chest x ray spotter set for radiology education and diagnosis imaging of chest pathology, description and diagnosis of chest x ray from the website

1. Chest x ray spotter set 2

3. There are multiple rounded well defined opacities of
varying sizes throughout both fields
* A left mastectomy is noted
* No obvious bony lesions
This lady has metastatic breast cancer.
Almost any tumour can metastasize to the lung.
Cavitation is rare in metastatic tumours (<5%)

5. There are bilateral air bronchograms and consolidation in bot
The left hemidiaphragm is a little indistinct, possibly reflecting
* There is an ETT, an NGT in situ, with a left subclavian
This is severe multilobar pneumonia.
*We know the lingula is involved because the left heart borde
Sputum cultures and urinary antigens for pneumococcus and
*The urinary antigen is useful as you generally get an answer

7. There is volume loss and fibrosis in the left upper lobe (hilum pulled up).
There is airspace opacification in the right lower lobe on a background of possible fibrosis thr
This man has acute right sided pneumonia, exacerbating his already weak ventilatory reserve.
* The left upper lobe fibrosis is highly likely to be caused by TB

8. 54

9. There are multiple small calcified parenchymal
densities projecting over both lung fields.
* The lungs are otherwise clear.A common cause for small calcified lung opacities is
healed varicella pneumonia.
These lesions are usually 2-3mm in size, and are
randomly scattered throughout the lungs.
A differential for small nodules in the lungs includes
chronic exposures in occupation-specific conditions such
as silicosis and coal worker’s pneumoconiosis.

12. There is are bilateral mid zone nodular infiltrates, predomina
There is a vesicular rash over the torso, arms and face.
The lesions are of different stages: macules, papules and ve
This is acute varicella infection (chicken pox) with varicella p
Varicella pneumonia can occur in up to 1:400 cases of
immune competent adults and carries a mortality of up to
30%.
Prompt administration of intravenous acyclovir is
associated with clinical improvement.

14. Both long fields are overinflated with flattened diaphragms.
There is a tumor in the right upper lobe with associated right
This man has COPD and likely lung cancer.
Once stable he requires a staging CT chest.
Endobronchial ultrasound (EBUS) allows safe, directed sam
When treatment options are dependent on the stage of lung

16. There is a large, rounded mass in the right upper zone.
There are multiple small rounded opacities in the right mid an
The aorta is unfolded. Bones look normal.
This is a large cancer originating within the lung parenchyma
Fine needle aspirate (FNA) revealed a poorly differentiated la
The concave angle(s) between the mass and the
pleura indicate that this mass has originated from the
lung.
A convex angle would usually lend toward a pleural
based origin.

17. There is deviation of the trachea to the right with associated
The right hilum appears prominent. Pleural spaces clear
This is likely to be lung cancer. A CT chest and
bronchoscopy are indicated.
Approximately 15 years after quitting tobacco smoking the rel

20. There is a rounded opacity laterally in the right upper lobe.
Sternotomy wires and a Carpentier-Edwards AVR are
noted.
Lateral film demonstrates the AVR in situ more clearly.
Incidental fast AF accounted for his ‘dizzy spells’.
The lung mass was new as compared to CXR from around t
CT brain was normal.
Patients with cardiovascular disease frequently have tobacc

22. There are air bronchograms and consolidation in the medial
This is pneumococcal pneumonia.
The left medial hemidiaphragm is obscured, confirming that
this is involving the lower lobe.
Streptococcus pneumoniae is cultured in 20-25% of cases of
* Studies using PCR to isolate S pneumoniae suggest the inc
*The use of PCR to detect S pneumoniae and other common

24. There is deviation of the trachea to the right and a raised righ
The right heart border is lost indicating right middle lobe colla
There is resultant volume loss in the right hemithorax.
There are multiple rounded opacitites in both lung fields, the
This is metastatic lung cancer.
Dependent on the duration of symptoms and CT appearance
Radiotherapy and chemotherapy continue to have a key role

26. There is over-inflation of both lung fields with flattening of the
There is a large spiculated mass in the right upper lobe.
This is consistent with COPD (predominant emphysema as g
After adjustment for tobacco smoke exposure, the presence
This is probably related to the chronic inflammatory milieu in

28. Lung fields are clear.
There are prominent, enlarged pulmonary arteries with pru
Heart size is normal.
This is pulmonary hypertension.
HIV is an unusual cause of this, even in the absence of
immune suppression.
In pulmonary hypertension syncope can occur due to a parad

30. There is increased soft tissue shadowing in the right apex an
The right hilum is raised. Otherwise lung fields are clear.
No obvious rib destruction around the lesion
This is a Pancoast tumour.
Pancoast tumour – a primary lung cancer in the apex of the lu
Henry Pancoast – the first Professor of Radiology in the United States – first
described this appearance in 1924.
Remember that a Pancoast Tumor is associated with Pancoast Syndrome in
patients with shoulder pain, C8-T2 radiculopathy and ipsilateral Horner syndrom
(Johan Friedrich Horner was a Swiss opthalmologist!)

31. 65

33. There is a large soft tissue mass in the medial right lower
zone.
Volume loss in the right hemithorax.
Lung fields otherwise clear, pleura clear.
CT confirms the presence of a large soft tissue mass in the m
This is a likely primary lung cancer.
Biopsy will be possible percutaneously or via
bronchoscopy.
On the CXR we can tell that this tumour is in the medial segm

35. There is a rounded soft tissue mass in the right lower lobe w
There is a further smaller lesion in the left upper lobe laterall
The pleural spaces are clear.
This is likely to be lung cancer.
The lesion on the left side suggests metastases are present a
About 40% of non small cell lung cancer is diagnosed at an a

38. There is diffuse opacity over the left hemithorax and loss of d
Pleural spaces are clear, right side normal.
Sternotomy wires noted
There is diffuse opacity over the left hemithorax and loss of d
Pleural spaces are clear, right side normal. Sternotomy wires
The radiological appearance of Left upper lobe (LUL) collaps

41. CXR Interpretation:
There is a lobulated ~5cm tumour just lateral to and above th
CT Interpretation:
CT demonstrates the large soft tissue mass in the left upper l

42. This is probably a large primary lung cancer.
There is no obvious bony destruction suggestive of bony me
Cerebral metastases as a cause of the falls should be inves
Approximately 7-10% of patients diagnosed with non small ce
Between 20-40% may develop metastases over the course o

45. CXR Interpretation:
There is infiltration of the left apex with a large soft tissue ma
Lung fields appear over-inflated consistent with COPD.
CT Interpretation:
CT confirms the presence of an invasive tumour with clavicle
This is a left sided Pancoast tumour.

46. In some circumstances surgery is possible with Pancoast tum
MRI is very useful at informing the degree of any soft tissue in
Otherwise, adequate analgesia to cover the local and neurop

49. CXR Interpretation:
There is a rounded small soft tissue mass in the left lower zo
Otherwise, lung fields are clear, heart size normal, pleura cle
CT Chest Interpretation:
There is a rounded (solitary) soft tissue mass in the left lowe
This is an incidentally found lung cancer.
It should be accessible using CT guidance as a percutaneou

50. Incidentaloma (of any kind) are are found in 15-20% of CTPA
Dependent on the definitions and findings, between 50-60%

53. CXR Interpretation:
There is a large soft tissue mass arising from the right super
The right hilum appears bulky. Both lung fields are over-infla
CT Chest Interpretation:
CT demonstrates a large cystic structure arising from the su
It is partially obstructing the airway due to external compress

54. Mediastinal cysts are relatively uncommon.
This will need further work up, however surgery may be indic
Causes of mediastinal cysts include bronchogenic, thymic, pe
While thymic cysts are most common in the anterior mediast

56. There are surgical wires over the left 5th and 6th ribs and
surgical clips lateral to the left hilum.
The lung fields project differently – the right is suggestive
of gas trapping and oligaemia; the left has normal
appearances of the pulmonary vasculature.
This man has had a left single lung transplant for severe
emphysema (as seen in his right lung).
Single lung transplants can be performed for emphysema, do

59. There is a right superior hilar mass.
There may be paratracheal adenopathy superior to it.
Lung fields and pleura clear.
Lateral confirms that this likely tumour is anterior and super
This is squamous cell lung cancer.
The proximity to the carina and adjacent lymphadenopathy p

60. Squamous cell lung cancer is usually more central / proxima
These central airway cancers are becoming less common du

63. There is a large mass in the medial right lung adjacent to th
The airway and right inferior pulmonary artery are clearly vis
Lung fields, pleura and bones otherwise normal.
Lateral X-ray confirms the presence of a large mass, poster
This is very likely to be a primary lung cancer.
Smoking history, occupational exposures (particularly asbesto

64. Haemoptysis occurs in at least 1 in 5 cases of non small cel
In the majority of cases it is relatively minor and can be man
Occasionally tranexamic acid is useful.

67. CXR Interpretation:
There is a rounded, spiculated opacity projected over the righ
CT Chest Interpretation:
CT chest demonstrates a rounded mass abutting the anterior
This is probably a primary lung cancer.
The absence of any other tumours in the chest (as
confirmed by CT) make metastases far less likely.

68. On the original CXR, the right inferior pulmonary artery (and o

70. There are multiple dense opacities of varying size
throughout both lung fields.
The trachea is deviated to the right suggesting some
mediastinal adenopathy.
The pleura and bones appear normal.
This man has multiple metastases from bowel cancer.
The most common cancer types to metastasize to the lungs
Sarcoma is less common, but commonly metastasizes to the

72. There are multiple small nodular lesions bilaterally, with a pr
No pleural involvement.
This is leiomyomatosis.
The basal distribution and multiple different sizes of lesions s

73. Leiomyomatosis is results from haematogenous spread of ‘b
There is commonly a venous tumour burden, masquerading a
Treatment is with hysterectomy and anti oestrogen / gonadotr
There is a rare hereditary form of leiomyomatosis that also inc

75. There is widespread, bilateral airspace opacification with air b
The peripheries are relatively spared.
ETT, central venous access and NGT are noted.
This is granulomatosis with polyangiitis (‘GPA‘) – old
school Wegener’s granulomatosis.
The renal failure is from associated glomerulonephritis.
PR-3 ANCA (c-ANCA) was positive.
High dose corticosteroids was started, followed by
cyclophosphamide – he survived.
The differential of the CXR includes a severe (infective)
pneumonia.

76. Other radiological appearances of GPA are nodules that may
Upper airways symptoms are very common in GPA (~95%) s

77. A 43 yo lady presents with pleuritic chest pain and cough. She is hypotensive, warm and dilated peripherally.

79. CXR Interpretation:
There is diffuse consolidation in the left lower lung field.
*The left heart border and the diaphragm are maintained (all
Lateral CXR Interpretation:
This lateral X-ray demonstrated lobar consolidation of the ap
This is lobar pneumonia with systemic sepsis.

82. There is airspace shadowing in the right base with loss of the
Otherwise lung fields and pleura are clear.
Lateral X-Ray confirms right lower lobe, lateral basal segmen
This is pneumonia.
Given his age and GI symptoms (so called) ‘atypical‘ pathoge

83. You are asked to review this CXR by the ICU. CXR of a 28 year old male ‘ANCA positive’ with re

84. There is patchy, diffuse airspace shadowing in both lung field
There is a large tunneled subclavian IV access cannula in situ
No pneumothorax.
This man had microscopic polyangiitis (MPA) with MPO-A
The vascath is for dialysis following acute renal failure. The in

86. There are bilateral moderate pleural effusions.
There is fluid in the horizontal fissure and upper lobe
diversion.
Common things are common: bilateral effusions are highly lik
This man had a history of type II diabetes and NSTEMI with 2

88. There is a right side pleural effusion and mediastinal shift to t
There is a smaller left pleural effusion.
There is upper lobe diversion. No focal lung lesion, bones are

89. There is likely at least dual pathology here – the right sided v
However, the presence of a contralateral pleural effusion cou
This lady needs a proper examination, followed by CT chest

90. this lady probably does need a pleural aspiration on the right

92. There is a right sided pleural effusion with an ipsilateral indw
There is a right sided hilar / upper lobe spiculated mass.
There is an infusaport in situ on the left.
Left lung field is normal.
Evidence of right sided mastectomy and axillary clearance (s
This lady has breast cancer with pulmonary and pleural meta

94. There is a multiloculated pleural effusion on the right side.
Left side is normal.
This is likely to be pleural empyema.
IV antibiotics, further imaging and a chest drain are
required.

97. There is a diffuse hazy shadowing over the lower left lung fie
There is loss of volume in the left lower hemithorax (right hea
Appearances suggest a loculated posterior-basal effusion.
Lateral X-ray demonstrates a large multiloculated posterior a
This man has a pleural empyema.

99. There is collapse and consolidation of the left lung, with trach
* There is a large bore chest drain in situ toward the left apex
This lady has pneumonia and a secondary pneumothorax.

101. There is left sided consolidation and loculated air within a co
There is a left hydropneumothorax.
Right lung field is clear.
This is a complex empyema with pneumothorax.

103. There is a large right sided pleural effusion filling the entire h
Left lung field and pleura is clear.
Large gastric bubble. Bilateral nipple rings.
A large unilateral pleural effusion is very likely to be malign
The other most common cause would be parapneumonic eff

105. There is a large bore chest drain on the right with surgical em
The chest drain tip is situated towards the apex (or cupola) o
This lady has trapped lung – the pleural fluid has been remo

107. There is airspace shadowing with air bronchograms in the le
This is lobar pneumonia.
Most likely caused by Streptococcus pneumoniae.
The loss of the left heart border indicates that the LUL is aff

110. There is a rounded opacity projected over the right hilum with
Lateral X-Ray demonstrates loculated fluid within the horizon
This is a localized parapneumonic effusion.

113. There is diffuse, hazy shadowing in the right lower lung field w
Thoracic ultrasound demonstrates a multiloculated basal pleu
This is a complex, loculated parapneumonic effusion that late

115. There is a partially loculated right pleural effusion. There are i
Left pleural space clear, bones appear normal.
This is a primary lung cancer with malignant pleural effusio

116. Lymphangitis carcinomatosa / carcinomatosis is a malignant
Frequently associated with lung cancer, but also breast, stom
Oral corticosteroids and diuretics can have transient benefit,

118. There is a right sided hydropneumothorax with lobulated p
The left side of the chest is clear.
This is malignant pleural disease and most likely to be mes
The risk of developing mesothelioma is (asbestos) dose depe
Time since first exposure is also important – latency following

120. There are multiple small opacities of varying size througho
There is a moderate basal and posterior pleural effusion an
This lady has disseminated breast cancer multiple pulmona
The veil-like opacity over the right mid zone indicates a pos
Malignant pleural effusions can have multiple, thick locula

123. CXR Interpretation:
There is encasement of the right lung from pleural thickenin
The left pleura is normal. There is a nipple shadow on the le
CT Interpretation:
CT chest demonstrates circumferential pleural thickening.
This is characteristic of malignant pleural mesothelioma.
This lady was a shop worker with no occupational exposure

125. There is left upper lobe consolidation with air bronchograms i
Linear shadows on the right lower lobe suggest atelectasis.
ETT and NGT in situ. The right subclavian line is incorrectly p
This pneumonia should be treated as an aspiration (as he is
Tricuspid valve endocarditis should be considered although y

127. There is a left pneumothorax with mediastinal shift suggestin
Tension pneumothorax
This needs immediate recognition and a needle decompress

128. Studies suggest that between 10-20% of the population may
If you can’t access the pleural space here then go for the 5th

130. There is a large right sided pneumothorax.
No evidence of trauma.
The left lung looks congested but no obvious parenchymal di
With no known underlying lung disease this is a primary spo
Marijuana smoking is associated with the development of ea

131. The size measurement of PSP is arbitrary
• the British guidelines suggest >2cm from chest wall to pleu
• the Americans suggest >3cm from apex to cupola.
Neither matter very much – the increasing evidence is that P
Size doesn’t matter although if you must the most reliable me