The document discusses abnormalities that may appear on a chest x-ray and how to interpret them. It describes findings related to the lung parenchyma including consolidations, interstitial diseases, nodules, cavities, and calcifications. It also covers pleural abnormalities such as effusions, thickening, and plaques. Key signs are explained like air bronchograms, silhouetting, and Kerley lines which provide clues to diagnose conditions like pneumonia.

1. ABNORMAL CHEST XRAY

2. • Lung Parenchyma
• Pleura
• Hilum
• Mediastinum
• Diaphragm
• Chest wall and bones

3. Parenchymal
diseases
Increased
radiographic
density
Predominantly
Airspace
Predominantly
Interstitial tissueDecreased
radiographic
density

4. ALVEOLAR DISEASE VS
INTERSTITIAL DISEASE

6. ALVEOLAR DISEASE

8. CONSOLIDATION
• Alveolar space filled
with inflammatory
exudate
• Interstitium and
architecture remain
intact
• The airway is patent
• Radiologically:This
transcribes to ;
• A density corresponding
to a segment or lobe
• Airbronchogram
• No significant loss of
lung volume

9. • Definition
Visualization of bronchi within parenchymal consolidation.
• Findings
Branching lucencies surrounded by consolidative opacity.
• Differential
non-obstructive atelectasis
pneumonia
pulmonary edema
hemorrhage
bronchoalveolar carcinoma
lymphoma
• Significance
Excludes a pleural or mediastinal lesion
AIR BRONCHOGRAM SIGN

10. AIR BRONCHOGRAM SIGN

11. BULGING FISSURES SIGN
• The bulging fissure
sign refers to
LOBAR CONSOLIDATION
where the affected portion
of the lung is expanded.
• The most common infective
causative agents are
Klebsiella pneumoniae
Streptococcus pneumoniae
Pseudomonas aeruginosa
Staphylococcus aureus

12. SILHOUETTE SIGN
• An intra-thoracic radio-
opacity, if in anatomic
contact with a border of
heart , aorta or
diaphragm , will obscure
that border.
• An intra-thoracic lesion
not anatomically
contiguous with a border
or a normal structure will
not obliterate that border.
Right middle lobe disease

13. SILHOUETTE SIGN

14. APPLICATION

16. ITS NOT JUST IN PNEUMONIA

18. • In a small percentage of normal individual, the right
heart border may not be seen
• A depressed sternum can produce loss of the right heart
border, an appearance which mimics middle lobe
pneumonia .This is because:
(a) the depressed sternum pushes the heart posteriorly
and to the left; and
(b) bunching of the soft tissues of the deformed chest wall
causes an increase in density.
PITFALLS

20. • The absence of a silhouette sign can tell you
where a shadow (consolidation or mass) is
NOT situated.
ITS NOT JUST THE PRESENCE

22. RT. MIDDLE LOBE PNEUMONIA
Indistinct borders, air bronchograms, and silhouetting of the right heart border.

23. COLLAPSE
In collapse air is absorbed
and not replaced in
contrast to consolidation.

24. • The signs of lobar or pulmonary collapse can be divided
into
1) Direct
2) Indirect
COLLAPSE

25. Direct signs are;
• Opacity of the affected lobe(s);
• Crowding of the vessels and bronchi within the collapsed area
• Displacement or bowing of the fissures .
Indirect signs are:
• Compensatory hyperinflation of the normal lung
• Displacement of the mediastinal structures toward the affected side
• Displacement of the ipsilateral hilum which changes shape
• Elevation of the ipsilateral hemidiaphragm
• Crowding of the ribs on the affected side
COLLAPSE

26. LEFT LUNG COLLAPSE

27. Golden S Sign:
• Seen in case of
collapse due to
a hilar mass
• The mass gives
a convexity to
the concave
displaced
fissure
COLLAPSE

28. DIFFERENCES
COLLAPSE
 Volume loss.
 Associated ipsilateral
shift
 Linear, wedge
shaped
 Apex at hilum
 Air bronchograms
are not seen
CONSOLIDATION
 Normal or increased
volume
 No shift, or if present
then contrlateral
 Consolidation, air
space process.
 Not centred at hilum
 Air bronchograms
are seen

29. INTERSTITIAL DISEASE

30. • Non-homogenous
• Various patterns are :
Linear
Septal Lines
Milliary Shadow
Reticulonodular, Nodular
Honeycoomb Shadowing
Cystic
Peribronchial Cuffing
DIFFUSE LUNG DISEASE

31. RETICULAR/LINEAR SHADOWING
• Appears as a fine
irregular network of
linear opacities
surrounding air –filled
lung.

32. RETICULAR/LINEAR SHADOWING
Fine reticular pattern Coarse reticular pattern

33. RETICULONODULAR SHADOWING
• More common than
reticular or nodular
shadowing alone.
• The nodules are less
than 1cm in diameter.
• Ill defined and
irregular in outline.

34. CAUSES OF DIFFUSE BILATERAL
RETICULONODULAR SHADOWING
•Infections – Fungal, viruses, mycoplasma
•Pneumoconiosis – Coal workers pneumoconiosis,
silicosis,asbestosis
•Collagen vascular diseases – SLE, Dermatomyositis,
Scleroderma, rheumatoid lung
•Cardiac – Pulmonary oedema, hemosiderosis ,
•Miscellaneous: Idopathic interstitial fibrosis, extrinsic
allergic alveolitis, drugs, sarcoidosis,
amyloidosis, alveolar proteinosis, lymphangitis
carcinomatosis

35. HONEYCOMB SHADOWING
• Air–containing spaces
with thick walls that are
lined with bronchiolar
epithelium and fibrous
tissue.
• Due to destruction of
alveoli and loss of acinar
architecture
• Associated with
pulmonary fibrosis.
• Usually 5-10 mm in size

36. LINEAR AND BAND SHADOWS
• Normal structures such
as the blood vessels
and fissures form linear
shadows within the
lung fields.
• However, there are
many disease processes
which may result in
linear shadows.
• Linear shadows are
less than 5 mm wide,
• Band shadows are
greater than 5 mm thick
.

37. • Pulmonary infarct
• Sentinel Lines
• Thickened Fissures
• Pulmonary and pleural scars
• Curvilinear shadows(Bullae/Pneumatocoele)
• Plate atelectasis ( Fleischner Lines) etc
CAUSES

38. SENTINEL LINES
• Mucus-filled bronchi
• Coarse lines lying
peripherally in contact
with the pleura and
curving upwards.
• Often left-sided and
associated with left lower
lobe collapse.
• They may develop due to
kinking of bronchi
adjacent to the collapse.

39. KERLEY LINES
Kerley's A lines (arrows) :
• Linear opacities extending from the periphery to the hila
• Due to distention of anastomotic channels between
peripheral and central lymphatics.
Kerley's B lines (white arrowheads) :
• Short horizontal lines situated perpendicularly to the
pleural surface at the lung base
• Due to edema of the interlobular septa.
Kerley's C lines (black arrowheads): Reticular opacities at
the lung base representing superimposed Kerley's B lines.

40. KERLEY LINES
B
A
C

41. • Pulmonary oedema
• Pneumoconiosis
• Infections (viral, mycoplasma)
• Lymphangiectasia
• Mitral valve disease
• Lymphangitis carcinomatosis
• Interstitial pulmonary fibrosis
• Lymphatic obstruction
• Congenital heart disease
• Sarcoidosis
• Alveolar cell carcinoma
• Lymphangiomyomatosis
• Pulmonary venous occlusive disease .
CAUSES OF KERLY LINES

42. MILIARY PATTERN
• Small discrete
opacities
• 2-4 mm in diameter
• MC in Tuberculosis

43. OLD PLEURAL AND PULMONARY
SCARS
• Scars are unchanged in
appearance on serial film.
• Thin linear shadow often
with associated pleural
thickening and tenting of
the diaphragm.
• Apical scarring is a
common finding with
healed tuberculosis,
sarcoidosis and fungal
disease

44. THICKENED BRONCHIAL WALLS
• Parallel TRAMLINE
shadows
• Ring shadows on end-on
view
• They are common finding
in
Bronchiectasis,
Recurrent asthma,
Bronchopulmonary
aspergillosis ,
Pulmonary oedema
Lymphangitis carcinomatosis.

45. • Discrete, well-marginated, rounded opacity
• Less than or equal to 3 cm in diameter
• Completely surrounded by lung parenchyma, does not
touch the hilum or mediastinum,
• Not associated with adenopathy, atelectasis, or pleural
effusion.
• Lesions larger than 4 cms are treated as malignancies
until proven otherwise.
SOLITARY PULMONARY NODULES

46. SOLITARY PULMONARY NODULES
A right lower lobe solitary pulmonary
nodule that was later identified as a
hamartoma.
Right lower lobe nodule later confirmed to
be primary pulmonary lymphoma

47. SOLITARY PULMONARY NODULES
• Intrapulmonary mass forms
an acute angle with the lung
edge.
• Extrapleural and
mediastinal masses form
obtuse angles .
• A nodule is assessed for its
size, shape and outline and
for the presence of
calcification or cavitation. .
Extra
pleural
Mass

48. SOLITARY PULMONARY
NODULES
• Carcinomas often have irregular, spiculated or notched
margins.
• Calcification favours a benign lesion although a
carcinoma may arise coincidentally at the site of an old
calcified focus.
• Calcified metastases are rare, the primary tumour being
usually an osteogenic or chondrosarcoma.
• Granulomas frequently calcify and are usually well
defined and lobulated.

49. SOLITARY PULMONARY NODULES
Hamartoma
Calcified mets in
Chondrosarcoma

50. MULTIPLE PULMONARY NODULES
• Multiple small nodules 2-4
mm are called miliary
shadows .
• Mostly metastases or
tuberculous granulomas.
• Calcified nodules are
generally benign except for
metastases from bone or
cartilaginous tumours.
Posteroanterior view of the chest showing multiplediffuse pulmonary nodules.

51. PULMONARY INFARCTS
• These are variable in
appearance.
• Usually wedge shaped
with base towards the
periphery(HAMPTON’
S HUMP)
• Resolve slowly over
months decreasing in
size (MELTING SIGN)

52. CAVITATING LESIONS AND CYSTS
• It’s a gas filled space surrounded by a complete wall which
is 3 mm or greater in thickness.
• Thinner walled cavities are called CYSTS or ring shadows.
• Requires a patent airway to communicate with necrotic area
• Common cavitating processes are tuberculosis,
staphylococcal infections and carcinoma

53. CAVITATING LESIONS
Bronchogenic Ca
Cavitating Staphylococcal
Pneumonia

54. Common sites of the Lesion
• Tuberculous cavities : Upper zone and apical segments
of the lower lobes.
• Lung abscesses following aspiration : Rightsided and
lower zone(patient position dependant)
• Traumatic lung cysts : Subpleural
• Amoebic abscesses : Right base ,infection extending
from the liver.
• Pulmonary infarcts : Usually in lower lobes
CAVITATING LESION

55. CAVITATING LESION
THICK WALLED
• Acute abscesses
• Most neoplasms (usually
squamous cell)
• Lymphoma
• Most metastases
• Wegener's granulomas
• Rheumatoid nodules
THIN WALLED
• Bulles
• Pneumatoceles,
• Cystic bronchiectasis
• Hydatid cysts
• Traumatic lung cysts
• Chronic inactive
tuberculous cavities
• Neoplasms

56. CAVITATING LESION
B/L Bullae
Thick walled cavity
with air-fluid

57. FLUID LEVELS
• Fluid levels are common
in primary tumors , and
irregular masses of blood
clot or necrotic tumor
may be present.
• Fluid levels are
uncommon in cavitating
metastases and
tuberculous cavities .

58. FLUID LEVELS ON A CHEST RADIOGRAPH
• Abscesses
• Hydropneumothorax-Trauma, surgery,
bronchopleural fistula
• Oesophageal – pharyngeal pouch, diverticula
Obstruction – tumours, achalasia
• Mediastinal – Infections, oesophageal perforation
• Pneumopericardium

59. AIR CRESCENT SIGN
Crescent-shaped radiolucency
within a parenchymal
consolidation or nodular
opacity
Air fills the space between the
devitalized tissue and
surrounding parenchyma
Opaque rim of hemorrhagic
tissue peripheral to the
radiolucency
Common in Aspergilloma

60. WATER LILY SIGN
Ruptured hydatid
cysts with daughter
cysts floating within
the cavity.

61. • Other intracavitory lesions include inspissated pus,blood
clot and cavernoliths.
• Blood clot may form within cavitating neoplasms,
tuberculosis and pulmonary infarcts

62. • Calcification is most easily recognized with low kVp
films.
• In the elderly , calcification of the tracheal and bronchial
cartilage is common.
• Tuberculosis is the commonest calcifying pulmonary
process usually upper zone.
• Chickenpox foci are smaller (1-3 mm), regular in size
and widely distributed.
CALCIFICATION

63. Pulmonary TB Chicken pox pneumonia
CALCIFICATION

64. CALCIFICATION
Punctate - Silicosis Irregular - Pleural Plaques

65. • Pleural caps
• Pleural fluid
• Bullae
• Pancoast tumour
• Pneumothorax
• Infections-tuberculosis
COMMON CAUSES OF APICAL SHADOWS

66. APICAL SHADOWING
Apical pleural thickening/Pleural Cap
• It is crescent shaped density
• It may represent old pleural thickening
• Also seen in Pancoast tumor – assess the ribs for
notching
Lung apex
• Commom site for Tb , fungal infection like
histoplasmosis , coccidioidomycosis, aspergillosis etc

67. APICAL SHADOWING

68. CAUSES OF AN OPAQUE HEMITHORAX
• Technical .
Rotation, scoliosis
• Pleural.
Hydrothorax, large effusion
Thickening, mesothelioma.
• Surgical.
Pneumonectomy,
thoracoplasty.
• Congenital.
Pulmonary agenesis.
• Mediastinal .
Cardiomegaly, Tumours.
• Pulmonary .
Collapse, consolidation,
fibrosis .
• Diaphragmatic hernias

69. • Comparision of lungs should reveal any focal or
generalized abnormality of transradiancy.
• Look for signs of obstructive or compensatory
emphysema such as
o splaying of the ribs
o separation of the vascular markings
o mediastinal displacement
o depression of the hemidiaphragm
UNILATERAL
HYPERTRANSLUCENCY

70. • Most common causes : Patient rotation and scoliosis
• With rotation to the left, the left side becomes more
radiolucent.
• Mastectomy is another important cause. An abnormal
axillary fold is seen following a radical mastectomy.
UNILATERAL
HYPERTRANSLUCENCY

71. UNILATERAL
HYPERTRANSLUCENCY
MastectomyObstructive Emphysema

72. PLEURAL ABNORMALITIES

73. • Pleural effusion.
• Pleural fibrosis/Thickening.
• Pleural plaques.
• Pleural calcification.
• Pleural tumors.
• Pneumothorax
• Fibrothorax
PLEURAL ABNORMALITIES

74. PLEURAL EFFUSION
• Fluid in the pleural
cavity.
• Erect CXR- commonest
appearance is an opaque
meniscus at costophrenic
angle.
• If the effusion is very
large entire hemithorax
may be opaque and heart
may be pushed to the
normal side.

75. Features on CXR:
• Blunting of the costophrenic angle
• Blunting of the cardiophrenic angle
• Fluid within the horizontal or oblique fissures
• A meniscus will be seen, on frontal films seen laterally and
gently sloping medially
• With large volume effusions, mediastinal shift occurs away
from the effusion
Approximately 200 ml of fluid are needed to
detect an effusion in the frontal film vs.
approximately 75ml for the lateral
PLEURAL EFFUSION

76. • LAMELLAR EFFUSION: Shallow collections between
the lung surface and the visceral pleura sometimes
sparing the costophrenic angle.
• LOCULATED EFFUSION: Effusion within the fissures.
ATYPICAL EFFUSION

77. ATYPICAL EFFUSION

78. SUBPULMONIC EFFUSION
• Effusions accumulate between the diaphragm and
undersurface of a lung.
The following features are helpful :
• Right: peak of the hemidiaphragm is shifted laterally
• Left: increased distance between lower lobe air and
gastric air bubble

79. SUBPULMONIC EFFUSION

80. PLEURAL PLAQUES
• Plaques are focal areas of
thickening of parietal pleura due
to previous exposure to asbestosis.
• Characteristically appear as
scattered islands of well
circumscribed pleural densities.
• Most commonly seen posteriorly
and laterally, predominantly
affecting the lower third of the
thorax.
• Do not involve the CP angles .
• May be calcified.

81. PLEURAL CALCIFICATION
True calcification
• Calcified pleural plaques from
asbestos exposure : typically has
sparing of costophernic angles
• Haemothorax
• Infection involving the pleura -
e.g pyothorax / empyema
• Tuberculous pleuritis
• extra skeletal osteosarcomaof
pleura .

82. • Refers to the presence of gas in the pleural space.
• Open Pneumothorax: If air can move in and out of
pleural space during respiration
• Closed Penumothorax: No movement of air occurs
• Valvular : Air enters pleural space on inspiration but
doesnot leave on expiration
• When this collection is constantly enlarging with
resulting compression of mediastinal structures it is
known as a tension pneumothorax.
PNEUMOTHORAX

83. DEEP SULCUS SIGN
• This sign refers to a deep
collection of intrapleural
air (pneumothorax) in the
costophrenic sulcus as
seen on the supine chest
radiograph .
•

84. CXR APPEARANCES
• Visible visceral pleural edge
see as a very thin, sharp white
line
• No lung markings are seen
peripheral to this line
• The peripheral space is
radiolucent compared to
adjacent lung
• The lung may completely
collapse
• No mediastinal shift unless
a tension pneumothorax is
present .

85. HYDROPNEUMOTHORAX
• It is the concurrent
presence of a
pneumothorax as well as
a hydrothorax in the
pleural space.
• On an erect chest
radiograph, classically
seen as an air-fluid level.

86. FIBROTHORAX
• Fibrosis within the pleural space
• Occurs secondary to the inflammatory response
• Seen in
TB
Asbestosis
Hemothorax etc

87. HILAR ABNORMALITIES

88. • Superior margin of left hilum is normally higher than
the right.
• Whenever a left hilum appears lower than right – check
whether there is other evidence suggestive of collapse of
either left lower lobe or of right upper lobe ; or
enlargement of right hilum(eg; tumor or nodes)
HILAR ABNORMALITIES

89. • Bilateral hilar enlargement -Enlarged lymph nodes, or
vascular enlargment.
• Unilateral enlargement : MC due to neoplasm or infections
such as tuberculosis and whooping cough.
• Nodes affected by lymphoma are often asymmetrically
involved.
• Bilateral involvement occurs with sarcoidosis, silicosis and
leukaemia
HILAR ENLARGEMENT

90. HILAR ABNORMALITY

91. MEDIASTINAL
ABNORMALITIES

92. MEDIASTINAL ABNORMALITIES

93. • Used to discern the anterior or posterior location of a lesion in
the superior mediastinum on frontal chest radiographs.
• The anterior mediastinum stops at the level of the superior
clavicle.
• Thus when a mass extends above the superior clavicle, it is
located either in the neck or in the posterior mediastinum.
• When lung tissue comes between the mass and the neck, the
mass is probably in the posterior mediastinum.
CERVICOTHORACIC SIGN

94. CERVICOTHORACIC SIGN
A mass extending above the
level of the clavicle and
there is lung tissue in front
of it, so this must be a mass
in the posterior
mediastinum.

95. ANTERIOR MEDIASTINAL MASS
T cell lymphoma
Anterior mediastinal masses consist of the 4 "T's" (Terrible lymphoma, Thymic tumors,
Teratoma, Thyroid mass) and aortic aneurysm, pericardial cyst, epicardial fat pad.

96. RETROSTERNAL GOITRE
• Retrosternal goitre
The plain chest film
shows a large
superior mediastinal
mass narrowing the
trachea

97. MIDDLE MEDIASTINAL MASS
MC:L
ymphadenopathy
due to metastases
or primary tumor.
 Other causes
include
hiatial hernia,
aortic aneurysm,
thyroid mass,
duplication cyst
bronchogenic cyst.
Esophageal duplication cyst

98. POSTERIOR MEDIASTINAL
MASS
Mass is detected by a pleural margin search along the superomedial part of right lung.
The interface is interrupted.
The differentials
• Neoplasm,
 Lymphadenopathy,
 Aortic aneurysm.
 Neurenteric cyst or
 Lateral meningocele
 Extramedullary
hematopoiesis.

99. • Lymphadenopathy is
the next most frequent
cause of a mediastinal
swelling..
• Lymphadenopathy
may occur in any of the
three compartments
and it is often possible
to diagnose enlarged
lymph nodes from their
lobulated outlines
and the multiple
locations involved.
Superior mediastinal lymph node
enlargement. Note the bilateral
lobular masses.

100. HILUM OVERLAY SIGN
• This sign is used to distinguish between cardiac
enlargement and an anterior mediastinal mass, as
follows;
• Hilum lateral to the lateral border of the “mass”–
Cardiac enlargement.
• Hilum medial to the lateral border of mass”–
Mediastinal mass.

101. HILUM OVERLAY SIGN

102. HILUM CONVERGENCE SIGN
• Used to distinguish between a prominent hilum and
an enlarged pulmonary artery.
• If the pulmonary arteries converge into the lateral
border of a hilar mass, the mass represents an
enlarged pulmonary artery.
• If the convergence appears behind the abnormality or
arises from the heart, a mediastinal mass is more
likely.

103. HILUM CONVERGENCE SIGN

104. THORACOABDOMINAL SIGN
• To localize the LOWER MEDIASTINAL MASS on frontal CXR

105. • It is the presence of extraluminal gas within
the mediastinum.
AETIOLOGY
• Blunt chest trauma
• Secondary to chest, neck, or retroperitoneal surgery
• Esophageal perforation :
– Boerhaave syndrome
– Endoscopic intervention
– Esophageal carcinoma
PNEUMOMEDIASTINUM

106. • Air around the pulmonary artery produces a black ring
appearance.
• Air around the arteries arising from the aortic arch
appears as a black rings and often referred to as the
“ring around the artery sign”.
• Angel wing sign – represents the normal thymus
surrounded by mediastinal air.
PNEUMOMEDIASTINUM- CXR
APPEARANCES.

107. CONTINUOUS DIAPHRAGM SIGN
 Continuous lucency outlining
the base of the heart,
representing
Pneumomediastinum .
• Air in the mediastinum
tracks extrapleurally,
between the heart and
diaphragm .
• Pneumopericardium can
have a similar appearance
but will show air
circumferentially outlining
the heart.

108. DIAPHRAGM

109. CAUSES OF A UNILATERAL ELEVATED DIAPHRAGM
• Above diaphragm: phrenic nerve palsy; infiltration from
bronchial carcinoma or mediastinal tumour.
• Diaphragm: eventration, more common on the left and results
from deficiency or atrophy of muscle.
• Below diaphragm: right diaphragm elevation; liver or
subphrenic abscess, liver secondary deposits.
DIAPHRAGM

110. CAUSES OF BILATERAL ELEVATED DIAPHRAGMS
• Obesity
• Hepatosplenomegaly
• Ascites
• Pregnancy
• Abdominal masses.
DIAPHRAGM

111. DIAPHRAGMATIC HERNIA
• A congenital defect in the
diaphragm, more common
on the left, allows bowel
protrusion into the thoracic
cavity.
Eg: Hiatus Hernia
Bochdalek Hernia
Morgagni Hernia

112. EVENTRATION OF THE DIAPHRAGM
• This is a congenital
condition in which the
diaphragm lacks muscle
and becomes a thin
membranous sheet.
• The eventration may only
involve part of one
hemidiaphragm, resulting
in a smooth 'hump
Localized eventration of the diaphragm.
There is a smooth localized elevation of the
medial half of the right hemidiaphragm
(arrows

113. CHEST WALL ABNORMALITY

114. BONES
CLAVICLE
• Old healed fractures are frequent findings.
• Erosion of the outer ends of the clavicles is associated
with rheumatoid arthritis and hyperparathyroidism.
• Hypoplastic clavicles are seen with the Holt-Oram
syndrome and cleido cranial dysostosis
CHEST WALL ABNORMALITIES

115. Holt Oram Syndrome Rheumatoid arthritis
CLAVICULAR ABNORMALITY

116. • Sternal fractures are often due to a steering wheel
injury.
• Associated with congenital heart disease: Sternal
agenesis, premature obliteration of the ossification
centres and pigeon chest which are found
with ventricular septal defects.
STERNAL ABNORMALITIES

117. • Depressed sternum(Pectus Excavatum) - Atrial septal
defects and Marfan's syndrome.
• Delayed epiphyseal fusion is a feature of cretinism
• Double ossification centres in the manubrium commonly
occur in Down's syndrome
STERNAL ABNORMALITIES

118. RIB NOTCHING
• It may affect the superior or
inferior surface and can be U/L or
B/L
• Superior notching : Rheumatoid
arthritis, SLE,hyperparathyroidism
Marfan's syndrome,
neurofibromatosis and in
paraplegics and polio victims.
• Inferior notching develops as a
result of hypertrophy of the
intercostal vessels or with
neurogenic tumours .

119. CAUSES OF INFERIOR RIB NOTCHING

120. CERVICAL RIB
• A cervical rib in humans
is a supernumerary rib
which arises from the
seventh cervical vertebra.
• Congenital rib anomalies
such as hypoplasia,
bridging and bifid ribs
are common.

121. RIB FRACTURE
• The sixth to ninth ribs line are the
common sites for cough fractures.
• Stress fractures usually affect the
first ribs.
• Pathological fractures may be due
to senile osteoporosis, myeloma,
Cushing's disease and other
endocrine disorders, steroid
therapy and diffuse metastases.
• Cushing's disease is associated
with abundant callus formation

122. • Check for abnormal curvature or alignment , bone and disc
destruction, sclerosis, paravertebral soft-tissue masses and
congenital lesions such as butterfly vertebrae
• Anterior erosion of vertebral bodies sparing the disc spaces is
noted with aneurysm of descending aorta, vascular tumors
and neurofibromatosis.
• A single dense vertebra , the ivory vetebra, - classical
appearance of lymphoma, but also – pagets disease and
metastasis.
THORACIC SPINE

123. THORACIC SPINE

124. • Destruction of pedicle is typical of METASTASIS .
• Destruction of the disc with adjacent bony
involvement is characteristic of an INFECTIVE
PROCESS.
• Disc calcification occurs in ochronosis and ankylosing
spondylitis.
THORACIC SPINE

125. SOFT TISSUE ABNORMALITIES
Skin lesions
• Skin lesions including
naevi and lipomas may
simulate lung tumours.
• Multiple nodules occur
with neurofibromatosis .
• Mastectomy is one of the
commonest causes of a
translucent hemithorax

126. • Poland’s syndrome;
There is a congenital absence of pectoralis major
and minor, associated with syndactyly and rib
abnormalities .
SOFT TISSUE ABNORMALITIES

127. Thank You