lung, liver, bone & brain.