CXRs Flashcards
Insidious onset of shoulder pain.
Patient Data
Age: 30 years
Gender: MaleInsidious onset of shoulder pain.
Patient Data
Age: 30 years
Gender: MalePatient with a known condition presenting with cough.
Patient Data
Age: 20 years
Gender: Male
Interstitial thickening and bronchial wall thickening with an upper zone predominance.
Dilated peripheral bronchioles are also seen in both upper zones.
Thick-walled cylindrical bronchiectasis involving the upper zones is typical of cystic fibrosis.
Age: Young adult
Gender: Female
Pul AVM - HHT
Age: Young adult
Gender: Female
Pul AVM - HHT
Asymptomatic adult.
Lucent right hemithorax.
CT: absence of pectoralis major and minor muscle on the right side. Poland syndrome
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
Marked cardiomegaly with dilatation of the main pulmonary artery.
Bilateral pulmonary plethora.
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
https://radiopaedia.org/play/25685/entry/460588/case/44398/studies/48040?lang=gb#findings
PDA measuring ~16 mm.
Ascending aorta + arch = dilated
- aortic diameter returning to normal limits at the proximal descending thoracic aorta.
Marked cardiomegaly mainly from left atrial and left ventricular dilatation.
Mild right ventricular wall thickening is present, suggestive of hypertrophy.
Marked dilatation of main pulmonary artery.
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
PDA closure device noted - appropriately positioned.
Marked enlargement of the pulmonary arteries + bilateral pulmonary plethora.
Enlarged cardiac contour - stable.
no hx
An enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally.
Dx: Pulmonary arterial hypertension
https://radiopaedia.org/play/25685/entry/460589/case/8653/studies/9468?lang=gb#findings
enlarged bronchial arteries.
right atrium + right ventricle are significantly dilated
complete inversion of the intraventricular septum = now convex toward the left ventricle = pulmonary arterial hypertension.
Lung window:
cystic change peripherally, anteriorly and laterally,
multiple wedge shape but small pleural based consolidations = healing or healed pulmonary infarctions.
The central main pulmonary artery shows irregularity although the wall thickening = laminated chronic embolism.
extensive eccentric bronchial wall thickening in RLL,
abrupt termination of blood vessels in the LUL
in RUL there is evidence of abrupt occlusion of vessels.
Dx: Pulmonary arterial hypertension
Age: 50 - 60 yrs
Gender: Female
Dx: Pulmonary arterial hypertension
Age: 15 years
Gender: Female
bronchiectasis: ring shadows and tram-track opacities are seen throughout both lungs, particularly in the upper zones.
Dx: CF
Patient with skin nodules and abnormal pigmentations.
Patient Data
Gender: Male
multiple nerve schwannomas
ribbon ribs.
Dx: NF1
sob
Hazy opacity in the left hemithorax
lucency near the aortic arch (luftsichel sign).
Left sided volume loss.
Dx: LUL collapse
child
HTN upper extremeties
lower limbs = cold + delayed brachio-fem pulses
Turner syndrome, biscupid aortic valve
focal indentation of the distal aortic arch - figure of 3 sign.
No definite inferior rib notching (cos of collaters)
Dx: coarctation of the aorta.
Age: 17 years
Gender: Male
focal indentation of the distal aortic arch - figure of 3 sign.
CT:
https://radiopaedia.org/play/25685/entry/462514/case/9434/studies/10118?lang=gb#findings
Progressive shortness of breath.
Patient Data
Age: 80 years
Gender: Male
bilateral diffuse upper lobe reticular opacification
occasional scattered mass like opacities.
Progressive shortness of breath.
Patient Data
Age: 80 years
Gender: Male
Upper zone predominant mass-like scarring + calcification + volume loss.
Hilar + mediastinal lymph node calc
No cavitary changes
Left pleural effusion.
DDx:
Beryliosis,
Radiation,
EAA/Eos
Granuloma LCH,
Silicosis,
TB,
Sarcoid
Features are in keeping with silicosis and progressive massive fibrosis (PMF).
Recognised occupational lung disease in a former ventilation engineer presenting with cough and fever.
Patient Data
Age: 70 years
Gender: Male
?Occ exposure
?Ca assoc
?Atelectasis assoc
Calcific pleural plaque.
In view of occupational exposure, asbestosis should be considered.
Assoc Ca? Bronchogenic carcinoma and mesothelioma.
Can see Round atelectasis (folding of pleura = mass-like appearance - Blesovsky syndrome)
Long history of respiratory wheeze and chronic cough.
Patient Data
Age: 35 years
Gender: Male
RUL
- tubular branching opacities = opacification of RUL bronchiectasis.
- most likely due to trapped mucous
- in pt w/ long standing wheeze = ABPA
- opacified expanded bronchi = finger-in-glovesign
LUL
- number of parallel lines = represent the walls of dilated bronchi -> extending from hilum (tram track) = bronchiectasis.
Next step = CT to confirm bronchiectasis + mucous plugging.
Long history of respiratory wheeze and chronic cough.
Patient Data
Age: 35 years
Gender: Male
Single axial image through upper zones
- left = presence of bronchiectasis + movement degraded
- right = dilated bronchi = filled with secretions
“Glove like” opacity in the right upper zone (yellow dotted line) represents sputum plugged bronchiectasis.
Air-filled bronchiectasis is seen bilaterally (green arrows).
Can also see: Transient patchy areas of consolidation #eosinophilic pneumonia
ABPA Major criteria = central bronchiectasis, pulmonary eosinophilia, asthma, blood eosinophilia, immediate skin reactivity to Aspergillus antigen, increased serum IgE.
Routine pre-operative chest radiograph prior to surgery for urethral stenosis. 50 year smoking history.
Patient Data
Age: 75 years
Gender: Male
Frontal:
Ill-defined bilateral hila
Multiple calcified adenopathies in hila + retrocardiac space.
Right CP angle blunting.
Aortic arch elongated and calcified.
Lateral:
“eggshell” calcification of multiple adenopathies along the mediastinum + bilateral pulmonary hila.
Dx: Silicosis (with egg shell calcification)
DDx: lymph node calcification:
benign:
tuberculosis
histoplasmosis
sarcoidosis
silicosis
coal worker’s pneumoconiosis
amyloidosis
malignant:
treated lymphoma and metastases
Aids to differentiating cause: silicosis vs sarcoidosis vs tuberculosis
calcified lymph nodes in tuberculosis tend to affect the mediastinum asymmetrically and unilaterally
diffuse bilateral lymph node involvement is more common in sarcoidosis
silicosis: the patient usually has a history of a silica-exposure related job (as in this case)
Back pain. History of sarcoidosis.
Patient Data
Age: 60 years
Gender: Female
Lung fibrosis
- more severe on right - right apex.
Hila pulled cranially, trachea pulled to right.
Bilateral hilar lymph nodes with peripheral calcification.
Right hemidiaphragm higher than the left, probably pulled by severe fibrosis.
Dx: End-stage (stage 4) pulmonary sarcoidosis
Shortness of breath.
Patient Data
Age: 50 years
Gender: Male
Veiling opacity in the right hemithorax,
- pleural effusion.
Most likely infective exacerabation COPD. Also right sided chest pain.
Patient Data
Age: 85 years
Gender: Male
RUZ completely opaque
- volume loss
- elevation of horizontal fissure
- tracheal deviation to right.
- Patchy opactiy in the right lung base.
Most likely infective exacerbation COPD. Also right sided chest pain.
Patient Data
Age: 85 years
Gender: Male
https://radiopaedia.org/play/25685/entry/465882/case/40240/studies/42780?lang=gb#images
RUL + right volume loss.
- RUL bronchus = truncated at its origin.
Mediastinal LNopathy (right paratracheal + pretracheal nodes).
Background of centrilobular emphysema.
Biopsy -> DIAGNOSIS: Right upper lobe lesion biopsies: Poorly differentiated squamous cell carcinoma.
Increasing breathlesness over many months
Patient Data
Age: 55
Gender: Female
Coarse reticular infiltrate @B/L upper lobes+ volume loss on both sides.
Increasing breathlesness over many months
Patient Data
Age: 55
Gender: Female
https://radiopaedia.org/play/25685/entry/465889/case/34388/studies/35695?lang=gb#images
Mediastinum calcified lymph nodes.
Architectural distortion of lung tissue,
Fibrosis #predominantly @ both upper zones.
Multiple pulmonary nodules bilaterally
- subpleural
- along fissures
Multiple ill defined conglomerate masses
Dx: sarcoidosis
No hx
Multiple tiny subcentimeter miliary opacities = throughout both lungs.
Uniform size, dense = calcification
Dx: Healed varicella pneumonia - miliary opacities
Presented to the GP with chronic cough. Patient had an incidental eosinophilia a year ago.
Patient Data
Age: 40 years
Gender: Female
Patchy air space opacities in bilateral upper zones.
Presented to the GP with chronic cough. Patient had an incidental eosinophilia a year ago.
Patient Data
Age: 40 years
Gender: Female
Reversed halo pattern (atoll sign):
- focal round areas of GGO
- surrounding crescent/ring shaped consolidation.
Reversed halo shape of a daisy
Dx: Cryptogenic organising pneumonia
Age: Adult
Gender: Female
LUL collapse
volume loss, such as elevation of the hemidiaphragm,
crowding of the left sided ribs,
shift of the mediastinum to the left.
Age: Adult
Gender: Female
LUL collapse
volume loss, such as elevation of the hemidiaphragm,
crowding of the left sided ribs,
shift of the mediastinum to the left.
Presentation
SOB and hypoxia.
Patient Data
Age: 75 years
Gender: Female
LUL collapse + Left hilar mass
mild volume loss, such as
-elevation of the hemidiaphragm,
-shift of the mediastinum to the left.
Cough and dyspnoea.
Patient Data
Age: 35 years
Gender: Male
Left upper lobe collapse - LINGULA
obliteration of the left cardiac silhouette.
The descending aorta and hemidiaphragm are still clearly visible.
Shortness of breath
Patient Data
No patient data supplied by author
veil-like opacity over left upper zone + Luftsichel sign.
Left upper lobe collapse with hilar mass
Chest pain and shortness of breath in a middle aged female
Patient Data
Age: 45
Gender: Female
Two circular artifactual opacities
identical contours to the breast
project over the lower thoracic cavity.
Breast implants
Attendance at ED with a racing pulse and anxiety
Patient Data
Age: 35 years
Gender: Female
Two concentric opacities
- the outer representing the normal breast tissue and
- the inner the capsule of the implant.
Breast prostheses
Smoker.
Patient Data
Age: 35 years
Gender: Male
Widespread cystic lung disease
- with cysts of varying sizes and shape and
- relative sparing of the lung bases!!!!!!!!!!!!!!!!!!!!! #CPangles
- Infrequent small solid nodules.
CT:
https://radiopaedia.org/play/25685/entry/469941/case/10757/studies/11217?lang=gb#findings
Langerhans cell histiocytosis
Chest pain
Patient Data
Age: 85 years
Gender: Female
Generalised prominence of the interstitial markings throughout the lungs.
An 8 mm pulmonary nodule projects within the right mid-upper zone.
Bilateral high riding humeral heads with extensive degenerative change including of the undersurface of the acromion.
Chest pain
Patient Data
Age: 85 years
Gender: Female
https://radiopaedia.org/play/25685/entry/470180/case/44769/studies/48583?lang=gb
Bilateral small pleural effusions
mild posterior basal atelectasis
peribronchial thickening
interlobular septal thickening/Kerley B lines = interstitial pulmonary oedema, with
accompanying subtle peribronchial ground glass + scattered centrilobular nodules = likely reflecting an early mixed airspace component of oedema.
Dx: Interstitial pulmonary oedema
Fall. Query rib fracture.
Patient Data
Age: 80 years
Gender: Male
Lobulated pleural opacity
encasing the right lung,
with associated volume loss.
No definite bony erosion / destruction or calcified pleural plaques seen.
https://radiopaedia.org/play/25685/entry/470190/case/26805/studies/26965?lang=gb
Mesothelioma
Chest pain
Patient Data
Age: 20 years
Gender: Female
obscuration of the right heart border
Lateral projection confirms the right middle lobe is clear + pectus excavatum
Pectus excavatum
Motor vehicle collision. Intubated.
Patient Data
Age: 45 years
Gender: Male
Malpositioned nasogastric tube located in the mid oesophagus
ETT and bilateral pneumocatheters.
Deep sulcus sign on the left in keeping with a large left pneumothorax.
Right apical pleural capping and widening of the superior mediastinum.
https://radiopaedia.org/play/25685/entry/471540/case/47381/studies/51986?lang=gb#findings
Cough
Patient Data
Age: 85 years
Gender: Male
large right upper lobe cavitary lesion, with air-fluid level.
Left midzone atelectasis.
C: cancer
bronchogenic carcinoma: most frequently SCC
cavitatory pulmonary metastasis(es): again most frequently SCC
A: autoimmune; granulomas from
Wegener’s granulomatosis
rheumatoid arthritis (rheumatoid nodules) etc.
V: vascular (both bland and septic pulmonary embolus)
I: infection (bacterial/fungal)
pulmonary abscess
pulmonary tuberculosis
T: trauma - pneumatocoeles
Y: youth
CPAM
pulmonary sequestration
bronchogenic cyst
Shortness of breath. Previous manual labourer. History of coronary artery bypass graft.
Patient Data
Age: 70 years
Gender: Male
midline sternotomy sutures
B/L
pleural plaques = holly-leaf asbestos #
calc
diaphragm + lateral = avoid apices + CP angles
- holly-leaf appearance
hyperinflated
Patient Data
Age: 75 years
Gender: Male
Well-defined ovoid opacity projected over the RUZ projected between 5-6th posterior right rib
CT: well-defined ovoid fat density + calc = PUL HAMAROTMA
No patient data supplied by author
CXR demonstrates an enlarged heart + prominent vascularity.
The aortic arch is normal or small and
left atrium does not appear enlarged.
An ASD closure device is noted.
Patient Data
Age: 17 years
Gender: Male
Small right lung + diminished vascular markings,
ipsilateral mediastinal shift.
Compensatory hyperinflation of left lung,
prominent left pulmonary artery + vascular markings.
Increased retrosternal space on lateral film, filled by superior lingular segment.
Patient Data
Age: 17 years
Gender: Male
https://radiopaedia.org/play/25685/entry/472239/case/52180/studies/58069?lang=gb
Absent right pulmonary artery.
Small right lung with peripheral fibrotic and cystic changes.
Numerous delicate linear opacities radiating from pleura into parenchyma of right lung = of collateral transpleural arteries (lung window).
Hyperinflated left lung, particularly superior lingular segment, with prominent pulmonary arteries.
Dx: Isolated absence of the right pulmonary artery
Patient Data
Age: Child
Overexpansion and hyperlucency of the left upper lobe.
post-infectious bronchiolitis obliterans consistent with Swyer-James syndrome.
Abdominal pain.
Patient Data
Age: 70 years
Gender: Male
Bilateral pleural plaques = holly leaf shaped
- calficied
- diaphragm + lateral
Right hemidiaphragm raised ?volume loss
Asbestos exposure
Presentation
Shortness of breath.
Patient Data
Age: 50 years
Gender: Female
Mediastinal sutures #right. Right subclavian line.
LArge opacity with wth air-fluid level right medial hemithorax
RLZ opacificatoin ill-defined conflent
small left pleural effusion.
post Ivor Lewis procedure
- oesophagectomy,
-gastric pull-up, and
-gastro-oesophageal anastomosis for disease (e.g. oesophageal cancer) in the distal two-thirds of the oesophagus.
The presence of surgical clips is key for not mistaking this for mega-oesophagus.
Presentation
Initial CXR performed for cough.
Patient Data
Age: 30 years
Gender: Female
Abnormal outline of the aortic knuckle
an indentation suggesting figure 3 sign of aortic coarctation.
https://radiopaedia.org/play/25685/entry/473514/case/18771/studies/18691?lang=gb
COARCTATOIN
chronic sinusitis
Patient Data
Age: 15 years
Gender: Female
dextrocardia
gastric air bubble on the right side
left-sided azygous fissure
Primary ciliary dyskinesia.
Complete situs inversus (situs inversus totalis), chronic sinusitis, bronchiectasis
Dx:
Cystic Fibrosis,
ABPA,
Postinfectious Bronchiectasis,
Immune Deficiency Disorders,
Young Syndrome
Presentation
Presented to the ED post collapse. A chest radiograph was carried out along other tests in the workup of collapse, which eventually was found due to a cardiac arrythmia.
Patient Data
Age: 80 years
Gender: Female
rounded ring shadows in the left upper zone represent = Plombage #TB
volume loss in the left hemithorax.
Several rounded ring shadows are seen in the left upper zone, with intervening radiopaque material.
Calcified hilar lymph nodes are evident.
There is left upper chest deformity with several ribs missing or fractured.