CXR Findings

Question 1

3 ways opacification is described?

Answer 1

Nodular
Reticular
Alveolar

Question 2

Reticular opacification:

• Where are the changes?
• What does it look like?
• Think of one example of this?

Alveolar opacification:

• Where are the changes?
• What does it look like?
• Think of one example of this?

Answer 2

ILD

Lung parenchyma

A network of fine lines, interstitial

Airspaces - alveoli

Fluffy - due to material filling - also called consolidation

Pneumonia

Question 3

Pleural effusion:

What does it obscure?

Why is there a meniscus?

What may happen if it is very large?

Answer 3

Costophrenic angle

Curved upper edge as it pools at the bottom of the lung - it would pool at the bottom of a lung love as the fluid is in the pleural cavity itself.

Opacification of the whole hemithorax and shift of mediastinum AWAY from it

Question 4

Pneumothorax:

What is absent in a pneumothorax when looking at the lungs?

What is seen in tension PE?

Answer 4

Black area - lack of lung markings

Tracheal deviation

Question 5

Pneumonia:

What is seen generally?

What is the air bronchogram sign?

What other lung pathology may be present due to pneumonia?

Answer 5

Consolidation - opacification of affected lobe from pus-filled alveoli

Air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white).

Lung collapse
Effusion
Abscess

Question 6

Pneumonia:

Findings by lobe:

What is obscured in:

• lower lobe pneumonia
• right middle-lobe pneumonia
• lingula pneumonia (Inferior projection of the left upper lobe )

Answer 6

Costo-phrenic angle

Right heart border

Left heart border

Question 7

Lobar collapse:

Why does the lung become opacified?

Why do you not have air bronchograms as seen in pneumonia?

Does the trachea and mediastinum shift towards or away from it?

What may happen to the hemidiaphragm?

Answer 7

Due to loss of patent airways - so a loss of air in alveoli, this increases tissue density making it whiter.

There is not enough opacity from collapse to cause it.
Pus in pneumonia causes more opacity.

Towards it - pulling action of the collapsed lobe

It becomes raised - loss of air in lobe so it will naturally

Question 8

Heart failure:

ABCDE mneumonic - what does it stand for?

Answer 8

Alveolar oedema - a sign of interstitial oedema
Kerley (B) lines - a sign of fluid in lung fissures
Cardiomegaly
Dilated upper lobe vessels
Pleural (e)ffusion

https://radiologyassistant.nl/chest/chest-x-ray-heart-failure

Question 9

Heart failure:

Why do you see dilated upper lobe vessels?

Kerley B lines:

• Where are they found?
• What are they?
• What do they look like?

What type of pleural effusion do they get and why?

How can you tell there is effusion if there is already pulmonary oedema within the lung?

Answer 9

Lung bases

Thickened interlobular septa

Transudative

Fluid leaks into pleural space, rather than from breakdown of tissue

There is an increased distance between the stomach bubble and the lung.
The stomach is normally located directly under the diaphragm, so, on an erect PA radiograph, the stomach bubble should always appear in close proximity to the diaphragm and the lung.

https://radiologyassistant.nl/chest/chest-x-ray-heart-failure

Question 10

Discrete lesions:

Over how many cm are they classed as lesions?

What may cause discrete lesions:

• Malignancy - 2
• Infection
• Autoimmune

Answer 10

> 3cm

Lung cancer or mets

Abscess

Rheumatoid nodules
Sarcoid