Download Air Fluid Levels You can encounter air fluid levels in chest x

Radiological signs of Disease
Air Fluid Levels
You can encounter air fluid levels in chest
x-rays in the following conditions:
Cavitary lung lesions
Loculated empyema
Hydropneumothorax
Esophageal obstruction
Mediastinal abscess
Hydropneumopericardium
Hiatal hernia
Chest wall abscess
 Most disease processes will either
increase or decrease the density of the
lung parenchyma
 A mediastinal lesion should have a sharp
margin convex towards the lungs and its
base abutting the mediastinum .
 A pleural lesion should be seen as a
homogenously dense opacity abutting the
pleural surface, without air bronchogram. If
the pleural lesion is free fluid, it will gravitate
to the dependant lung parts first to form a
miniscus (concavity) along its upper surface.
 An extra pleural lesion demonstrates a
homogenous density which makes obtuse
angles with the chest wall, or may appear
similar to pleural disease.
 A lung opacity may be due to a mass or
lung- parenchymal opacification.
Identification of clear margins vs
indistinct or diffuse opacification is
important in making the differentiation.If
the diffuse opacification demonstrates
lucencies or air bronchogram within it, it
is most likely air space disease
(consolidation).
Signs of lobar collapse
 Local increase in density due to nonaerated lung.
 Decreased lung volume.
 Displacement of pulmonary fissures.
 Elevation of hemidiaphragm.
 Displacement of hila.
Pleural effusion + lobar densities
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Pneumonia with empyema
Pulmonary infarction
Bronchogenic carcinoma
Tuberculosis
Pleural effusion + subsegmental
atelectasis
 Postoperative (thoracotomy,
splenectomy, renal surgery) secondary
to thoracic splinting + small airway
mucous plugging
 Pulmonary infarction
 Abdominal mass
 Ascites
 Rib fractures
Upper lung zone distribution
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Cystic fibrosis
Ankylosing spondylitis
Sarcoidosis
Silicosis
Histiocytosis (Langerhan's cell)
TB, fungal
Radiation pneumonitis ( cancers of
head/neck and breast)
Peripheral lung zone distribution
 BOOP (bronchiolitis obliterans organizing
pneumonia)
 UIP (usual interstitial pneumonitis, and DIP
desquamative interstitial pneumonitis)
 Infarcts
 Eosinophilic pneumonia
 Alveolar sarcoidosis
 Contusions
'Bat's wing distribution
Acute
Chronic
* Pulmonary oedema:
* Atypical pneumonia
- cardiac
* Lymphoma/Leukemia
- non cardiac
* Sarcoidosis: interstitial
* Pneumonia:
form much more common
- often 'unusual' etiology;
* Pulmonary
alveolar
- pneumocystis carinii (AIDS);
proteinosis
- TB, viral pneumonias;
* Alveolar cell carcinoma:
- mycoplasma.
localised form more
common
* Pulmonary haemorrhage:
- Goodpasture's syndrome;
Wegner's and other vasculitides
- anticoagulants;
- bleeding diathesis: haemophilia,
DIC;
extensive contusion.
LUNG VOLUME
*Reduced
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Idiopathic pulmonary fibrosis.
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Chronic interstitial pneumonia
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Asbestosis
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Collagen vascular disease
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Chronic pulmonary tuberculosis
*Normal
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Sarcoidosis
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Histiocytosis
*Increased
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Bronchial Asthma
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Emphysema
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Lymphangioleiomyomatosis
Reticulations & Hilar Adenopathy
 - Sarcoidosis
 Silicosis
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carcinoma
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obstuction/spread
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-
Lymphoma/leukemia
Lung primary: particulary oat cell
Metastases: lymphatic
Fungal disease
Tuberculosis
Viral pneumonia (rare combination)
Lung mass
 of more than Clinical history and
patient’s age .
 Mass borders .
 Comparison with previous examinations.
 Presence of calcifications.
 Associated adjacent rib erosions, pleural
effusion, hilar or mediastinal nodal
enlargement.
 Presence of more than one mass.
SIGNS OF INTERSTITIAL
DISEASE
Distribution of opacities
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Unifocal or multifocal.
Lobar.
Segmental.
Perihilar.
Peripheral.
Upper, middle or lower zones.
Lung fields appear dark because
of air. Ninety-nine percent of the
lung is air. The pulmonary
vasculature, interstitium
constitute 1% and give the lacy
lung pattern.
You have to know what is normal
before you can recognize
abnormalities. Knowledge of
anatomy is essential for this
purpose.
Which lung is larger?
Which diaphragm is higher and
why?
What is the normal size of the
heart?
What is the normal size and
shape of the aorta?
Silhouette sign is extremely
useful in localizing lung lesions
Silouhette
Adjacent lobe/segment
Right Diaphragm
RLL/Basal segments
Right Heart margin
RML/Medial segment
Ascending Aorta
RUL/Anterior segment
Aortic knob
LUL/Posterior segemnt
Left Heart margin
Lingula/Inferior segment
Descending Aorta
LLL/Superior and medial segments
Left Diaphragm
LLL/Basal segments
Hyperlucent Lung
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Factors
– Vasculature: Decrease
– Air: Excess
– Tissue : Decrease
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Bilateral diffuse
– Emphysema
– Asthma
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Unilateral
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–
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Swyer James syndrome
Agenesis of pulmonary artery
Absent breast or pectoral muscle
Partial airway obstruction
Compensatory hyperinflation
Localized
– Bullae
– Westermark's sign : Pulmonary embolus .
Honeycombing
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Seen in end stage lung disease
Indicative of diffuse interstitial fibrosis
Due to bronchiolectasia
Most of the time in bases
Upper lobe distribution seen in eosinophilic
granuloma
Bronchiectasis
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Normal appearing CXR in most
Tubular shadows
Tram line
Gloved fingers
Mucocele
Ring shadows with thickened bronchial walls
Air fluid levels
Watch for dextrocardia
– Immotile cilia syndrome
 Diffuse lung fibrosis
– Due to recurrent infections
Pulmonary Embolism
.
The primary purpose of a chest film
in suspected PE is to rule out other
diagnoses as a cause of dyspnea
or hypoxia. Most CXRs in patients
with PE are normal.