This document describes how to identify different types of abnormalities on a chest radiograph, including lung collapse, pneumonectomy, and mediastinal masses. It provides examples of specific abnormalities like right upper lobe collapse, left lower lobe collapse, and left-sided pneumonectomy. For each abnormality, it identifies key radiographic findings such as changes in lung volumes, diaphragm or heart positioning, tracheal deviation, and silhouette signs. The goal is to recognize changes that indicate different pathologies based on comparison to normal anatomy.

1. Abnormal Chest Radiograph
– part 1
B Widaja
Awesomemedicalnotes.wordpress.com

2. Describe the abnormality

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. Case 1

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. Case 2

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. Case 3

9. Case 3
 Right lower lobe
collapse
◦ Whiteness
immediately above
the diaphragm (1)
causing loss of its
outline
◦ Right heart border
maintained

10. Case 3

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. Case 4

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. Describe the abnormality

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. 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. Case 6

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. Case 7

20. Case 7
 Mass lesion in
mediastinum
?enlarged thyroid
gland
◦ Tracheal deviation
caused by mass
◦ Long volume, ribs
and diaphragms are
normal