This chest x-ray report discusses various abnormalities that can be seen on a chest x-ray including hilar abnormalities, the hilum overlay sign, hilum convergence sign, and continuous diaphragm sign. Specific lung abnormalities are also described such as alveolar disease, interstitial disease, bulging fissure sign, lobar consolidation, Kerley lines, and a miliary pattern. Causes of a miliary pattern include tuberculosis, sarcoidosis, silicosis, histoplasmosis, and haemochromatosis.

1. CHEST X-RAY
• Dr. ROHIT AGGARWAL
Medicine Resident
1st Year

2. HILAR ABNORMALITIES

3. HILAR ABNORMALITIES
• 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)

4. HILAR ABNORMALITIES
• 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

5. HILAR ABNORMALITIES

6. 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.

7. HILUM OVERLAY SIGN

8. 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.

9. HILUM CONVERGENCE SIGN

10. CONTINUEOUS 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.

11. LUNG PARENCYMA

12. LUNG PARENCHYMA

13. ALVEOLAR DISEASE

14. INTERSTITIAL DISEASE

16. BULGING FISSURE 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

17. 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.

18. KERLEY LINES

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

20. D/D OF MILIARY PATTERN
• TB (HAEMATOGENOUS)(lower lobe predominant due
to more perfusion)
[Primary TB present as U/L hilar lymphadenopathy]
• SARCOIDOSIS
• SILICOSIS (upper lobe predominant)
• HISTOPLASMOSIS
• HAEMOSIDEROSIS
• ALVEOLAR MICROLITHIASIS
• FAT EMBOLISM
• METASTASIS (sometimes)