CXR ddx

Question 1

bilateral hilar lymphadenopathy

Answer 1

1. TB
2. Sarcoidosis
3. Lymphoma
4. Bronchial carcinoma, metastaatic tumour
5. recurrent pneumonia

Question 2

cavitating lung lesions

Answer 2

1. Abscesses
2. Infections with: TANKS - 1)TB 2)Aspergillus 3)Nocardia 4)Klebsiella 5)S. aureus and PSeudomonas
3. Infarctions
4. Tumours

Question 3

COin lesions

Answer 3

1. TUmours: 1ary or 2dary from breast, RCC, prostate, bone, GI
2. hartomas, granulomas, cysts
3. Infections: TB, pneumonia, abscesses
4. foreign body
5. infarction
6. encysted pleural effusion
7. rheumatoid nodule
8. vasculitides
9. AV malformations

Question 4

parenchyma changes (reticualr opacifications):

Answer 4

acute interstitial oedema
infection
fibrosis
malignancy

Question 5

Heart failure appearance

Answer 5

Alveolar shadowing (bat)
kerley-B lines
Cardiomegaly
upper lobe Diversions (prominent blood vessels)
Effusion

Question 6

Upper lobe fibrosis

Answer 6

1. Extrinsic allergic alveolitis
2. radiotherapy
3. cystic fibrosis
4. sarcoidosis
5. ankylosing spondylitis
6. berylliosis
7. TB

Question 7

lower lobe fibrosis”

Answer 7

1. rheumatoid arthritis and other connective tissue
2. scleroderma
3. asbestosis
4. Cryptogenic fibrosing alveolitis
5. Drugs: methotrexate, amiodarone

Question 8

white hemithorax

Answer 8

1. large pleural effusion
   2 collapse
2. pneumonectomy
3. congenital absence of lung

Question 9

increased density in the hemithorax with CENTRAl mediastinum

Answer 9

consolidatiom +/- aib bronchogram

Question 10

increased density of the hemithorax with mediastinum away from the dense hemithorax

Answer 10

pleural effusion

diaphragmatic hernia

Question 11

increased density of hemithorax with mediastinum TOWARD the dense hemithorax

Answer 11

COllapse

Post-pneumonectomy

Question 12

honeycom preceded by ground glass

Answer 12

cryptogenic fibrosing alveolitis

Question 13

tramlines

Answer 13

broncheictasis

Question 14

fluid level

Answer 14

pleural effusion

Question 15

points when inspecting the hila

Answer 15

The left hilum is usually higher than the right
Check the size of the hila
Check the density of the hila
If a hilum is displaced, ask yourself if it has been pushed or pulled

Question 16

points when inspecting pleura

Answer 16

the pleura and pleural spaces are only visible when abnormal
There should be no visible space between the visceral and parietal pleura
Check for pleural thickening and pleural effusions
If you miss a tension pneumothorax you risk your patient’s life - as well as your result at finals!

Question 17

what does pleural thickening look like?

Answer 17

may seem like a ‘peripheral effusion’ but lacks meniscus sign

Unilateral pleural thickening

\+/- Loss of right lung volume if mesothelioma
Shadowing over the whole right lung due to circumferential pleural thickening

Question 18

pleural effusion appearance

Answer 18

Thelower zone is uniformly white
At the top of this white area there is a concave surface - meniscus sign
The left heart border, costophrenic angle and hemidiaphragm are obscured if large effusion on the left
Slight blunting of the costophrenic angle indicates a small pleural effusion on that side

Question 19

do pleural effusions cause volume loss? what if there is mediastinal shift towards the hemithorax with blunted costophrenic angle ?

Answer 19

it is likely lower lobe collapse because pleural effusions do not cause volume loss and don’t pull the mediastinum towards them (but may push it away)

Question 20

left atrial enlargement appearance

Answer 20

The left and right heart borders are marked (arrows)
Extra right heart border - formed by the edge of the enlarged left atrium (blue area)
Slight bulge in the left heart border (*) due to enlargement of the left atrial appendage
Splaying of the carina to greater than 90 degrees - the carina lies directly above the left atrium