CXRs Flashcards
Insidious onset of shoulder pain.
Patient Data
Age: 30 years
Gender: MaleInsidious onset of shoulder pain.
Patient Data
Age: 30 years
Gender: MalePatient with a known condition presenting with cough.
Patient Data
Age: 20 years
Gender: Male
Interstitial thickening and bronchial wall thickening with an upper zone predominance.
Dilated peripheral bronchioles are also seen in both upper zones.
Thick-walled cylindrical bronchiectasis involving the upper zones is typical of cystic fibrosis.
Age: Young adult
Gender: Female
Pul AVM - HHT
Age: Young adult
Gender: Female
Pul AVM - HHT
Asymptomatic adult.
Lucent right hemithorax.
CT: absence of pectoralis major and minor muscle on the right side. Poland syndrome
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
Marked cardiomegaly with dilatation of the main pulmonary artery.
Bilateral pulmonary plethora.
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
https://radiopaedia.org/play/25685/entry/460588/case/44398/studies/48040?lang=gb#findings
PDA measuring ~16 mm.
Ascending aorta + arch = dilated
- aortic diameter returning to normal limits at the proximal descending thoracic aorta.
Marked cardiomegaly mainly from left atrial and left ventricular dilatation.
Mild right ventricular wall thickening is present, suggestive of hypertrophy.
Marked dilatation of main pulmonary artery.
Progressive shortness of breath.
Patient Data
Age: 30 years
Gender: Female
PDA closure device noted - appropriately positioned.
Marked enlargement of the pulmonary arteries + bilateral pulmonary plethora.
Enlarged cardiac contour - stable.
no hx
An enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally.
Dx: Pulmonary arterial hypertension
https://radiopaedia.org/play/25685/entry/460589/case/8653/studies/9468?lang=gb#findings
enlarged bronchial arteries.
right atrium + right ventricle are significantly dilated
complete inversion of the intraventricular septum = now convex toward the left ventricle = pulmonary arterial hypertension.
Lung window:
cystic change peripherally, anteriorly and laterally,
multiple wedge shape but small pleural based consolidations = healing or healed pulmonary infarctions.
The central main pulmonary artery shows irregularity although the wall thickening = laminated chronic embolism.
extensive eccentric bronchial wall thickening in RLL,
abrupt termination of blood vessels in the LUL
in RUL there is evidence of abrupt occlusion of vessels.
Dx: Pulmonary arterial hypertension
Age: 50 - 60 yrs
Gender: Female
Dx: Pulmonary arterial hypertension
Age: 15 years
Gender: Female
bronchiectasis: ring shadows and tram-track opacities are seen throughout both lungs, particularly in the upper zones.
Dx: CF
Patient with skin nodules and abnormal pigmentations.
Patient Data
Gender: Male
multiple nerve schwannomas
ribbon ribs.
Dx: NF1
sob
Hazy opacity in the left hemithorax
lucency near the aortic arch (luftsichel sign).
Left sided volume loss.
Dx: LUL collapse
child
HTN upper extremeties
lower limbs = cold + delayed brachio-fem pulses
Turner syndrome, biscupid aortic valve
focal indentation of the distal aortic arch - figure of 3 sign.
No definite inferior rib notching (cos of collaters)
Dx: coarctation of the aorta.
Age: 17 years
Gender: Male
focal indentation of the distal aortic arch - figure of 3 sign.
CT:
https://radiopaedia.org/play/25685/entry/462514/case/9434/studies/10118?lang=gb#findings
Progressive shortness of breath.
Patient Data
Age: 80 years
Gender: Male
bilateral diffuse upper lobe reticular opacification
occasional scattered mass like opacities.
Progressive shortness of breath.
Patient Data
Age: 80 years
Gender: Male
Upper zone predominant mass-like scarring + calcification + volume loss.
Hilar + mediastinal lymph node calc
No cavitary changes
Left pleural effusion.
DDx:
Beryliosis,
Radiation,
EAA/Eos
Granuloma LCH,
Silicosis,
TB,
Sarcoid
Features are in keeping with silicosis and progressive massive fibrosis (PMF).
Recognised occupational lung disease in a former ventilation engineer presenting with cough and fever.
Patient Data
Age: 70 years
Gender: Male
?Occ exposure
?Ca assoc
?Atelectasis assoc
Calcific pleural plaque.
In view of occupational exposure, asbestosis should be considered.
Assoc Ca? Bronchogenic carcinoma and mesothelioma.
Can see Round atelectasis (folding of pleura = mass-like appearance - Blesovsky syndrome)
Long history of respiratory wheeze and chronic cough.
Patient Data
Age: 35 years
Gender: Male
RUL
- tubular branching opacities = opacification of RUL bronchiectasis.
- most likely due to trapped mucous
- in pt w/ long standing wheeze = ABPA
- opacified expanded bronchi = finger-in-glovesign
LUL
- number of parallel lines = represent the walls of dilated bronchi -> extending from hilum (tram track) = bronchiectasis.
Next step = CT to confirm bronchiectasis + mucous plugging.
Long history of respiratory wheeze and chronic cough.
Patient Data
Age: 35 years
Gender: Male
Single axial image through upper zones
- left = presence of bronchiectasis + movement degraded
- right = dilated bronchi = filled with secretions
“Glove like” opacity in the right upper zone (yellow dotted line) represents sputum plugged bronchiectasis.
Air-filled bronchiectasis is seen bilaterally (green arrows).
Can also see: Transient patchy areas of consolidation #eosinophilic pneumonia
ABPA Major criteria = central bronchiectasis, pulmonary eosinophilia, asthma, blood eosinophilia, immediate skin reactivity to Aspergillus antigen, increased serum IgE.
Routine pre-operative chest radiograph prior to surgery for urethral stenosis. 50 year smoking history.
Patient Data
Age: 75 years
Gender: Male
Frontal:
Ill-defined bilateral hila
Multiple calcified adenopathies in hila + retrocardiac space.
Right CP angle blunting.
Aortic arch elongated and calcified.
Lateral:
“eggshell” calcification of multiple adenopathies along the mediastinum + bilateral pulmonary hila.
Dx: Silicosis (with egg shell calcification)
DDx: lymph node calcification:
benign:
tuberculosis
histoplasmosis
sarcoidosis
silicosis
coal worker’s pneumoconiosis
amyloidosis
malignant:
treated lymphoma and metastases
Aids to differentiating cause: silicosis vs sarcoidosis vs tuberculosis
calcified lymph nodes in tuberculosis tend to affect the mediastinum asymmetrically and unilaterally
diffuse bilateral lymph node involvement is more common in sarcoidosis
silicosis: the patient usually has a history of a silica-exposure related job (as in this case)
Back pain. History of sarcoidosis.
Patient Data
Age: 60 years
Gender: Female
Lung fibrosis
- more severe on right - right apex.
Hila pulled cranially, trachea pulled to right.
Bilateral hilar lymph nodes with peripheral calcification.
Right hemidiaphragm higher than the left, probably pulled by severe fibrosis.
Dx: End-stage (stage 4) pulmonary sarcoidosis
Shortness of breath.
Patient Data
Age: 50 years
Gender: Male
Veiling opacity in the right hemithorax,
- pleural effusion.
Most likely infective exacerabation COPD. Also right sided chest pain.
Patient Data
Age: 85 years
Gender: Male
RUZ completely opaque
- volume loss
- elevation of horizontal fissure
- tracheal deviation to right.
- Patchy opactiy in the right lung base.
Most likely infective exacerbation COPD. Also right sided chest pain.
Patient Data
Age: 85 years
Gender: Male
https://radiopaedia.org/play/25685/entry/465882/case/40240/studies/42780?lang=gb#images
RUL + right volume loss.
- RUL bronchus = truncated at its origin.
Mediastinal LNopathy (right paratracheal + pretracheal nodes).
Background of centrilobular emphysema.
Biopsy -> DIAGNOSIS: Right upper lobe lesion biopsies: Poorly differentiated squamous cell carcinoma.
Increasing breathlesness over many months
Patient Data
Age: 55
Gender: Female
Coarse reticular infiltrate @B/L upper lobes+ volume loss on both sides.
Increasing breathlesness over many months
Patient Data
Age: 55
Gender: Female
https://radiopaedia.org/play/25685/entry/465889/case/34388/studies/35695?lang=gb#images
Mediastinum calcified lymph nodes.
Architectural distortion of lung tissue,
Fibrosis #predominantly @ both upper zones.
Multiple pulmonary nodules bilaterally
- subpleural
- along fissures
Multiple ill defined conglomerate masses
Dx: sarcoidosis
No hx
Multiple tiny subcentimeter miliary opacities = throughout both lungs.
Uniform size, dense = calcification
Dx: Healed varicella pneumonia - miliary opacities
Presented to the GP with chronic cough. Patient had an incidental eosinophilia a year ago.
Patient Data
Age: 40 years
Gender: Female
Patchy air space opacities in bilateral upper zones.
Presented to the GP with chronic cough. Patient had an incidental eosinophilia a year ago.
Patient Data
Age: 40 years
Gender: Female
Reversed halo pattern (atoll sign):
- focal round areas of GGO
- surrounding crescent/ring shaped consolidation.
Reversed halo shape of a daisy
Dx: Cryptogenic organising pneumonia
Age: Adult
Gender: Female
LUL collapse
volume loss, such as elevation of the hemidiaphragm,
crowding of the left sided ribs,
shift of the mediastinum to the left.
Age: Adult
Gender: Female
LUL collapse
volume loss, such as elevation of the hemidiaphragm,
crowding of the left sided ribs,
shift of the mediastinum to the left.
Presentation
SOB and hypoxia.
Patient Data
Age: 75 years
Gender: Female
LUL collapse + Left hilar mass
mild volume loss, such as
-elevation of the hemidiaphragm,
-shift of the mediastinum to the left.
Cough and dyspnoea.
Patient Data
Age: 35 years
Gender: Male
Left upper lobe collapse - LINGULA
obliteration of the left cardiac silhouette.
The descending aorta and hemidiaphragm are still clearly visible.
Shortness of breath
Patient Data
No patient data supplied by author
veil-like opacity over left upper zone + Luftsichel sign.
Left upper lobe collapse with hilar mass
Chest pain and shortness of breath in a middle aged female
Patient Data
Age: 45
Gender: Female
Two circular artifactual opacities
identical contours to the breast
project over the lower thoracic cavity.
Breast implants
Attendance at ED with a racing pulse and anxiety
Patient Data
Age: 35 years
Gender: Female
Two concentric opacities
- the outer representing the normal breast tissue and
- the inner the capsule of the implant.
Breast prostheses
Smoker.
Patient Data
Age: 35 years
Gender: Male
Widespread cystic lung disease
- with cysts of varying sizes and shape and
- relative sparing of the lung bases!!!!!!!!!!!!!!!!!!!!! #CPangles
- Infrequent small solid nodules.
CT:
https://radiopaedia.org/play/25685/entry/469941/case/10757/studies/11217?lang=gb#findings
Langerhans cell histiocytosis
Chest pain
Patient Data
Age: 85 years
Gender: Female
Generalised prominence of the interstitial markings throughout the lungs.
An 8 mm pulmonary nodule projects within the right mid-upper zone.
Bilateral high riding humeral heads with extensive degenerative change including of the undersurface of the acromion.
Chest pain
Patient Data
Age: 85 years
Gender: Female
https://radiopaedia.org/play/25685/entry/470180/case/44769/studies/48583?lang=gb
Bilateral small pleural effusions
mild posterior basal atelectasis
peribronchial thickening
interlobular septal thickening/Kerley B lines = interstitial pulmonary oedema, with
accompanying subtle peribronchial ground glass + scattered centrilobular nodules = likely reflecting an early mixed airspace component of oedema.
Dx: Interstitial pulmonary oedema
Fall. Query rib fracture.
Patient Data
Age: 80 years
Gender: Male
Lobulated pleural opacity
encasing the right lung,
with associated volume loss.
No definite bony erosion / destruction or calcified pleural plaques seen.
https://radiopaedia.org/play/25685/entry/470190/case/26805/studies/26965?lang=gb
Mesothelioma
Chest pain
Patient Data
Age: 20 years
Gender: Female
obscuration of the right heart border
Lateral projection confirms the right middle lobe is clear + pectus excavatum
Pectus excavatum
Motor vehicle collision. Intubated.
Patient Data
Age: 45 years
Gender: Male
Malpositioned nasogastric tube located in the mid oesophagus
ETT and bilateral pneumocatheters.
Deep sulcus sign on the left in keeping with a large left pneumothorax.
Right apical pleural capping and widening of the superior mediastinum.
https://radiopaedia.org/play/25685/entry/471540/case/47381/studies/51986?lang=gb#findings
Cough
Patient Data
Age: 85 years
Gender: Male
large right upper lobe cavitary lesion, with air-fluid level.
Left midzone atelectasis.
C: cancer
bronchogenic carcinoma: most frequently SCC
cavitatory pulmonary metastasis(es): again most frequently SCC
A: autoimmune; granulomas from
Wegener’s granulomatosis
rheumatoid arthritis (rheumatoid nodules) etc.
V: vascular (both bland and septic pulmonary embolus)
I: infection (bacterial/fungal)
pulmonary abscess
pulmonary tuberculosis
T: trauma - pneumatocoeles
Y: youth
CPAM
pulmonary sequestration
bronchogenic cyst
Shortness of breath. Previous manual labourer. History of coronary artery bypass graft.
Patient Data
Age: 70 years
Gender: Male
midline sternotomy sutures
B/L
pleural plaques = holly-leaf asbestos #
calc
diaphragm + lateral = avoid apices + CP angles
- holly-leaf appearance
hyperinflated
Patient Data
Age: 75 years
Gender: Male
Well-defined ovoid opacity projected over the RUZ projected between 5-6th posterior right rib
CT: well-defined ovoid fat density + calc = PUL HAMAROTMA
No patient data supplied by author
CXR demonstrates an enlarged heart + prominent vascularity.
The aortic arch is normal or small and
left atrium does not appear enlarged.
An ASD closure device is noted.
Patient Data
Age: 17 years
Gender: Male
Small right lung + diminished vascular markings,
ipsilateral mediastinal shift.
Compensatory hyperinflation of left lung,
prominent left pulmonary artery + vascular markings.
Increased retrosternal space on lateral film, filled by superior lingular segment.
Patient Data
Age: 17 years
Gender: Male
https://radiopaedia.org/play/25685/entry/472239/case/52180/studies/58069?lang=gb
Absent right pulmonary artery.
Small right lung with peripheral fibrotic and cystic changes.
Numerous delicate linear opacities radiating from pleura into parenchyma of right lung = of collateral transpleural arteries (lung window).
Hyperinflated left lung, particularly superior lingular segment, with prominent pulmonary arteries.
Dx: Isolated absence of the right pulmonary artery
Patient Data
Age: Child
Overexpansion and hyperlucency of the left upper lobe.
post-infectious bronchiolitis obliterans consistent with Swyer-James syndrome.
Abdominal pain.
Patient Data
Age: 70 years
Gender: Male
Bilateral pleural plaques = holly leaf shaped
- calficied
- diaphragm + lateral
Right hemidiaphragm raised ?volume loss
Asbestos exposure
Presentation
Shortness of breath.
Patient Data
Age: 50 years
Gender: Female
Mediastinal sutures #right. Right subclavian line.
LArge opacity with wth air-fluid level right medial hemithorax
RLZ opacificatoin ill-defined conflent
small left pleural effusion.
post Ivor Lewis procedure
- oesophagectomy,
-gastric pull-up, and
-gastro-oesophageal anastomosis for disease (e.g. oesophageal cancer) in the distal two-thirds of the oesophagus.
The presence of surgical clips is key for not mistaking this for mega-oesophagus.
Presentation
Initial CXR performed for cough.
Patient Data
Age: 30 years
Gender: Female
Abnormal outline of the aortic knuckle
an indentation suggesting figure 3 sign of aortic coarctation.
https://radiopaedia.org/play/25685/entry/473514/case/18771/studies/18691?lang=gb
COARCTATOIN
chronic sinusitis
Patient Data
Age: 15 years
Gender: Female
dextrocardia
gastric air bubble on the right side
left-sided azygous fissure
Primary ciliary dyskinesia.
Complete situs inversus (situs inversus totalis), chronic sinusitis, bronchiectasis
Dx:
Cystic Fibrosis,
ABPA,
Postinfectious Bronchiectasis,
Immune Deficiency Disorders,
Young Syndrome
Presentation
Presented to the ED post collapse. A chest radiograph was carried out along other tests in the workup of collapse, which eventually was found due to a cardiac arrythmia.
Patient Data
Age: 80 years
Gender: Female
rounded ring shadows in the left upper zone represent = Plombage #TB
volume loss in the left hemithorax.
Several rounded ring shadows are seen in the left upper zone, with intervening radiopaque material.
Calcified hilar lymph nodes are evident.
There is left upper chest deformity with several ribs missing or fractured.
This patient attends medical outpatient clinics in two specialties.
Patient Data
Age: 65 years old
Gender: Male
Reticular pattern of confluent opacification in the right middle and left upper-mid-zones in keeping with fibrotic changes. Volume loss.
Upper zone fibrosis: OCC pneumoconioses (silica, coal = pmf), Beryliosis, Radiation, EAA/Eosinohilic granuloma LCH, Ank SPOND, Sarcoid, TB
CT
- upper and mid zone fibrosis bilaterally
- extensive bullous change.
- Syndesmophytes and vertebral body squaring @thoracic spine.
- kyphosis.
Sepsis, confusion. Found on ground.
Patient Data
Age: 50 years
Gender: Male
Hazy opacity in a perihilar pattern. Possible pulmonary nodules.
https://radiopaedia.org/play/25685/entry/478701/case/49397/studies/54521?lang=gb#findings
ct: Perihilar ground glass opacity with multiple pulmonary cysts - upper lobe predominance
B/L perihilar GGO + lung cysts = PCP!!!
Shortness of breath
Patient Data
Age: 85 years
Gender: Male
Veiling of the right hemithorax.
- patient is supine (note the label) #layering out posteriorly
- mediastinal shift away from the white-out
- lung marking seen through the density = crap is NEXT to, rather than within the lung
https://radiopaedia.org/play/25685/entry/480504/case/22269/studies/22306?lang=gb#findings
CT: Moderate free right pleural effusion and mild free left pleural effusion with relaxation atelectasis of both lower lobes.
Incidental pleural calcifications.
Cystic fibrosis and a non-resolving pneumothorax despite having a drain in situ for 4 days. Surgical planning scan.
Patient Data
Age: 20 years
Gender: Male
Pneumocath + left chest drain # surgical emphysema
Left sided pneumothorax .
B/L coarse bronchovascular markings with upper lobe ring shadows + reticular opacification = bronchiectactatic changes.
Dx: CF
https://radiopaedia.org/play/25685/entry/480686/case/13448/studies/13403?lang=gb
Shortness of Breath
Patient Data
No patient data supplied by author
deep sulcus sign at the base of the left hemithorax= pneumothorax.
Multiple left 8th, 9th and 10 ribs #s
Presentation
No clinical presentation supplied by author
Patient Data
No patient data supplied by author
Pleural spaces + lungs are clear.
Dilated oesophagus demonstrated = achalasia.
convex opacity overlapping the right mediastinum
absent gastric bubble
anterior displacement and bowing of the tracheal shadow on the lateral view
bilateral patchy alveolar opacities
Presentation
Known diagnosis of dermatomyositis.
Patient Data
Age: 55 years
Gender: Female
Calcinosis universalis = Coarse subcutaneous calcifications in the chest wall and abdominal wall.
https://radiopaedia.org/play/25685/entry/481946/case/68714/studies/78421?lang=gb
CT: Coarse subcutaneous calcifications in the arms, chest wall and abdominal wall (Calcinosis universalis).
Very little intramuscular calcification, notably in the quadratus femoris
Dx: dermatomyositis/polymyositis/sclerderma, SLE
Unlike tumoural calcinosis, it is plaque or sheet like rather than mass like.
Presentation
Pre operative CXR.
Patient Data
Age: 40 years
Gender: Male
Hypoplastic right lung
linear opacity consistent = venous drainage at the right lung base = scimitar syndrome.
Fever and tachypnoea.
Patient Data
Age: 5 months
Gender: Female
There is ill-defined confluent peri-hilar opacification on the right = obscuring right heart border = RML infection
Small, hypoplastic right lung + ipsilateral mediastinal shift
A curving tubular shadow is seen at the lower zone of the right lung paralleling the right heart border in the shape of a Turkish sword “Scimitar”.
Presentation
Cough and haemoptysis.
Patient Data
Age: 20 years
Gender: Male
solitary rounded opacity is present in the right lower zone.
Dx: pul AVM CHoPP
- cyanosis (due to the right to left shunt)
- high output congestive cardiac failure
- polycythaemia
- paradoxical cerebral embolism
Presentation
Intravenous drug user with end-stage renal failure on long term peritoneal dialysis. She was non-compliant with her peritoneal dialysis and had poor calcium phosphate control. She presented with digital ischaemia involving her right hand and both feet.
Patient Data
Age: 40 years
Gender: Female
B/L diffuse fluffy nodular infiltrates.
Chest drain right + subcut emphysema
diffuse calcification of both brachial arteries.
Patient Data
Age: 28-year-old
Gender: Male
Hilum overlay mediastinal mass
- splaying of post ribs
- post jct line dx
Patient Data
No patient data supplied by author
Bilateral posterior mediastinal paravertebral soft tissue shadows
Patient Data
No patient data supplied by author
Bilateral para-vertebral soft tissue masses.
Extramedullary haematopoiesis in a thalassaemia patient
Patient Data
Age: 25 years
Gender: Male
B/L loblated well-defined mediastinal masses - well-defined
Extramedullary haematopoiesis
Presentation
Attended with chest pain following an RTA. No prior medical history indicated.
Patient Data
Age: 25 years
Gender: Male
CXR: Bilateral paraspinal masses - symmetrical in nature at the level of the heart. Abnormal contour at the right hilar level, but the hilum is separately delineated (hilum overlay sign).
Left paraspinal and para-arterial lines are obscured = post mediast mass.
AXR: Splenomegaly down to the level of the iliac crest. Coarse trabeculation of the bony skeleton.
Minor expansion of some of the ribs, most pronounced in the upper thoracic cavity, with narrowing of the intercostal spaces.
Dx: Classical appearances of extramedullary haematopoiesis, in this case from thalassaemia. The paraspinal regions are a very common site.
Presentation
Left sided chest pain in a young lady.
Patient Data
Age: 30 years
Gender: Female
There is a large mass
- in the left paravertebral region projected behind the heart
https://radiopaedia.org/play/25685/entry/484436/case/38464/studies/40556?lang=gb
Left paravertebral mass lesion from T7-T11.
- foci of calc
- associated scalloping of the left side of the adjacent thoracic vertebral bodies,
- neurogenic tumour= sympathetic trunk.
Ganglioneuromas
Presentation
Rushed into the ED with sudden dyspnoea and left sided chest pain.
Patient Data
Age: 25 years old
Gender: Male
left px
reticular interstitial opacification in both lungs.
https://radiopaedia.org/play/25685/entry/486964/case/35387/studies/36889?lang=gb#findings
CT:
numerous thin-walled pulmonary cysts of
varying sizes and shapes,
some of which are confluent
U/M > L
Pulmonary Langerhans cell histiocytosis
Presentation
Chronic dyspnoea
Patient Data
Age: 50 years
Gender: Male
Diffuse bilateral confluent opacification with lower zone predom.
“Sandstorm” of diffuse pulmonary microcalcification in a peripheral distribution
“lucent mediastinum” sign
“black pleura” sign
Pulmonary alveolar microlithiasis
Presentation
Passed out and fell. Incidental finding.
Patient Data
Age: 60 years
Gender: Female
cotton silo in their yard………………………
Displaced right midclavicular fracture.
Diffuse, extremely high density opacification of the lower and middle zones of both lungs, prominent linear and reticular opacities in the upper zones.
https://radiopaedia.org/play/25685/entry/487010/case/68676/studies/78356?lang=gb#findings
CT: Diffuse interstitial and alveolar calcification, most severe in the basal lower lobes and right subpleural lung.
Minimal pericardial effusion.
Pulmonary alveolar microlithiasis
Presentation
Several months of right chest pain.
Patient Data
Age: 11 years
Mixed lytic/sclerotic lesion involving the right lateral 10th rib with associated soft tissue density surrounding the lesion.
Given patient’s age, finding is most suspicious for a primary neoplasm, unlikely metastasis. Recommend CT for further evaluation.
Why is this finding suspicious for malignancy (versus more benign skeletal lesion e.g. fibrous dysplasia)?
The extent of associated soft tissue mass is unusual for non-neoplastic lesions. Langerhans cell histiocytosis could theoretically appear similar.
Why is this finding unlikely a metastasis?
The patient is older than a typical age range for neuroblastoma, which is the most likely malignancy to present with such a metastatic lesion. Other tumors that involve the chest wall (e.g. breast, lung carcinoma) are mostly in adults.
DX: Ewing sarcoma
Progressive dysphagia and a history of a long known untreated hiatus hernia.
Patient Data
Age: 75 years
Gender: Male
Large retrocardiac mass with air-fluid level.
Pulmonary findings suggest COPD.
Presented to the Emergency Department with Horner syndrome. On examination he was found to have large swelling in the neck.
Patient Data
Age: 30 years
Gender: Male
There is widening of the superior mediastinum
trachea displaced anteriorly on the lateral image.
https://radiopaedia.org/play/25685/entry/488019/case/9354/studies/10040?lang=gb#findings
CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall.
Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.
Dx: Tuberculous spondylitis with large prevertebral abscess
Back pain.
Patient Data
Age: 70 years
Gender: Male
Mediastinal opacity at the level of the right hilum.
Within the superior segment of the right lower lobe, together with the pleural surface, and at the level of T4-T7, there is a well-defined mass characterised by a thick enhancing capsule and homogeneous hypoattenuating content
It causes mild surrounding ground glass opacities and adjacent pleural thickening.
https://radiopaedia.org/play/25685/entry/496804/case/44923/studies/48820?lang=gb#findings
Thoracic paravertebral abscess and osteomyelitis
Gradual worsening dyspnoea over several years. There was no clear history of childhood infection.
Patient Data
Age: 35 years
Gender: Female
hyperlucency of the left upper and mid zone without hyperexpansion or volume loss. Central branching opacity.
unilateral hypertransradiant hemithorax
Ddx:
Rotation
Chest wall: surg, Polio, Poland,
Pleura: Px
Lung: Comp emphysema, CLE, Airway obstruction, Bullae, Bronchal atresia, Swyer James
Pul vessels: PE
focal area of hypoattenuation left upper lobe.
reduced vascularity within this hyperlucent segment.
Centrally, there is a bronchocele
- No evidence of over expansion of the lobe
Posterior mediastinal mass = above fluid density = bronchopulmonary foregut duplication cyst.
Quantitative analysis demonstrates photopenia within the superolateral aspect of the left upper lobe on the perfusion study with less pronounced defect on ventilation.
Dx: Bronchial atresia
Increasing shortness of breath over the last few weeks.
Patient Data
Age: 20 years old
Gender: Male
Opacification LMZ-LLZ with vol loss + mediastinal shift to right.
Can see hilar vessels = ant/post mediastinal mass
Lat: retrosternal space (normally air lucent) appears to be filled with the mass.
anterior cardiac border is silhouetted by the mass also.
Left hemidiaphragm is not seen.
https://radiopaedia.org/play/25685/entry/498655/case/44896/studies/48786?lang=gb#findings
huge heterogenous antero-superior mediastinal mass, mainly of fat density with thick soft tissue strands within, without calcification or fat-fluid level. Most of the left lung (except for apico-posterior segment of the upper lobe) is completely collapsed. Moderate shift of the mediastinum and the heart to the right side. The mass effect on the left pulmonary vessels and major airways is also obvious.
Retired male with history of childhood infection and chronic cough.
Patient Data
Age: 65 years
Gender: Male
Multiple air-fluid levels suggest cystic structures. Iccreased reticulo-nod opacification, right more than left. right hemidiaphragm pleural sutures.
Cystic bronchiectasis
Posterior swelling in the left upper back, noted by her family 3 months ago.
Patient Data
Age: 30 years
Gender: Female
There is a soft tissue density = well-defined inferiorly projected over the LUZ
- rib dx/deformity
- vol loss + mediat shift to right
- internal calc
- can see it above clavicle = cervicothoracic sign #post (if ant it’d fade!)
https://radiopaedia.org/play/25685/entry/500627/case/65192/studies/74199?lang=gb
Large left-sided chest wall mass
well-defined, predominantly hypodense with central calcified component. It is extending to the mediastinum
with intra and extrathoracic extension developed mainly on the left 2nd rib, but involving the left 3rd rib.
mass causes bony erosion of the T2 and to a lesser extent T3 vertebral body,
tumoral tissues extending to the left neural foramen of T2-T3
mild extension to the epidural space without significant compression of the spinal cord.
compression and narrowing of the left brachiocephalic vein although it is patent; however, the left subclavian vein is not well seen
Dx: chondrosarcoma
- presence of rings and arcs calcification on CT,
- MRI signal characteristics of low T1 compared to muscles + high T2 signal intensity are suggestive of a chondroid origin of the tumour.
Chest mass.
Patient Data
Age: 90 years
Gender: Female
Anterior mediastinum opacity without the silhouette sign.
https://radiopaedia.org/play/25685/entry/500647/case/56422/studies/63098?lang=gb#findings
There is a well-defined enhancing soft tissue structure with internal enhancing septae and calc centred over the left cost-sternal joint. Extends anteriorly into the ant chest wall and posteriorly into the LUL.
left goitre too
Chest mass.
Patient Data
Age: 90 years
Gender: Female
Anterior mediastinum opacity without the silhouette sign.
https://radiopaedia.org/play/25685/entry/500647/case/56422/studies/63098?lang=gb#findings
There is a well-defined enhancing soft tissue structure with internal enhancing septae and calc centred over the left cost-sternal joint. Extends anteriorly into the ant chest wall and posteriorly into the LUL.
left goitre too
Dx: Low-grade chondrosarcoma: sternum
Cough and shortness of breath. Pneumonia?
Patient Data
Age: 43
Gender: Male
Lucent expansile left sided rib lesion without cortical thinning.
Lucent expansile rib lesion.
FAME
F: fibrous dysplasia
A: aneurysmal bone cyst
M: metastases to bone or multiple myeloma/plasmacytoma
E: enchondroma or eosinophilic granuloma
In this case the most likely causes is fibrous dysplasia.
Cough.
Patient Data
Age: 50 years
Gender: Male
Hypertransradiant right hemithorax peripherally + no lung markings
horizonal fissure up
mediastinal shift to left
increased opaciication right lung
Giant bulle due to some fibrotic paracicatrical process
Cough and fever. Recent chemotherapy.
Patient Data
Age: 17 years
Gender: Male
left subclavian line , left portacatch
Right proximal humeral intramedullary nail.
increased well-defined rounded opacities LUZ, left periphery
left base infection
Dx: Osteosarcoma pulmonary metastases
Known tuberculosis
Patient Data
Age: 45 years
Gender: Female
bilateral nodular opacities diffuse throughout both lungs = miliary TB
TEMPeSt: Tuberculosis, Eosinophilic granuloma, Metastases, Pneumoconiosis, Sarcoidosis.
Cough and shortness of breath. LRTI?
Patient Data
Age: 75 years
Gender: Male
same appearance 3 years ago
sup mediastinum = well-defioned irreg shaped opacity tracheal shift to right
right clavicle is thickened + sclerotic
- coarsening of the trabeculae
Paget disease of the clavicle
Discussion:
This patient has no prior history of malignancy or trauma. This incidental finding was identified on a radiograph performed for respiratory indications.
A few life lessons from this kind of radiograph, and why this may feature in Fellowship exams, such as a discussion case in a viva or rapid reporting examination.
Periphery of film finding. Will the reporter/candidate identify it?
Common sense reporting. Rather than suggest other tests or provide a ‘hanging’ descriptive report, will the reporter review old films?
Common pathology in a less common location. If this was in the pelvis it would be Paget disease every time.
Knowing the important differential in an older male patient - metastatic disease from prostate carcinoma
Palpitations and dizziness. Known history of sickle cell disease.
Patient Data
Age: 55 years
Gender: Male
Bilateral humeral head bone infarcts,
mildly H-shaped vertebral bodies
heart is enlarged
sickle cell anaemia.
spleen has undergone presumed autoinfarction #clumped calcification LUQ
Young adult with sickle cell anemia. Admitted with abdominal pain
Patient Data
Age: 20 years
Gender: Male
splenomegaly - sequestration
h-shaped vertebrae
femoral head sclerosis = avn
sickle cell dx
Known case of thalassemia, on regular blood transfusion.
Patient Data
Age: 25 years
Gender: Female
EMH: multiple B/L paravertebral lobulated opacities
Female with history of thalassemia and known extramedullary hemopoiesis
Patient Data
Gender: Female
EMH: multiple B/L paravertebral lobulated opacities
Staphylococcal bacteremia on IV antibiotics. He is febrile and has a right thigh swelling possibly hematoma or abscess. Chest X-ray was requested to exclude pneumonia.
Patient Data
Age: 30 years
Gender: Male
Coarse trabeculae of bones.
Expansion of ribs with thinned out cortex.
splenomegaly displacing the stomach.
Findings are consistent with Thalassemia major.
Hemoptysis.
Patient Data
Age: 40 years
Gender: Male
hyperlucency in the right lower zone + central oval opacity is seen within the lucent area.
hyperaerated and hypovascular basal segments of the right lower lobe. A mucus filled segment of dilated bronchus (bronchocele) is centrally located in the hyeprlucent lung
ground-glass opacities in the left lower lobe that are secondary to alveolar hemorrhage #unrelated
https://radiopaedia.org/play/25685/entry/501659/case/58271/studies/65417?lang=us#findings
Insidious onset of shoulder pain.
Patient Data
Age: 30 years
Gender: Male
lytic lesion right clavicle - expansion, no cortical disruption
soap bubbly lesion in the clavicle = Aneurysmal bone cyst (ABC)
intraoperative histology revealed giant cells = Giant cell tumor = Osteoclastoma = brown tumor
bone density in this 30 year old is diminshed,
he has distal clavicular resportion, and subperiosteal resportion along the medial aspect of the humeral neck.
All classic findings suggestive of hyperparathyroidism (HPT).
report
There is faint nephrocalcinosis bilaterally within the renal pyramids, and a large renal stone within the superior pole of the left kidney.
moderate osteopenia, with ill-defined lytic destruction of the left pubic bone which also appears mildly enlarged.
There is a transverse linear lucent line through the left superior pubic ramus that is suspicious for a pathological fracture.
The SI joints are minimally indistinct bilaterally.
There are well-defined, soap-bubbly lesions with sclerotic margins within the ilii bilaterally, in the regions of the right ASIS and left AIIS
Primary hyperparathyroidism with brown tumor
Elderly male patient who is a regular respiratory clinic attendee and former coal miner.
Patient Data
Age: 80 years
Gender: Male
bilateral diffuse noduarity
upper lobe reticulonodular opacities
pneumoconiosis
Breathlessness.
Patient Data
Age: Adult
Gender: Female
splaying of carina, ?Atrial escape, LMB sup displacement
left atrial enlargement
Mx: Echo CT cardiax
https://radiopaedia.org/play/25685/entry/503806/case/8544/studies/9382?lang=us#findings
A low density filling defect occupying almost the entire right atrium = attached to the inter-atrial septum = high t2 vs heart
When symptomatic, what are the three main forms of clinical presentation?
Valvular obstruction, embolic events, constitutional symptoms.
Carney complex?
Multiple endocrine neoplasia syndrome, cardiac myxomas (often multiple) and skin pigmentation..
Dx: Atrial myxoma
Worsening dyspnea on exertion. No infective symptoms.
Patient Data
Age: 55 years
Gender: Female
Increased lung volumes with symmetric hyperlucency in the lower zones. Thick vertical band of plate atelectasis in the right lower zone.
Alpha 1 antitrypsin deficiency
Shoulder pain
Patient Data
Age: 50 years
Gender: Female
osseous expansion, cortical thickening, and increased density of the right 5th rib posteriorly.
- Paget disease 2. fibrous dysplasia 3. melorheostosis
dx= pagets
Post bilateral lung transplant for cystic fibrosis
Patient Data
Age: 35 years
Gender: Female
hilar clips and median sternotomy post bilateral lung transplant
a left PICC line noted in situ, the tip well into the right atrium; ideally this would be pulled back to the cavoatrial junction
bilateral pulmonary artery stent
12 months of mild SOBOE.
Patient Data
Age: 25 years
Gender: Female
Curvilinear tubular opacity in the medial right lower zone paralleling the right heart border representing a scimitar.
The right lung is slightly more dense and smaller than the left lung with decreased intercostal spacing.
Scimitar syndrome represents a combination of pulmonary hypoplasia and partial anomalous pulmonary venous return (PAPVR)
Admitted with sepsis and shortness of breath. Infection?
Patient Data
Age: 65 years
Gender: Male
increased retic-nodular opacification right lung, vol loss, tracheal shift to right , rt diaphragm raised
left lung transplant - fine
- right lung = fibrotic honecominb, traction bronchiectasis. UIP changes.
https://radiopaedia.org/play/25685/entry/508202/case/52114/studies/57985?lang=us
Incidental finding
Patient Data
Age: 54
Gender: Female
left paravertebral Round opacity projeted over LUZ
erosion of the inferior aspect of the posterior 4th rib.
heterogeneous, partially calcified pleurally based mass in the left hemithorax abutting the proximal descending aorta.
The mass partially erodes the posterior forth and fifth ribs and there is periosteal reaction on the anterosuperior edge of the forth rib
T1 hypointense, heterogenously T2 hyperintense, enhancing, pleurally based left paraspinal mass. areas of non-enhancement/cystic change within the mass, likely representing necrosis. Foci of susceptibility change within the mass are in keeping with calcification seen on CT
Ancient neurilemmoma
Patient with a known autoimmune connective tissue disorder. Thoracic X-ray and CT for suspected pulmonary infection (cough and fever).
Patient Data
Age: 30 years
Gender: Female
amorphous cloud-like calcifications in the soft tissues
Scleroderma
Young female with chronic dysphagia.
Patient Data
Age: 20 years
Gender: Female
Chest x-ray demonstrates a mass with mixed density silhouetting the right hilum and paraspinal stripe
Esophageal achalasia
Young gentleman involved in low impact trauma. Abnormal feeling right side of the neck.
Patient Data
Age: 20 years
Gender: Male
right scf gas = subcut emphysema
Thin linear outline along the left side of the pericardium, extending towards the aortic arch.
Thin linear outline along the left side of the pericardium, extending towards the aortic arch.
Young gentleman involved in low impact trauma. Abnormal feeling right side of the neck.
Patient Data
Age: 20 years
Gender: Male
right scf gas = subcut emphysema
Thin linear outline along the left side of the pericardium, extending towards the aortic arch.
Thin linear outline along the left side of the pericardium, extending towards the aortic arch.
Incidental finding on post coronary angiogram. Previous RTA 20 years ago. Patient had complained of intermittent inter-scapular back pain.
Patient Data
Age: 60 years
Gender: Female
Frontal chest X-ray reveals an abnormal shape to the aortic knuckle, with peripheral calcification and smooth margins.
ring of calc @aorta arch = post trauma calc
Arterial phase CT confirms a saccular aortic arch aneurysm with a calcified rim.
Dx: post-traumatic aneurysm
Follow up of pneumothorax treated with pleural pigtail drain. Recurrent pneumothorax on a background of lymphangioleiomyomatosis and tuberous sclerosis.
Patient Data
Age: 35 years
Gender: Female
left pig-tail catheter
Left apical capping
- blunted cp angles = pleural thickening
bilateral cystic lucencies + reticular opacities
https://radiopaedia.org/play/25685/entry/509626/case/73359/studies/84114?lang=us
pig-tail catheter @left ANT CP angle
- Px @ left LAT CP angle #residual
stable left pleural thickening
30 years old female with cystic fibrosis. History of bilateral lung transplant.
Patient Data
Age: 30 years
Gender: Female
right dialysis catheter
- mediastinal surg clips
- Clamshell sternotomy wires
pleural spaces + lungs clear
unremarkable cardiomediastinum
POINT: Clamshell sternotomy is the standard incision for sequential bilateral lung transplantation. Recognizing the “butterfly” morphology of the Kirschner wires and hila surgical clips assist to elicit this crucial piece of information
Previous lung transplant years before. Stable SOB. Clinic follow up.
Patient Data
Age: 70 years
Gender: Male
ruq surg clip
- RMB stent
- left picc line
increased opacification rul
- fibrotic linear reticular opacities + patchy consol @UZ
- reduced right lung vol
- efaced right HD = consol?
- LLL atelectqis
blunted cp angle = right effusion
Bronchial stenosis post lung transplant is most commonly due to post-operative ischemia of the donor bronchial stump. It is associated with necrosis, dehiscence and infection and surprisingly is not always symptomatic.
Stenting is a successful treatment strategy for stenosis, usually performed after bronchoscopic dilatation is unsuccessful. Stent complications include mucous retention, stent colonization and lobar pneumonia, which typically occur in the first year. Stent removal can be difficult, complicated by epithelial overgrowth. Some centers advocate stent removal at 6 months.
Low-grade dysphagia to solids.
Patient Data
Age: 50 years
Gender: Male
pleural spaces clear
left superior mediastinal mass
- laterally well-defined opacity with ill-defined medial border obscuring aortic arch extending supraclavicularly =
- cervicothoracic sign = posterior mediastinal mass
- left paraspinal line obscured
- ?narrowing of trachea
CT: cystic mass abutting lsca, oesophagus, arch
esophageal duplication cyst
Acute shortness of breath, post AVR.
Patient Data
Age: 62
Gender: Female
midlien sternotomy sutures
- b/l presumably avm embol coils
- prosthetic aortic valve
pleural spaces clear
- some opacities nodules
normal cm + bones
Dx: Pulmonary arteriovenous malformations with background hereditary hemorrhagic telengectasia
Chronic cough.
Patient Data
Age: 45 years
Gender: Female
incr opaification projected over the RLZ
- right lung vol loss
- obscured right heart border + hemidiaphragm ?consol/effusion
- lat: rll mass
https://radiopaedia.org/play/25685/entry/513929/case/51027/studies/56585?lang=us
ct: large vascular well-defined lobulated mass - soft tissue denisty , broad posterior attachment
- no CW invasion, no LN
Dx: Pleural solitary fibrous tumor
Passenger in motor vehicle collision
Patient Data
Age: Adult
ng tube + ETT ok
wide mediastinum
- left sup mediastnium mass with lateral well defined border
- homogenous opacification over left lung = LUL collapse/if supine + trauma = effusion/haemthorax
- obscured aortic knuckle
- left apical cap
Right atelectasis, some fluid in horizontal fissure
- left hemidiaphragm obscured = ?infection
Dx: mediastinal haematoma
CT: dissection @isthmus, meastinal haematoma, left effusion (blood), atelectasis
Trauamtic aortic injury @isthmus
Low velocity MVC, hit chest on steering wheel.
Patient Data
Gender: Female
supine + left homogenous opacification + wide mediastinum + left apical capping = aortic trauma?
ct: left cp angle/basal Px
- chest drain insitu
Dx: Transection of the thoracic aorta near the isthmus with large pseudoaneurysm.
Distal esophageal malignancy with dysphagia. For palliative treatment.
Patient Data
Age: 70 years
oesophagweal stent crossing goj
- distended stomach bubble
pleural spaces + lungs clear
- unremarkable cardiomediastinum
Nomal bones
Neck mass.
Patient Data
Age: 70 years
Gender: Male
pleural spaces clear
bilateral nodular opacities difusely spread #miliary
right neck mass
https://radiopaedia.org/play/25685/entry/515063/case/8584/studies/9423?lang=us
Papillary thyroid carcinoma - with miliary metastases
Post upper gastrointestinal surgery for esophageal malignancy.
Patient Data
Age: 71
Gender: Male
gastric pull up for oesophageal ca
right 6th rib frac
Pleuritic chest pain.
Patient Data
Age: 22 years
Gender: Female
right sided abnormality
- diffuse right sided heterogenous , predominantly opacificied region with multiple areas of lucencies
The appearances of the right hemithorax maybe due to prior surgery for oesophageal atresia and pull-up of the stomach into the right hemithorax.
A large collection within the right hemithorax represents stomach (the patient had a gastric pull through procedure as a neonate) and not massive empyema
- distended stomach ?large meal ? GOObstruction
Oesophageal atresia (gastric pull-up procedure)
Presentation to the emergency departement with sudden onset of left sided pleuritic chest pain.
Patient Data
Age: 20 years
Gender: Male
continuous diaphragm sign =
pericardial lucency = pneumopericardium/mediastinum
https://radiopaedia.org/play/25685/entry/516497/case/21694/studies/21665?lang=gb#findings
Moderate pneumomediastinum is seen extending superiorly into the neck and tracking laterally into the oblique fissures.
Shortness of breath with on and off fever.
Patient Data
Age: 11 years
Gender: Male
curvilinear opacity @left apex/HB
Cardiac shadow is enlarged appearing rounded, globular
ddx: pericarditis vs calcfied LV aneurysm
Dx: calcific constrictive pericarditis
History of breast cancer. New increasing breathlessness.
Patient Data
Age: 50 years
Gender: Female
right axillary surg clip
+
Widespread, bilateral interstitial lines. No mass. No effusion.
Dx: lymphangitis carcinomatosis
Age: 75 years
Gender: Male
thoracoplasty
- upper left ribs = resected
- with collapse of the upper part of the left side of the thoracic cage
- with underlying atelectasis of the upper zone.
Thoracoplasty was a fairly frequently performed operation for the treatment of pulmonary tuberculosis.
Routine follow-up. Patient is currently well.
Patient Data
Age: 65
Gender: Male
curvilinear calc @left lv
- ?LV aneurysm
cardiomeg
midline sternotomy sutures
What are the most common causes for an enlarged cardiac contour?
- ischaemic heart disease or
-cardiomyopathy, - pericardial effusion,
- extracardiac mass abutting the heart.
What uncommon scenario is the cause of enlarged cardiac contour in this patient (HINT: there was a sudden change in cardiac contour following successful surgery).
Heterotopic heart transplant.
ct: native heart with calcified left ventricular aneurysm and calcified coronary arteries
Asymptomatic patient came for routine health check -up
Patient Data
Age: 45 years
Gender: Male
well-defined opacity obscuring the left heart border + hilum overlay sign confirming anterior mediastinal mass or mass abutting heart.
thin-walled cystic lesion along the pericardium
Dx: Pericardial cyst
Age: 46
Gender: Male
there is a left hilar mass obscuring left atrial appendage. and hila.
small left pl effusion
https://radiopaedia.org/play/25685/entry/517827/case/38068/studies/40054?lang=gb
left PA leiomyosarcoma + pl thickening
pleural spaces + lungs clear
unremarkable cardiomediastinum
normal bones/
focal well definde opcity projected over the right hemidiaphragm
Dx: Liver hydatid cyst: calcified
Follow up for a liver lesion.
Patient Data
Age: 30 years
Gender: Female
A faintly opaque but large round lesion at the hepatic area.
https://radiopaedia.org/play/25685/entry/517837/case/44770/studies/48585?lang=gb#findings
CT: calcified hydatid cyst and the membranes of the daughter cyst inside of it. Appearances are those of a calcified hydatid cyst.
Patient Data
Age: 25 years
Gender: Female
The ribs are gracile (thin/slender), and there is
severe osteopenia of all visualized skeletal structures.
No fractures are identified.
The mid diaphysis of the left femur is mildly deformed from an old, healed fracture.
There are several transverse lucent lines extending through the posterior cortex of the mid diaphysis of the fibula with surrounding cortical thickening, indicating stress fractures at this site (looser’s zones).
triradiate deformity of the pelvis, which is a combination of bilateral protrusio acetabuli and caudal migration of the sacrum secondary to softening of the pelvic bones.
https://radiopaedia.org/play/25685/entry/519934/case/29279/studies/29707?lang=gb#findings
Tachyarrhythmia.
Patient Data
Age: 55 years
Gender: Female
Levoposition of the heart = left soded
pericardial agenesis, with subtle pericardial remain overlying the right atrium. Note is also made of a tongue of lung tissue between the aorta and pulmonary artery
Radiologically, it presents with the following :
levoposition of the heart
prominent pulmonary artery
air interface in the aorto-pulmonary window or between the base of the heart and the diapgragm
70 year old presents with chest pain and coronary artery disease presents prior to PCI please evaluate for pulmonary edema.
Patient Data
Age: 70
Gender: Male
