3. POSITION
PA AP
QUALITY
ROTATION PENETRATION INSPIRATION
LESION
OPACIT
OPACITY
Homo
Heterogenous Wellill defined Zone
Centralperipher
Silhouet sign
al
Y Necrotic
PATCHY
HILUMMEDIASTINAL
NODULE Central deviasionwided
MASS
COSTO-PHRENIC ANGEL
Freeoblitern
CAVITARY
OTHER
INFILTIRATION
Bone soft tissuediaphragm
5. Solitary Pulmonary Nodule(SPN)
Appearance
Margin Calcification cavitation
Comparison with a
Size
previous x-ray to >8mm
<8mm
Assess growth over
time. Location
Upperhillar zone Lowerbasesup-pleural
Associated abnormalities
Lymph node enlargement Rib destruction/erosion
6. Cavitary lesion
Air +
Air-fluid level Air only
tissue
Wall thickness
Straight Wavy Thick Thin
1. Fungal ball.
2. Rupture hydatid cyct site
3. Necrotic tumor
ruptured
4. Blood glot Hydatid
Abscess Irregular Regular
Peripheral Central
inner wall inner wall
cyst
Emphesemato
Cavitating Chronic us pneumatoc
neoplasm abscess ele
bulla
7. LINEAR PATTERN
LINEAR PATTERN
LEFT VENTRICULAR FAILURE Perihilar and peripheral basal septal lines,
changes acutely and resolves with diuretics
Normal ageing Coarsening of lung markings in lower zones, no
change on review of recent films
Lymphangitis Coarse nodular and linear thickening of
markings, known malignancy, often associated
with pleural effusion, rapid clinical
deterioration of patient
8. LINEAR PATTERN
LINEAR PATTERN
Atelectasis Short thin lines, often basal, new on review of
previous films
Subsegmental Longer thicker bands, often perihilar or basal,
collapse suggest recent infection or infarction
Scarring Any length, persist over time unchanged
Fibrosis Volume loss is key, persists over time
9. Causes of fibrosis
Mid zone lung Lower zone lung Upper zone lung
tuberculosis Drug indused fibrosis sarcoidosis
(most common)
Chronic extrinsic allergic UIP
alveolitis
Radio-therapy Asbestose-related fibrosis
Ankylosing spondylitis
Progressive massive
fibrosis
histoplasmosis
41. CASE-1
• 44-year-old woman is admitted with hemoptysis and progressive shortness of breath.
• On physical examination, her vital signs are:
– pulse 110bpm;
– temperature 99°F;
– respirations 22/min;
– blood pressure 118/68 mmHg.
• She is in mild distress and her lung exam is normal except for occasional crackles.
• Laboratory data:
– Hb 9.8 g/dL; Hct 30%;
– WBCs 9.0/μL; differential normal;
– BUN 46 g/dL; creatinine 1.9 mg/dL.
– Urinalysis shows RBC casts.
• ABGs on room air: pH 7.42; PCO2 38 mm Hg; PO2 72 mm Hg.
• Pulmonary function tests are within normal limits except for DLCO, which is 110% of predicted.
• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this
patient?
• a. CXR-1
• b. CXR-2
• c. CXR-3
• d. CXR-4
43. CASE-2
• 62-year-old man is admitted with chest pain.
• He has four-vessel disease and undergoes CABG.
• On the third postoperative day, the patient develops increasing
shortness of breath with diffuse crackles on lung exam.
• Laboratory data:
– Hb 12 g/dL; Hct 36%;
– WBCs 9.8/μL; differential normal;
– BUN and creatinine normal.
• ABGs on 3% Ventimask: pH 7.50; PCO2 30mm Hg; PO2 87 mm Hg.
• Based on this clinical scenario, which of the above chest x-rays is
most likely to belong to this patient?
• a. CXR-1
• b. CXR-2
• c. CXR-3
• d. CXR-4
45. CASE-3
• A 38-year-old female smoker is admitted with progressive shortness of
• breath and productive cough with copious amounts of white mucoid
sputum.
• On physical examination, vital signs are:
• pulse 98 bpm;
• Temperature normal;
• respirations 35/min;
• blood pressure 110/80 mm Hg.
• The patient is in mild distress and has bilateral crackles in the mid-lung
fields with areas of egophony in the right posterior lung zone.
• ABGs on room air: pH 7.47; PCO2 34 mm Hg; PO2 57 mm Hg.
• Based on this clinical scenario, which of the above chest x-rays is most
likely to belong to this patient?
• a. CXR-1
• b. CXR-2
• c. CXR-3
• d. CXR-4
47. CASE-4
• A 72-year-old man with a history of COPD and chronic sputum production, on home O2, with a
long-standing history of reflux esophagitis and difficulty swallowing, is admitted with shortness
of breath and fever.
• On physical examination, his vital signs are:
– pulse 128 bpm;
– temperature101°F;
– respirations 34/min;
– blood pressure: 98/65 mm Hg.
• He appears frail and has bilateral crackles and rhonchi on lung exam.
• Laboratory data:
– Hb 10 g/dL; Hct 30%;
– WBCs 15.8/μL;
– BUN 56 mg/dL; creatinine 2.8mg/dL;
– sodium 128 mEq/L; potassium 3.2 mEq/L.
• ABGs on room air: pH7.5; PCO2 34 mm Hg; PO2 48 mm Hg.
• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this
patient?
• a. CXR-1
• b. CXR-2
• c. CXR-3
• d. CXR-4
