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Abnormal chest radiograph part 1

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Ben Widaja

This document describes how to identify different types of abnormalities on a chest radiograph, including lung collapse, pneumonectomy, and mediastinal masses. It provides examples of specific abnormalities like right upper lobe collapse, left lower lobe collapse, and left-sided pneumonectomy. For each abnormality, it identifies key radiographic findings such as changes in lung volumes, diaphragm or heart positioning, tracheal deviation, and silhouette signs. The goal is to recognize changes that indicate different pathologies based on comparison to normal anatomy.

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Abnormal Chest Radiograph – part 1 B Widaja Awesomemedicalnotes.wordpress.com
Describe the abnormality
Collapse  Compare with previous films if available (new or long standing?)  Lung fields – right lung should be larger than left. If not, suspect area of right sided collapse  Diaphragms – right diaphragm should be higher than left. Distortion may suggest left sided collapse  Horizonal fissure in right lung – If pulled up, suspect right upper lobe collapse. If pulled down, suspect right lower lobe collapse  Trachea – pulled towards area of collapse  Heart – deviated towards side of collape  Borders (diaphragm, heart or mediastinum) – blurred if lung adjacent to it is collapsed (silhouette sign)
Case 1
Case 1  Right upper lobe collapse ◦ Shadowing in upper zone of right lung (1) ◦ Horizontal fissure is elevated ◦ Tracheal deviation towards the right (2) ◦ Ribs over shadowing are closer together than normal
Case 2
Case 2  Right middle lobe collapse ◦ Right diaphragm may be slightly raised (1) ◦ Horizontal fissure may be slightly lower than usual (2) ◦ Upper part of lower zone may have hazy shadowing (3) ◦ Right heart border may be indistinct
Case 3
Case 3  Right lower lobe collapse ◦ Whiteness immediately above the diaphragm (1) causing loss of its outline ◦ Right heart border maintained
Case 3
Case 3  Left upper lobe collapse ◦ Most left upper lobe lies in front of lower lobe ◦ Collapse of upper lobe causes a haze to appear over the whole left lung field
Case 4
Case 4  Left lower lobe collapse ◦ Left lower lobe collapses behind heart ◦ Heart shadow appears whiter ◦ Double left heart border (sail sign) ◦ Left hemidiaphragm border can’t be followed to spine
Describe the abnormality
Volume loss - pneumonectomy  Mediastinum ◦ tracheal deviation towards side of pneumonectomy. ◦ Heart border not visible  Contralateral lung field ◦ Hyperinflation of contralateral lung due to mediastinal shift. ◦ Appears darker (unaffected lung over-inflate, causing vessels to become more spread out, hence reduced vascular markings)  Diaphragm ◦ Upper border obliterated  Ribs ◦ Pneumonectomy usually involve cutting or removing ribs during operation. Look for rib deformity or absence of rib. Usually 5th rib  Note extensive hypoplasia or congenital absence of one lung may cause similar appearance
Case 5  Left sided pneumonectomy ◦ Left hemithorax white ◦ Left mediastinal shift ◦ Lft ribs crowded together ◦ Slight curvature of spine ◦ Right lung hyperinflated + crosses over midline
Case 6
Case 6  Right upper lobe lobectomy ◦ Volume loss of right lung ◦ Right tracheal deviation ◦ Remaining right lung hyperinflated, appea rs darker ◦ Right diaphragm – diagphragmatic tenting
Case 7
Case 7  Mass lesion in mediastinum ?enlarged thyroid gland ◦ Tracheal deviation caused by mass ◦ Long volume, ribs and diaphragms are normal

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Abnormal chest radiograph part 1

  • 1. Abnormal Chest Radiograph – part 1 B Widaja Awesomemedicalnotes.wordpress.com
  • 3. Collapse  Compare with previous films if available (new or long standing?)  Lung fields – right lung should be larger than left. If not, suspect area of right sided collapse  Diaphragms – right diaphragm should be higher than left. Distortion may suggest left sided collapse  Horizonal fissure in right lung – If pulled up, suspect right upper lobe collapse. If pulled down, suspect right lower lobe collapse  Trachea – pulled towards area of collapse  Heart – deviated towards side of collape  Borders (diaphragm, heart or mediastinum) – blurred if lung adjacent to it is collapsed (silhouette sign)
  • 5. Case 1  Right upper lobe collapse ◦ Shadowing in upper zone of right lung (1) ◦ Horizontal fissure is elevated ◦ Tracheal deviation towards the right (2) ◦ Ribs over shadowing are closer together than normal
  • 7. Case 2  Right middle lobe collapse ◦ Right diaphragm may be slightly raised (1) ◦ Horizontal fissure may be slightly lower than usual (2) ◦ Upper part of lower zone may have hazy shadowing (3) ◦ Right heart border may be indistinct
  • 9. Case 3  Right lower lobe collapse ◦ Whiteness immediately above the diaphragm (1) causing loss of its outline ◦ Right heart border maintained
  • 11. Case 3  Left upper lobe collapse ◦ Most left upper lobe lies in front of lower lobe ◦ Collapse of upper lobe causes a haze to appear over the whole left lung field
  • 13. Case 4  Left lower lobe collapse ◦ Left lower lobe collapses behind heart ◦ Heart shadow appears whiter ◦ Double left heart border (sail sign) ◦ Left hemidiaphragm border can’t be followed to spine
  • 15. Volume loss - pneumonectomy  Mediastinum ◦ tracheal deviation towards side of pneumonectomy. ◦ Heart border not visible  Contralateral lung field ◦ Hyperinflation of contralateral lung due to mediastinal shift. ◦ Appears darker (unaffected lung over-inflate, causing vessels to become more spread out, hence reduced vascular markings)  Diaphragm ◦ Upper border obliterated  Ribs ◦ Pneumonectomy usually involve cutting or removing ribs during operation. Look for rib deformity or absence of rib. Usually 5th rib  Note extensive hypoplasia or congenital absence of one lung may cause similar appearance
  • 16. Case 5  Left sided pneumonectomy ◦ Left hemithorax white ◦ Left mediastinal shift ◦ Lft ribs crowded together ◦ Slight curvature of spine ◦ Right lung hyperinflated + crosses over midline
  • 18. Case 6  Right upper lobe lobectomy ◦ Volume loss of right lung ◦ Right tracheal deviation ◦ Remaining right lung hyperinflated, appea rs darker ◦ Right diaphragm – diagphragmatic tenting
  • 20. Case 7  Mass lesion in mediastinum ?enlarged thyroid gland ◦ Tracheal deviation caused by mass ◦ Long volume, ribs and diaphragms are normal