Common Chest X-ray

CXR-1: Hyperinflation and increased translucency of both lung fields

Type of X-ray: Plain X-ray chest PA view.

Findings: Hyperinflation and increased translucency of both lung fields with smaller (tubular) heart.

Diagnosis: Acute asthma.

Mechanism of image findings:

The findings are due to widespread narrowing of different sized

airways from spasm of bronchial smooth muscles, edematous swelling of the airways due to

vasodilation with increased permeability and mucous gland hypersecretion. Air can proceed beyond

narrow airway during inspiration but can not come out efficiently during expiration. So, inspired air is

trapped in the alveoli with their distension and radiologically seen as hyperlucent.

Fig: RT sided pleural effusion

Fig: Left sided pleural effusin.

Common Radiological Findings of pleural effusion :

1.Dense Homogenous opacity in lower zone(rt/left/both)

2.Obliteraton of Costophrenic angle(Right/left/both)

3.Trachea & heart(mediastinum) shift to opposite side

fig: RT sided pleural effusion

Percusion finding :

1.Stony dall 

Auscultation

1.Breath sound diminished /absent 

Common cause PE:

1.Pulmonary TB 

2.Parapeumonia

3.pulmonary infarction 

4.Branchial Carcinoma

Fig: Bronchiectasis x-ray

Bronchiectasis X-ray Findings :

chest X-ray show multiple ring shadows involving the mid & lower zone of (both/right/left) lungs fields more on Right side. 

Common causes :

1.Childhood pneumonia 

2.pulmonary infection like measles, whooping cough.

Fig: pneumonic consolidation(rt)

Fig: pneumonic consolidation(rt)

Pneumonic consolidation  X-ray findings :

x-ray showing 

1.Dense, homogenous opacity involving (right/left/both) lungs field with air bronchogram within its.

2.Trachea is cental in position. 

3.Costophrenic & cardiophrenic angle normal

4.Domes of diaphragm normal in position. 

5.Transverse diameter of Cardiac shadow is normal.

common cause of consolidation :

Pneumonia

Common D/D x-ray:

1.Consolidation 

2.TB 

3.Bronchial carcinoma

Percussion Findings:

woody dull 

Type of X-ray: Plain X-ray chest AP view:Acute Bronchiolitis x-ray

Findings:

1. Hyperinflation as noted by depression of domes of the diaphragm

CXR-1: hyperinflation & increased translucency

CXR-2: Only hyperinflation

2.ribs are seen more horizontal 

3. increased translucency, the lungs fields look more black than normal.

fig: Hyperinflation

Diagnosis:

Acute bronchiolitis.

Mechanism of image findings:

In acute bronchiolitis, air is trapped in the alveoli because of

narrowing of bronchioles by inflammatory edema and mucosal plugging.

Type of X-ray: X-ray chest AP & lateral view

CXR-1: frontal: Left sided hyperinflation

Findings:

CXR-1:

1. Increased translucency of the left lung field

2. Pushing down of left dome of the diaphragm

3. Shifting of heart to the right hemithorax

4. Flattening of the ribs

All these above features are characteristics of unilateral hyperinflation suggesting ‘ball-valve’ effect of

FB in the left principal bronchus.

CXR-2 left lateral: FB in left principal bronchus

CXR-2:

A small radio-opaque shadow is seen in the airway

Mechanism of image findings:

Here the foreign body block the right principal bronchus (CXR-2)

in such a way that it allows air to pass beyond the block during inspiration but prevents the air from

coming out during expiration (ball-valve effect) (Pic 1). This leads to air trapping causing increased

translucency, unilateral hyperinflation, mediastinal shifting to the right side and depression of left dome

of the diaphragm.

Type of X-ray: Plain CXR AP view.

CXR-1: Collapse of left lungs

Findings:

1. Opacification of left hemithorax

2. Pulling of the mediastinum (trachea and heart) towards the left side

3. Crowding of the ribs in the left side

4. Elevation of the left hemi-diaphragm

5. Compensatory hyperinflation of the right lung

6. Air-bronchogram on the left side

Diagnosis: Lung collapse on the left side.

Mechanism of image findings:

Lung-collapse is the result of loss of air in a lung or part of the lung

with subsequent volume loss due to complete airway obstruction on the affected side (absorption

collapse). In addition collapse can also occur due to pleural effusion or pneumothorax (pressure

collapse). In that case, mediastinum will be pushed to the opposite side.

NB: Note that the term “atelectasis” is typically used when there is partial collapse, whereas the term

“collapsed lung” is typically reserved for when the entire lung is collapsed.

Type of X-ray: Plain X-ray chest AP view.

CXR-1: Conflunt opacities seen scattered throughout both the lung fields (L > R)

Findings:

Conflunt opacities seen scattered throughout both the lung fields.

Diagnosis: Bronchopneumonia (post-measles).

Mechanism of image findings:

Wide spread infection of the lung parenchyma with outpouring of inflammatory

exudate in the alveoli in an immuno-compromized state induced by measles infection.

Type of X-ray: Plan X-ray chest P-A view:

CXR-1: Fine reticulation with tiny nodular  opacities seen mostly in the perihilar and right

para cardiac region

CXR-2: Lateral view showing perihilar infiltrates

Findings: Fine reticulation with tiny nodular opecities

seen mostly in the perihilar and right para cardiac region.

The lesions are not associated with pleural effusion.(CXR-1 & 2)

Diagnosis:

Interstitial pneumonia

Mechanism of image findings:

Atypical organisms cause inflammation in pulmonary interstitium in

between the alveoli, giving the appearance of reticulo-nodular pattern and linear thread like opacity in lungs.

Type of X-ray: Plain X-ray chest A-P view:

CXR-1: Viral pneumonia

Findings:

Diffuse fluffy opacities in both lung fields with ground glass appearance in right upper and mid zones.

Note:

Pleural effusion, hilar lymphadenopathy and pneumothoraxare uncommon findings.

Type of X-ray: Plain X-ray chest AP view:

Fig: Anatomy of pneumonia

Findings:

Punctate and mottled densities are present in both lungs.

Diagnosis:

Chemical pneumonitis.

Mechanism of image findings:

Aspiration of kerosene into the respiratory tract causes

inflammation of lung parenchyma. The major effects of inflammation are chemical pneumonitis,

atelectasis, pulmonary edema and pneumothorax.

Lungs Abscess X-ray findings :

Fig: CXR lung Abscess

1.x-ray showing a cavitations with air-fluid level (right/left lungs) & Rest of lungs Fields clear.

2.Trachea is central in position. 

Percussion Node:

Dull 

Auscaltation node :

Brinchial breath sound, increase vocal reasonance.

X-ray Pneumothorax:

Fig: CXR Tension pneumothorax

Pneumothorax X-ray findings :

X-ray chest posterior anterior view shows -

1.Increased translucency with a clear cut collapsed lung margin (Rt/lt)

2.Absence of vascular marking lateral to the collapsed lung margin (Right/left)

3.Rest of the lung fields are clear

4.Tracheais shifted to the left

5.Transverse diameter of the cardiac shadow is normal

Types of pneumothorax?

comothrax (spontaneous) is of three types

1.Closed type : The communication between lungs & pleural space seals off.

2.Open type : The communication between lungs & pleural space fails to seal & air

continue to transfer freely.

3.Tension type: The communication between lungs & pleural space is small, it acts as

an one way valve allowing air to enter the pleural space during inspiration but not to escape on expiration.

What is the presenting features of pneumothorax?

1. Sudden onset of unilateral pleuritic chest pain

2. Breathlessness diseases if any

X-ray COPD/Emphysema:

COPD/Emphysema X-ray findings :

X-ray chest posterior-anterior view shows

1.There is a thin walled rounded area in the mid & part of the lower zone of

(right/left) lung field (indicate bullae).

2.Hyperlucent lung field

3.Low flat diaphragm

4. Vertical cardiac shadow/Tubular shape Cardiac shadow. 

5.Ribs are widely spaced.

Common cause of COPD/Emphysema :

1.Smoking

2.Dust exposure

3. Alpha-1 antitrypsin deficiency

4. Air pollution

5. Low birth weight & low socioeconomic status.

X-ray Pulmonary Tuberculosis:

Fig:X-ray Pulmonary Tuberculosis

Pulmonary Tuberculosis X-ray findings :

X-ray chest posterior anterior view shows -

1.Patchy opacity in the upper zone of both lung fields

2.A cavity is visible in the upper zone of left lung field.

3.Costophrenic & cardiophrenic angles are normal on both side.

4.Transverse diameter of cardiac shadow is normal

Diagnosis:

So my radiological diagnosis is pulmonary tuberculosis

X-ray Bronchial Carcinoma/mass lesion:

Fig: Adenocarcinoma in lungs

Bronchial Carcinoma/mass lesion X-ray Findings :

1.X-ray chest PA view showing opacity with Irregular

margin, occupying the (right/left) upper and part of mid

zone.

2.Rest of lungs field clear.

3.Trachea is centrally placed

4.Costophrenic & cardiophrenic angle normal 

5.Transverse diameter of heart Shadow normal 

Fig: Lungs mass 

X-ray Hydropneumothorax:

Hydropneumothorax X-ray findings :

1. Increased translucency with collapse lung margin

on the right side.

2. There is a horizontal fluid level with obliteration

of right costophrenic and cardiophrenic angles

Causes:

1.latrogenic (during aspiration of pleural fluid) -

2. Bronchopleural fistula.

Trauma (penetrating injury, thoracic surgery).

3. Rupture of lung abscess.

4. Oesophageal rupture.

5.  Erosion by bronchial carcinoma.

6. Pulmonary tuberculosis

X-ray Miliary Tuberculosis:

  Miliary Tuberculosis x-ray findings:

X-ra cst posterior anterior view shows1.Multiple miliary mottling shadows in all zones of both lung fields

2.Trachea is central in position

3. Costophrenic & cardiophrenic angles are normal

4. Both domes of diaphragm are normal in position

5. Transverse diameter of cardiac shadow is normal

 So my radiological diagnosis is Millary tuberculosis.

D/D:

1.Sarcoidosis.

2. Pulmonary eosinophilia.

3. Histoplasmosis

4. Pneumoconiosis.

Transient tachypnea of the newborn (TTN):

CXR-1: Prominent perihilar vascular markings in a “sunburst” pattern

Type of X-ray: Plain X-ray chest AP view.

Findings:

CXR-1:

1. Prominent perihilar pulmonary vascular markings in a “sunburst” pattern

2. Indistinct pulmonary vessels and diffuse pulmonary edema

3. Hyperinflated lungs

Diagnosis: TTN.

Mechanism of image findings: Amniotic fluid is normally squeezed from the lungs during vaginal

delivery and then absorbed. But in TTN, there is build-up of fluid in the lungs and is thought to be due

to the reduced mechanical squeeze and reduced capillary and lymphatic absorption of amniotic fluid.

This reduced clearance of fluid from the lungs gives rise to clinico-radiological characteristics of TTN.

Respiratory distress syndrome (RDS):

Type of X-ray: Plain X-ray chest AP view.

Findings:

CXR-1:

1. Ground glass appearance of both lung fields

2. Bilateral air bronchogram

3. Loss of clarity of cardiac outline and that of

the domes of diaphragm

Diagnosis: Respiratory distress syndrome(RDS)

Mechanism of image findings: In RDS

there is widespread alveolar collapse because

of paucity or absence of surfactant and as a

result the lung fields look whitish. Presence of

air in the major airway seen as blackish shadow.

This is against whitish pulmonary parenchymal

background giving rise to air bronchogram.

Altered radio density of the collapsed lung make

it difficult to find a line of demarcation between

heart margins and the adjacent lungs and other

structures.

X-ray Pleural calcification:

CXR-1

CXR-1: Chest X-ray PA view showing multiple calcified pleural plaques in right upper, mid and lower zones.

Calcification of diaphragmatic pleura, on both the right and left sides. Obliteration of right costophrenic angle.

Diagnosis: Pleural calcification.

CXR-2

CXR-2: Chest X-ray PA view showing plaques of calcified shadow on the left side at the periphery and lower zone.

Calcified shadows in the left diaphragmatic pleura. Obliteration of right and left costophrenic angles.

Diagnosis: Pleural calcification (with bilateral pleural effusion).

Causes of pleural calcification:

Honeycomb lung

CXR-1: Chest X-ray PA view showing reticulonodular shadow involving the lower zones of both lung fields. There are multiple translucent ring-like shadows of variable size and shape involving mostly lower zones of both lungs.

Diagnosis: Honeycomb lung with ILD (or DPLD).