Clinical indicators Chest (from Radiology masterclass - Chest x-ray abnormalities Flashcards
CI: Joint pain, erythema nodosum.
Findings on chest x-ray:
Bilateral, symmetrical hilar enlargement.
Patchy bilateral parenchymal shadowing.
Diagnosis: Sarcoidosis
(a chronic disease of unknown cause characterized by the enlargement of lymph nodes in many parts of the body and the widespread appearance of granulomas derived from the reticuloendothelial system).
Differential diagnosis:
Lymphoma, metastatic diease or infection. Pulmonary arterial hypertension may also cause this appearance.
CI: known breast cancer. Increasing SOB.
Findings on chest x-ray: Both hila larger and denser than normal. Right hilum bigger. Multiple small lung nodules. (missing right breast shadow from masectomy)
Diagnosis: Metastatic disease and breast cancer.
CI: hx of left hilar malignancy treated with radiotherapy.
Findings on chest x-ray:
Abnormal hilar position.
Left is large, dense and pulled laterally and upwards to left.
trachial deviation/pulled to left, indicating loss of lung volume in the left hemithorax.
Diagnosis: radiation fibrosis
CI: patient had a high temp and productive cough.
Findings on x-ray:
Consolidation with air bronchogram.
Diagnosis:
Pneumonia - consolidation with pus.
Differential diagnosis:
Cancer - airways full of cells.
Pulmonary haemorrhage - airways full of blood.
Pulmonary oedema - airways full of fluid.
Air bronchogram: area of lung that is condolidated becomes dense and white. Larger airways are spared and appear blacker/lower density. Characteristic sign of consolidation.
CI: hx of intravenous drug abuse and presents with high fever.
Findings on chest x-ray:
Unilateral, small irregular opacity on right. Opacity contains dark area/cavity. Rest of lung normal.
Diagnosis: Septic embolus.
Differential diagnosis: Lung abscess - TB Lung cancer Fungal infection Septic embolus - infected thrombus (A thrombus is a blood clot that forms in a vessel and remains there. An embolism is a clot that travels from the site where it formed to another location in the body. Thrombi or emboli can lodge in a blood vessel and block the flow of blood in that location depriving tissues of normal blood flow and oxygen.)
CI: SOB, weight loss and clinically suspected underlying malignancy.
Findings on chest x-ray:
Bilaterally abnormal lung zones. Multiple bilateral lung nodules, symmetrical distribution, more nodules in lung bases.
Diagnosis: Pulmonary metastases.
CI: chronic smoker with increasing SOB
Findings on chest x-ray:
Unilateral blacker lower zone, Asymmetrical lower zones, lung hyperexpansion.
Diagnosis: Chronic obstructive pulmonary disease with a large lower zone lung bulla.
CI: Fall from height - trauma to chest.
Findings on chest x-ray:
Visible pleural edge. Lung markings not visible beyond this edge.
Diagnosis: Pneumothorax due to rib fracture.
If trachea and medialstinal structures are not displaced, there is no ‘tension’.
CI: history of asbestos exposure.
Findings on x-ray:
unilateral pleural thickening, peripheral shadowing on right, loss of lung volume on right.
Diagnosis: Malignant mesothelioma - an aggressive cancer affecting the membrane lining of the lungs and abdomen. Most serious of all asbestos-related diseases. Exposure to asbestos is the primary cause and risk factor for mesothelioma.
Differential diagnosis: Empyema Pleural metastases Pleural effusions (all of which don't cause volume loss).
CI: Chronic mild SOB.
Retired dock worker with hx of asbestos exposure.
Findings on chest x-ray:
Bilateral well defined irregular shadows that are as dense as the bones.
Peripheral pleural thickening.
Diagnosis: bilateral calcified asbestos related pleural plaques.
(have a characteristic appearance, irregular, well defined, classically look like holly leaves).
CI: life long smoker, weight loss and increasing SOB.
Findings on chest x-ray:
Left lower zone is uniformally white. At the top of this area there is a concave surface = meniscus sign.
Left heart border, costophrenic angle and hemidiaphragm are obscured.
Slight blunting of the right costophrenic angle.
Diagnosis: Large left pleural effusion (and small right).
Underlying bronchogenic carcinoma.
Meniscus sign:
in radiography of the lung, a crescent of gas near the top of a mass lesion, signifying cavitation with a space above the debris; seen in aspergilloma, hydatidoma;
CI: child with cough and fever.
Findings on chest x-ray: Mid right sided, consolidation. Right heart border is obscured. Crisp line seen in horizontal fissure. More extensive shadowing also involves right and left peri-hilar regions.
Diagnosis: Pneumonia involving right middle lobe (crisp line in horizontal fissure limiting consolidation - therefore pathology involves right middle lobe.
CI: Smoker, progressive SOB and cough.
Findings on x-ray:
The horizontal fissure has been displaced upwards from original postition.
Dense opacification of medial, upper right zone.
Enlarged right hilum.
Diagnosis: Right upper lobe collapse.
CI: Long term smoker with a cough.
Findings on x-ray:
PA: large, round, thick-walled lung cavity in left middle zone, close to hilum.
Lat: cavity seem behind oblique fissure.
Diagnosis: Left lower lung cavity due to squamous cell lung carcinoma.
CI: Chronic smoker, chronic SOB with recent worsening.
Findings on chest x-ray:
Left lung/costophrenic angle are normal.
Right costophrenic angle blunt.
Volume loss in right hemithorax with mediastinal and tracheal shift to right.
Diagnosis: Lung cancer occluding central airways and causing right middle and lower lobe collapse..
Note: pleural effusions don’t cause volume loss.
