Radiological signs of Disease

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Radiological signs of Disease
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Air Fluid LevelsYou can encounter air fluid
levels in chest x-rays in the following
conditionsCavitary lung lesions Loculated
empyema Hydropneumothorax Esophageal
obstruction Mediastinal abscess
Hydropneumopericardium Hiatal hernia Chest
wall abscess
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• Most disease processes will either increase or
  decrease the density of the lung parenchyma

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• A mediastinal lesion should have a sharp margin
  convex towards the lungs and its base abutting
  the mediastinum .

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• 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.

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• 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).

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Signs of lobar collapse

• Local increase in density due to non-aerated
  lung.
• Decreased lung volume.
• Displacement of pulmonary fissures.
• Elevation of hemidiaphragm.
• Displacement of hila.

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Pleural effusion lobar densities

• Pneumonia with empyema
• Pulmonary infarction
• Bronchogenic carcinoma
• Tuberculosis

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Pleural effusion subsegmental atelectasis

• Postoperative (thoracotomy, splenectomy, renal
  surgery) secondary to thoracic splinting small
  airway
• mucous plugging
• Pulmonary infarction
• Abdominal mass
• Ascites
• Rib fractures

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Upper lung zone distribution

• Cystic fibrosis
• Ankylosing spondylitis
• Sarcoidosis
• Silicosis
• Histiocytosis (Langerhan's cell)
• TB, fungal
• Radiation pneumonitis ( cancers of head/neck and
  breast)

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Peripheral lung zone distribution

• BOOP (bronchiolitis obliterans organizing
• pneumonia)
• UIP (usual interstitial pneumonitis, and DIP
• desquamative interstitial pneumonitis)
• Infarcts
• Eosinophilic pneumonia
• Alveolar sarcoidosis
• Contusions

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'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.

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LUNG VOLUME

• Reduced
• Idiopathic pulmonary fibrosis.
• Chronic interstitial pneumonia
• Asbestosis
• Collagen vascular disease
• Chronic pulmonary tuberculosis
• Normal
• Sarcoidosis
• Histiocytosis
• Increased
• Bronchial Asthma
• Emphysema
• Lymphangioleiomyomatosis

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Reticulations Hilar Adenopathy

• - Sarcoidosis
• Silicosis
• - Lymphoma/leukemia
• - Lung primary particulary oat cell
  carcinoma
• - Metastases lymphatic obstuction/spread
• - Fungal disease
• - Tuberculosis
• - Viral pneumonia (rare combination)

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Lung mass

• of more than Clinical history and patients 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.

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SIGNS OF INTERSTITIAL DISEASE
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Distribution of opacities

• Unifocal or multifocal.
• Lobar.
• Segmental.
• Perihilar.
• Peripheral.
• Upper, middle or lower zones.

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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.
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You have to know what is normal before you can
recognize abnormalities. Knowledge of anatomy is
essential for this purpose.
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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?
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Silhouette sign is extremely useful in localizing
lung lesions
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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
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Hyperlucent Lung

• Factors
• Vasculature Decrease
• Air Excess
• Tissue Decrease
• Bilateral diffuse
• Emphysema
• Asthma
• Unilateral
• Swyer James syndrome
• Agenesis of pulmonary artery
• Absent breast or pectoral muscle
• Partial airway obstruction
• Compensatory hyperinflation
• Localized
• Bullae
• Westermark's sign Pulmonary embolus .

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Honeycombing

• 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

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Bronchiectasis

• 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

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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. 

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