X Ray Findings Flashcards
Air space opacification (more spec than consolidation)
Infection or pulmonary oedema
Types of opacification
Hazy or patchy
Differentiating between pulmonary oedema and infection
PO typically bilateral and spares the upper lobes, infection can be unilateral and lobar of any part of the lung
Atelectasis
Collapse of a part of the lung due to a decrease in the amount of air - creates increased volume and increased density
Key findings of consolidation
ill-defined homogenous opacity obscuring vessels, silhouette sign, air bronchogram, no volume loss, extension to pleura or fissure but doesn’t cross it
Silhouette sign
Loss of lung/soft tissue interface - blurring of lines
White out
Whole lung dense opacification
Clips on trachea/ hilum
surgical clips
Checking for hyperinflation
Count anterior ribs - 5-7th rib should intersect diaphragm. Is Diaphragm normal curved shape? flat = hyperinflation
Meniscus sign
Pleural effusion - concave surface of white opacification
Looking for rotation
Look at clavicle and spinous processes are they in line - clavicle moves away from spine on side of rotation
AP portable film be aware
Patient sick bed bound - technical quality likely poor
Look thoroughly around the edge of the pleura for
Pneumothorax
Pushed tracheal deviation
Anything that increases pressure or volume in the hemithorax - will push trachea and mediastinum - hyperinflation and pneumothorax
Pulled tracheal deviation
Any disease which causes volume loss in one hemithorax will pull the trachea over towards that side - collapse
Bilateral symmetrical hilar enlargement suspicious of
Sarcoidosis - particularly when there is paratracheal enlargement, or lung parenchymal shadowing. DDx - pulmonary arterial hypertension
Asymmetric hilar enlargement
TB importantly
Lung infarction
PE usually has a normal CXR, could see peripheral consolidation in region of emboli - haemorrhage
Congestive heart failure
bilateral perihilar consolidation with air bronchograms and ill-defined borders
an increased heart size
subtle interstitial markings
probably a large vascular pedicle (distance from lateral border of SVC and subclavian artery origin)
Bronchopneumonia
multi focal, ill-defined densities progresses to diffuse consolidation
Batwing appearance
Bilateral perihilar consolidation - sparing at the peripheries due to better lymphatic drainage
Stage 0 sarcoidosis
Normal CXR
Stage 1 sarcoidosis
Hilar or mediastinal nodal enlargement (white opacities around hilar rest of lung normal)
Stage 2 sarcoidosis
Nodal enlargement and parenchymal disease (opacities are more diffuse into pulmonary vessels - larger white area)
Stage 3 sarcoidosis
Parenchymal disease (less intense opacity in centre, still diffuse opacity)
Stage 4 sarcoidosis
Pulmonary fibrosis (reticular shadowing, small lung volume)
Idiopathic pulmonary fibrosis (usual interstitial pneumonia)
Reticulonodular infiltrates on chest xray -basilar, peripheral, bilateral, asymmetrical
Non-specific interstitial pneumonia
Ground glass opacity
Pneumoconiosis - silicosis and coal worker’s lung
progressive upper zone calcified ‘egg shell calcification’, progressively affects all zones
Pneumoconiosis - silicosis and berilliosis
Upper zone linear interstitial fibrosis
Acute and sub-acute hypersensitivity pneumonitis (low specificity)
patchy nodular infiltrates
Chronic HSP (low specificity)
Fibrosis
TB
Fibronodular opacities in upper lobes (sharply defined opacities found in clusters) with or without cavitation.
Atypical TB
Opacities in lower lobes
HAP
opacity, blurring of diaphragm or heart borders
CAP
consolidation, effusion, cavitations
bronchiectasis
round black circles surrounded by dense opacity - thin walled ring shadows. tubular opacities. may be normal, or show skewed hemidiaphragm
lobectomy
changed shape or volume of the lung - typically raised
Lung abscess
consolidation in lobar distribution with central cavitation cavity wall thick and irregular,
Asthma
normal or hyper inflated - excludes other pathologies
COPD
rules out other pathologies. Hyperinflation, flattened diaphragm, increased intercostal spaces, hyperlucent lungs
small cell lung cancer
central mass, lymphadenopathy, pleural effusion
non-small cell lung cancer
single or multiple pulmonary nodules, mass, pleural effusion, lung collapse, mediastinal or hilar fullness
tension pneumothorax
heart trachea and mediastinum can be shifted to one side, in combination with a black space containing no lung markings and a collapsed lung - grey shape with convex border
pneumothorax
a black space containing no lung markings and a collapsed lung - grey shape with convex border(plueral line)
pleural effusion
a dense white shadow with a concave upper edge.
small pleural effusion
can cause no more than blunting of a costophrenic angle
large pleural effusion
can cause a ‘white out’ of an entire hemi-thorax, with shift of the mediastinum to the opposite side
If patient is only able to be in supine when imaging PTX or pleural effusion..
a lateral decubitus film should be performed
Sail sign
Left lower lobe diagonal line like a sail obscuring portion of heart - suggests lower lobe collapse
