The document summarizes the anatomy and radiographic investigation of the thorax. It describes the structures that make up the thoracic wall and cavities. It then discusses various imaging modalities used to examine the thorax, including plain radiography, CT, MRI, PET, and others. It provides details on technical factors and positioning for chest x-rays and interpreting chest x-ray findings based on relative tissue densities.

1. Dr. SAILENDRA KUMAR PRUSTY
VSSIMSAR, BURLA

2. Introduction-
The musculoskeletal wall of the thorax is flexible and consists
of segmentally arranged vertebrae, ribs, muscles, and the
sternum.
The thoracic cavity enclosed by the thoracic wall and the
diaphragm, is subdivided into three major compartments:
• a left and a right pleural cavity, each surrounding a lung;
•mediastinum.

3.  A horizontal plane passing
through the sternal angle and
the intervertebral disc between
vertebrae TIV and TV separates
the mediastinum into superior
and inferior parts .
 The inferior part is further
subdivided by the pericardium,
which encloses the pericardial
cavity surrounding the heart.
The mediastinum is a thick midline partition that extends from the
sternum anteriorly to the thoracic vertebrae posteriorly, and from the
superior thoracic aperture to the inferior thoracic aperture.

6. BRONCHOPULMONARY SEGMENTS

7. Secondary pulmonary lobule
•smalllest discrete unit of lung tissue, polyhedral in shape, surrounded
by connective tissue septa (the interlobular septa)
•Each lobule contains up to a
dozen acini and 30-50 primary
pulmonary lobules.
•Within the secondary lobule,
separating adjacent acini is a much
less pronounced network of
supporting connective tissue which
forms the intralobular septa.

8. Methods of Investigation-
 Plain films:
a)PA, lateral
b)AP, decubitus,supine,oblique
c)Inspiratory-expiratory
d)Lordotic, apical, penetrated
e)Portable/mobile radiographs
 Digital radiography
 Fluoroscopy
 CT scanning
Conventional
Contrast
HRCT
 V/Q (ventilation/perfusion) scan
 Needle biopsy
 Ultrasound
 Bronchography
 Pulmonary angiography
 Bronchial arteriography
 Lymphangiography
 MRI
 PET

9. The plain chest film i s the most frequently requested radiological examination.
Visualisation of the lungs is excellent because of the inherent contrast of the tissues of the
thorax.
Digital radiography is a form of X-ray imaging, where digital X-ray sensors are used
instead of traditional photographic film
Instead of X-ray film, digital radiography uses a digital image capture device.
•immediate image preview and availability
•elimination of costly film processing steps
•ability to apply special image processing techniques that enhance overall display quality of
the image.
Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of
the interior of an object.
CT scanning i s far superior for staging malignancy, detecting pulmonary metastases, and
assessing chest wall and pleural lesions, the lung mass, the hilum and mediastinum.
HRCT scanning is of proven value in the diagnosis of diffuse lung disease, particularly in the
early stages when the chest radiograph is normal, and for follow-up.

10. Transthoracic needle biopsy (TNB) is a safe rapid method used to achieve definitive
diagnosis for most thoracic lesions, whether the lesion is located in the pleura, the lung
parenchyma, or the mediastinum. Malignant lesions are differentiated from benign
lesions by using TNB .
When a bronchogenic neoplasm is suspected, biopsy of the lesion is often needed to
determine the cell type before the course of treatment is planned.
Ultrasound is of use for investigating chest wall and pleural lesions adjacent to the
chest wall. It is used for the localisation of pleural fluid.
Pulmonary angiography remains the gold standard
for the diagnosis of pulmonary embolism.
It may also be used to help diagnose:
•AV malformations of the lung
•Congenital narrowing of the pulmonary vessels
•Pulmonary artery aneurysms
•Pulmonary hypertension
Selective left pulmonary angiogram shows abrupt
tapering of the segmental pulmonary arteries (arrow).

11. Bronchial arteriography is radiography of bronchial arteries by
selective injection of the intercostal arteries from which they arise.
Bronchial artery embolization (BAE) is one of the treatment options for
hemoptysis.
Bronchography is a radiographic (x-ray) examination of the interior
passage ways of the lower respiratory tract after coating the airways
with contrast.
Bronchography is rarely performed, as it has been made obsolete with
improvements in computed tomography and bronchoscopy.
Lymphangiography is used to visualize the lymph vessels.Chylous
reflux with the formation of a chylothorax may be demonstrated by this
procedure.

12. Magnetic resonance imaging (MRI) is an important tool in
assessment of diseases of the heart, mediastinum, pleura, and chest
wall.
Strengths of MRI include excellent tissue contrast, multiplanar
imaging capability, sensitivity to blood flow, and lack of ionizing
radiation.
MRI of the lung is less well established
Positron Emision Tomography
•PET is now the most accurate imaging technique for the staging of
primary lung tumors
•Intravenously administered deoxyglucose labelled with fluorine-18
(FDG) accumulates in metabolically active cells as FDG-6-phosphate.
•FDG uptake correlates with the level of glycolylic activity in the cell,
and this is itself an indicator of the rate of cell growth and the degree
of malignancy of tumours.

13. V/Q (ventilation/perfusion) scan is a scintigraphic examination of the lung
that evaluates pulmonary vasculature perfusion and segmental bronchoalveolar tree
ventilation.
Indications
•suspected pulmonary embolism(PE)
•monitor pulmonary function following lung transplant
•provide preoperative estimates of lung function in lung cancer patients, where
pneumonectomy is planned
In the ventilation phase of the test, a gaseous
radionuclide such
as xenon or technetium DTPA in an aerosol
form is inhaled by the patient through a
mouthpiece or mask that covers the nose and
mouth.
The perfusion phase of the test involves the
intravenous injection of radioactive technetium
macro aggregated albumin(Tc99m-MAA).
A gamma camera acquires the images for both
phases of the study.

14. Scheme for viewing the PA film
1. Request form - Name, age, date, sex,Clinical information
2. Technical - Adequate inspiration
Centring, patient position/rotation
Side markers
Exposure/adequate penetration
3. Trachea - Position, outline
4. Heart and mediastinum - Size, shape, displacement
5. Diaphragms - outline, shape, Relative position
6. Pleural spaces - Position of horizontal fissure
Costophrenic, cardiophrenic angles

15. 7. Lungs - Local, generalised abnormality
Comparison of the translucency and
vascular markings of the lungs
8. Hidden areas -Apices, posterior sulcus, mediastinum, hila, bones
9. Hila -Density, position, shape
1 0. Below diaphragms- Gas shadows, calcification
11. Soft tissues - Mastectomy, gas, densities, etc.
1 2. Bones- Destructive lesions, etc

17. X-rays are a form of electromagnetic radiation
with wavelengths shorter than visible light.
Unlike visible light, radiation passes through stuff.
When you shine a beam of X-Ray at a person
and put a film on the other side , a shadow is
produced of the inside of their body.
Different tissues in our body absorb X-rays
at different extents.

18. Relative Densities
The images seen on a chest radiograph result from the
differences in densities of the materials in the body.
The hierarchy of relative densities from least dense (dark on the
radiograph) to most dense (light on the radiograph) include:
 Gas (air in the lungs)
 Fat (fat layer in soft tissue)
 Water (same density as heart and blood vessels)
 Bone (the most dense of the tissues)
 Metal (foreign bodies)

20. Three Main Factors Determine the
Technical Quality of the Radiograph
 Inspiration
 Penetration
 Rotation

21. Inspiration
The chest radiograph should be obtained with the patient in
full inspiration to help assess intrapulmonary abnormalities.
At full inspiration, the diaphragm should be observed at about
the level of the
8th to 10th rib posteriorly, or
5th to 6th rib anteriorly.

23. Penetration
On a properly exposed chest radiograph:
 The lower thoracic vertebrae should be visible through the
heart
 The bronchovascular structures behind the heart (trachea,
aortic arch, pulmonary arteries, etc.) should be seen

24. Underexposure
cardiac shadow is opaque,
with little or no visibility of
the thoracic vertebrae.
The lungs may appear much
denser and whiter, much as
they might appear with
infiltrates present.

25. Overexposure
heart becomes more
radiolucent
lungs become proportionately
darker.
the air-filled lung periphery
becomes extremely radiolucent,
and often gives the appearance
of lacking lung tissue, as would
be seen in a condition such as
emphysema.

26. Rotation
Assessed by observing the clavicular heads and determining
whether they are equal distance from the spinous processes of the
thoracic vertebral bodies.

27. Four major positions are utilized for
producing a chest radiograph:
 Posterior-anterior (PA)
 Lateral
 Anterior-posterior (AP)
 Lateral Decubitus

28. Posterioranterior (PA) Position
 The standard position for obtaining a routine adult chest
radiograph
 Patient stands upright with the anterior chest placed against
the front of the film
 The shoulders are rotated forward enough to touch the film,
ensuring that the scapulae do not obscure a portion of the
lung fields
 Usually taken with the patient in full inspiration
 The PA film is viewed as if the patient is standing in front of
you with his/her right side on your left

30. Lateral Position
 Patient stands upright with the left side of the chest against
the film and the arms raised over the head
 Allows the viewer to see behind the heart and diaphragmatic
dome
 Is typically used in conjunction with a PA view of the same
chest to help determine the three-dimensional position of
organs or abnormal densities

31. SPINE SIGN

32. Anteriorposterior (AP) Position
 Used when the patient is debilitated, immobilized, or unable
to cooperate with the PA procedure
 The film is placed behind the patient’s back with the patient
in a supine position
 Because the heart is at a greater distance from the film, it will
appear more magnified than in a PA
 The scapulae are usually visible in the lung fields because
they are not rotated out of the view as they are in a PA

34. Lateral Decubitus Position
 The patient lies on either the
right or left side
 The radiograph is labeled
according to the side that is
placed down
 Often useful in revealing a
pleural effusion that cannot be
easily observed in an upright
view

35. •The AP lordotic chest radiograph demonstrates areas of the
lung apices that appear obscured on the PA/AP chest views.
•used to evaluate suspicious areas within the lung apices
LORDOTIC VIEW

36. Anatomical Structures in the Chest
 Mediastinum
 Hilum
 Lung Fields
 Diaphragmatic Domes
 Pleural Surfaces
 Bones
 Soft Tissue

38. Mediastinum
 The trachea should be centrally located or slightly to the right
 The aortic arch is the first convexity on the left side of the
mediastinum
 The pulmonary artery is the next convexity on the left, and
the branches should be traceable as it fans out through the
lungs
 The lateral margin of the superior vena cava lies above the
right heart border

39. The Heart
 Two-thirds of the heart should lie on the left side of the chest,
with one-third on the right
 The heart should take up less that half of the thoracic cavity
(C/T ratio < 50%)
 The left atrium and the left ventricle create the left heart
border
 The right heart border is created entirely by the right atrium
(the right ventricle lies anteriorly and, therefore, does not
have a border on the PA)

40. The cardiac diameter should be the maximum cardiac diameter(r+l).
The transeverse thoracic diameter is measured as the maximum internal
diameter of the thorax.

42. Hilum
 The hila consist primarily of the major
bronchi and the pulmonary veins and
arteries
 Only the pulmonary arteries &
upper lobe veins contribute
significantly to the hilar shadows
 Left pulmonary artery lies above the
left main bronchus, where as on right
side artery is anterior to bronchus
resulting in right hilum being the
lower
 Both hila should be of similar size and
density

43. Lungs
 Normally, there are visible markings throughout the lungs
due to the pulmonary arteries and veins, continuing all the
way to the chest wall
 Both lungs should be scanned, starting at the apices and
working downward, comparing the left and right lung fields
at the same level (as is done with ascultation)

45. Lungs
 On a PA radiograph, the horizontal fissure can often be seen
as a faint horizontal line dividing the RML from the RUL.
 The oblique fissures are not usually seen on a PA view because
they are being viewed obliquely.
 All fissures are clearly seen on the lateral film.
 The horizontal fissure runs anteriorly and often slightly
downward.
 Both oblique fissures commence posteriorly at the level of T4
or T5, passing through the hilum. The left is steeper and
finishes 5 cm behind the anterior costophrcnic angle. whereas
the right ends just behind the angle.

52. Diaphragm
 The left dome is normally
slightly lower than the right due
to the heart depressing the left
side.
 The costophrenic recesses are
formed by the hemidiaphragms
and the chest wall.
 Margins should be sharp

53. Pleura
 The pleura and pleural spaces will only be visible when there is an
abnormality present
 Common abnormalities seen with the pleura include pleural
thickening, or fluid or air in the pleural space.

54. Soft Tissue
Thick soft tissue may obscure underlying structures:
 Thick soft tissue due to obesity may obscure some underlying
structures such as lung markings
 Breast tissue may obscure the costophrenic angles
Lucencies within soft tissue may represent gas (as observed
with subcutaneous air)

55. Bones
The bones visible in the chest radiograph include:
 Ribs
 Clavicles
 Scapulae
 Vertebrae
 Proximal humeri
The bones are useful as markers to assess patient rotation,
adequacy of inspiration, and x-ray penetration.

56. Describing Abnormal Findings on a
Chest Radiograph
 When addressing an abnormal finding on a chest radiograph,
only a description of what is seen, rather than a diagnosis,
should be presented (a chest radiograph alone is NOT
diagnostic, but is only one piece of descriptive information
used to formulate a diagnosis)
 Descriptive words such as shadows, density, or patchiness,
should be used to discuss the findings

57. Common Abnormal Findings

58. Silhouette Sign
 The loss of the lung/soft tissue interface due to the presence
of mass or fluid in the normally air-filled lung
 If an intrathoracic opacity is in anatomic contact with a
border, then the opacity will obscure that border.
 Commonly seen with the borders of the heart, aorta, chest
wall, and diaphragm.

59. Lobe Silhouetted structure
Right middle lobe Right heart border
Left lingula Left heart border
Right lower lobe Right hemidiaphragm
Left lower lobe Left hemidiaphragm
Post apical segment left upper lobe Aortic knob
Ant segment right upper lobe Ascending aorta
Silhouette Sign

60. The right heart border is silhouetted out.

61. Air Bronchogram
A tubular outline of an airway made visible due to the filling of the
surrounding alveoli by fluid or inflammatory exudates.
It is an important sign showing that an opacity is intrapulmonary.
Conditions in which air bronchograms are seen:
 Normal expiration
 Lung consolidation
 Pulmonary edema
 Hyaline membrane disease
 Lymphoma
 Alveolar cell carcinoma
 ARDS

62. Hyaline membrane disease.
Extensive homogeneous consolidation with a
prominent air bronchogram

63. This patient has bilateral lower lobe pulmonary edema. The alveoli are
filled with fluid making the bronchi visible as an air bronchogram.

64. Consolidation is the result of replacement of air in the alveoli by
transudate, pus, blood, cells or other substances.
Pneumonia is by far the most common cause of consolidation.
The disease usually starts within the alveoli and spreads from one
alveolus to another.
When it reaches a fissure the spread stops there.
The key-findings on the X-ray are:
•ill-defined homogeneous opacity obscuring vessels
•Silhouette sign: loss of lung/soft tissue interface
•Air-bronchogram
•Extention to the pleura or fissure, but not crossing it
•No volume loss
Consolidation

65. •Density in right upper lung
field
•Lobar density
•Loss of ascending aorta
silhouette
•No shift of mediastinum
•Transverse fissure not
significantly shifted
•Air bronchogram
Consolidation Right Upper Lobe

66. Atelectasis
 Almost always associated with a linear increased density due to
volume loss
 Direct signs
(i)opacity of the affected lobe(s)
(ii)crowding of the vessels and bronchi within the collapsed area &
(iii) displacement or bowing of the fissures
 Indirect signs
(i)compensatory hyperinflation of the normal lung or lobes
(ii) displacement of the mediastinal structures toward the affected side
(iii) displacement of the ipsilateral hilum
(iv) elevation of the ipsilateral hemidiaphragm: and
(v) crowding of the ribs on the affected side, particularly common in
children.

67. Atelectasis Left Lung
•Homogenous density
left hemithorax
•Mediastinal shift to left
•Left hemithorax smaller
•Diaphragm and heart
silhouette are not
identifiable

68. Atelectasis Right
Upper Lobe
•Density in the right
upper lung field
•Transverse fissure
pulled up
•Right hilum pulled up
•Smaller right lung
•Smaller right
hemithorax

69. Right hilar mass (orange)
obstructing the right upper
lobe bronchus results in
collapse of the right upper
lobe (green arrow). This
results in a reverse S shape to
the pleural edge.
RUL collapse
Golden S sign

70. RLL collapse
when a calcified granuloma is present in a lung and a significant parenchymal collapse
shifts it from one place to other.
Shifting granuloma sign

72. The Luftsichel sign
refers to the frontal chest
radiographic appearance due to
hyperinflation of the superior
segment of the left lower lobe
interposing itself between the
mediastinum and the collapsed
left upper lobe.
LUL collapse

73. Atelectasis Left
Lower Lobe
•Loss of left
diaphragmatic
silhouette
•Blunting of
costophrenic angle
•Left main bronchus
pulled down

74. Juxtaphrenic peak sign
• refers to the peaked or tented
appearance of
a hemidiaphragm.
• caused by retraction of the
lower end of diaphragm at
an inferior accessory
fissure(most common), major
fissure or inferior pulmonary
ligament.
• It is commonly seen
in upper lobe collapse but
may also be seen in middle
lobe collapse. diaphragmatic tenting

75. • Also known as folded lung or Blesovsky syndrome
•Occurs as a consequence of diseases with chronic pleural scarring, especially asbestos-
related pleural disease and TB
•Comet tail on CT: vessels and bronchi converge upon and appear to swirl around mass
•The way the lung collapses can at times give a false mass-like appearance.
Round atelectasis

76. characterized by linear shadows of increased density at the lung bases.
Usually horizontal, measure 1-3 mm in thickness and are only a few cm long.
In most cases these findings have no clinical significance and are seen in smokers and
elderly.
They are seen in patients, that are in a poor condition and who breathe superficially, for
instance after abdominal surgery (figure) or patients with rib fracture.
Plate-like atelectasis

77. Areas of decreased density in the lung as:
•Cavity - lucency with a thick wall
•Cyst - lucency with a thin wall
•Emphysema - lucency without a visible wall

78. Bronchiectasis
•Chronic condition characterised by local, irreversible dilation of bronchi
•Three subtypes- cylindrical, varicose, cystic

79. CHRONIC BRONCHITIS
Dirty chest
•Generalised accentuation of the
bronchovascular markings
•Small poorlydefined opacities may
be seen anywhere in the lungs

80. EMPHYSEMA
Common features seen on the chest radiograph include:
•Hyperinflation with flattening of the diaphragms
•Reduction of pulmonary vascularity peripherally
•Increased retrosternal space
•Enlargement of PA/RV (cor pulmonale)

82. Pleural Effusion
In the AP film, an effusion will appear as a graded haze that is
denser at the base.
A lateral decubitus film is helpful in confirming an effusion as the
fluid will collect on the dependent side
Approximately 200 ml of fluid are needed to detect an effusion in a
PA film, while approximately 75 ml of fluid would be visible in the
lateral view.
 The vascular shadows can usually be seen through the effusion.

83. The most dependent recess of the pleura is the posterior costophrenic
angle. A small effusion will, therefore, tend to collect posteriorly and in
most patients 100-200 ml of fluid are required to fill this recess before
fluid will be seen above the dome of the diaphragm on the frontal view

86. Larmelar effusion Loculated pleural effusion

87. Pseudotumor of Lung. Frontal and lateral views of the chest demonstrate a
lemon-shaped soft-tissue density corresponding to the location of the minor
fissure on both views . This is a classic appearance for a pseudotumor of the
lung.

89. Differentiation between pleural effusion and ascites on CT scans
•Displaced crus sign
•Diaphragm sign
•Interface sign
•Bare area sign

90. Pneumothorax
 Pneumothorax is presence of air in pleural cavity
 It is useful to divide pneumothoraces into three categories :
1. primary spontaneous: no underlying lung disease
2. secondary spontaneous: underlying lung disease is present
3. iatrogenic/traumatic

91.  Appears in the chest
radiograph as air without
lung markings
 In a PA film it is usually seen
in the apices since the air
rises to the least dependent
part of the chest
 The air is typically found
peripheral to the white line of
the visceral pleura
 Best demonstrated by an
expiration film

93. The deep sulcus sign on
a supine chest radiograph
is an indication of
a pneumothorax.
The costophrenic angle is
abnormally deepened
when the pleural air
collects laterally,
producing the deep sulcus
sign.

94. ULTRASOUND-
Visualising the junction between sliding lung and absent sliding is known
as the lung point sign and is near 100% specific for pneumothorax and
also gives an indication of pneumothorax size by its location.
On M mode, classical signs for the gray scale imaging are seen:
•seashore sign: normal lung sliding
•barcode/stratosphere sign: pneumothorax

96. CT is considered the gold-standard in the diagnosis of pneumothorax.

97. Tension pneumothorax
•ipsilateral increased intercostal spaces
•shift of the mediastinum to the contralateral side
•depression of the hemidiaphragm

98. PLEURAL CALCIFICATION

99. PLEURAL PLAQUE

100. Pleural lipoma
well-circumscribed, round capacity
(arrowheads) projected over the heart

101. Malignant mesothelioma
lobulated left pleural opacities
encasement of the right lung by nodular
pleural tumour.

102. Pulmonary Edema
There are two basic types of pulmonary edema:
 Cardiogenic pulmonary edema caused by increased
hydrostatic pulmonary capillary pressure
 Noncardiogenic pulmonary edema caused by either altered
capillary membrane permeability or decreased plasma
oncotic pressure

103. Cardiogenic pulmonary edema Non-cardiogenic pulmonary edema
Patchy infiltrates in bases Homogenous infiltrates
Pleural effusion No pleural effusion
Cardiomegaly Normal size heart
Kerley B lines No kerley b lines

104. Congestive Heart Failure
Common features observed on the chest radiograph of a CHF
patient include:
 Cardiomegaly (cardiothoracic ratio > 50%)
 Cephalization of the pulmonary veins
 Appearance of Kerley B lines
 Alveolar edema often present in a classis perihilar bat wing
pattern of density

105. chest x-ray of a patient
in severe CHF
•cardiomegaly
•alveolar edema
•haziness of
vascular margins

106. Kerley B Lines
Transverse non-branching 1-2 mm lines at the lung bases
perpendicular to the pleura 1-3 cm long
Thickened interlobular septa

107. Acute intra-alveolar pulmonary oedema
with a bat's wing distribution.

108. Primary pulmonary tuberculosis in 18-year-old boy
TUBERCULOSIS
patchy
consolidation,
nodules, and
cavities (arrows)
in bilateral upper
lung zones.

109. Tuberculosis Tuberculosis
Post-primary Tuberculosis

110. Miliary tuberculosis
( 1-3 mm diameter nodules, which are uniform in size and uniformly distributed)

111. Garland triad, also known as the 1-2-3 sign or Pawnbrokers sign
sarcoidosis

112. Sarcoidosis

113. MEDIASTINAL MASS
Superior mediastinum
LYMPHOMA

114. Invasive thymoma
Anterior mediastinum
43-year-old woman presenting with chest pain and dyspnoea. PA film (A) shows widening of the
mediastinum on the right with bilateral pleural effusions. CT scan with contrast soft-tissue
enhancement (B) at the level of the tracheal bifurcation shows an oval mass of mixed density
(arrow) in the anterior mediastinum with a small pleural mass anteriorly on the right.
Diagnosis confirmed by needle biopsy and surgery.

115. Middle mediastinum
Bronchogenic cyst

116. Posterior mediastinum
Neurofibroma.

117. Hilum overlay sign
Differentiates large pulmonary artery from hilar mass,
mass superimposes on vessels.
Hilar vessels are seen through the mass
Lymphoma

118. Hilum convergence sign
Differentiates large pulmonary artery from hilar mass on chest x ray,
vessels converge on pulmonaary artery but go past hilar mass

119. A solitary pulmonary nodule or SPN is defined as a discrete,
well-marginated, rounded opacity less than or equal to 3
cm in diameter.
It has to be completely surrounded by lung parenchyma,
does not touch the hilum or mediastinum and
is not associated with adenopathy, atelectasis or pleural
effusion.
Lesions smaller than 3 cm, i.e. SPN's are most commonly
benign granulomas, while lesions larger than 3 cm are
treated as malignancies until proven otherwise and are
called masses.
Solitary Pulmonary Nodule-

120. Neoplastic
malignant
bronchogenic carcinoma
solitary pulmonary metastasis
lymphoma
carcinoid tumour
benign
pulmonary hamartoma
pulmonary chondroma
congenital
arteriovenous malformation
lung cyst
Miscellaneous
pulmonary infarct
intrapulmonary lymph node
mucoid impaction
pulmonary haematoma
pulmonary amyloidosis
normal confluence of pulmonary veins
Inflammatory
granuloma
lung abscess
rheumatoid nodule
round pneumonia

121. A pulmonary mass is any area of pulmonary
opacification that measures more than 3cm. The
commonest cause for a pulmonary mass is lung cancer.
Corona radiata sign
Features suggestive of malignancy-
•Corona radiata sign
•Air bronchogram sign
•Nodules containing aground glass component
•Contrast enhancement >15 HU

122. PECTUS EXCAVATUM
Bilateral cervical ribs
BONES-

123. Inferior rib notching
Superior rib notching

124. Diaphragmatic hernia
Agenesis of right lung
Pediatric chest

125. Thymic sail sign Wave Sign of Mulvey

126. Spinnaker Sail Sign

127. THANK YOU