MC Malignant tumor of diaphragm
Fibrosarcoma
Most common disturbance of the diaphragm
Singultus (Hiccups)
MC benign tumor of diaphragm
Lipoma
PA Chest view w/ Expiration is best view to see…
Obstruction & Pneumothorax
Unilateral Hilum enlargement is MC due to:
Bronchogenic Carcinoma
What fissure separates the middle & upper lobes from the lower lobes?
Right Oblique / Major fissure
What fissure separates the upper & middle lobes?
Left Oblique / Major fissure
Separates the middle lobe from the upper & lower lobe
Right Horizontal / Minor fissure
Sign that determines enlargement of Left Ventricle
- Draw line from diaphragm & inferior vena cava
- Inferior vena cava: superior 2cm & posterior 2cm
Rigler Hoffman Sign
Unilateral elevated diaphragm is caused by:
Atelectasis
Bilateral elevated diaphragm is caused by:
Subpulmonic Pleural Effusion
Best view to see Pleural Effusion
Lateral Decubitus View
MC accessory lobe seen on x-ray
- occurs in 1% of population
- right lung
- PA chest xray
Azygos Lobe & fissure
MC accessory lobe/fissure that MC occurs in the general public?
Inferior Accessory lobe / fissure of Right Lung
Normal variant of the diaphragm (unilateral or bilateral)
Etiologies:
1. Abnormal muscle development (thin membranous sheet)
2. Nerve deficiency (phrenic nerve paralysis)
Eventration/Scalloping
Partial Eventration/Scalloping is MC seen on what side?
Complete is MC seen on what side?
Partial MC seen on Right
Complete MC seen on Left
Peak-like pulling on the pleura
MC cause if viral pneumonia
Tenting
Preferred view to see Lung Apices
Apical Lordotic View
Cords in between the alveoli
Kahn
Cords between the alveoli to bronchi/bronchioles
Canals of Lambert
Pattern of Parenchymal Lung Disease
- Fluid in alveoli
- Possible air bronchogram sign or silhouette sign
- Fluffy, cloud-like, hazy
Air Space / Alveolar disease
Visualization of air in the bronchus (airways) because of surrounding airspace disease
Air Bronchogram Sign
Two objects of the same radiographic density touch each other so that the edge or margin b/t them is not seen.
Silhouette Sign
Right heart border forms a silhouette sign with the….
RML
Left heart border forms a silhouette sign with the…
Lingulas of the LUL
Diaphragm forms a silhouette sign with the…
Lower Lobes (costophrenic angles)
Ascending Aorta forms a silhouette sign with the…
Anterior Segment of the RUL
Aortic Arch forms a silhouette sign with the …
Apical segment of LUL
3 Patterns of Interstitial Disease:
- Network of lines
- Nodules & Circles
- Netty w/spots
- Reticular - network of lines
- Nodular - nodules & circles
- Reticulonodular - netty w/spots
Fibrous dysplasia of the chest
“Great imitator of lung disease”
Type of reticulonodular disease
Sarcoidosis
Loss of air volume in all or part of a lung; usually due to complete main stem bronchus obstruction
Lobes collapse in a fan-like configuration w/base anchored @ pleural surface
Atelactasis
XRay of Atelectasis: heart & mediastinal structures shift _____ the affected side
Toward
Direct Atelectasis causes
- Displacement of fissures
2. Increased density
Indirect causes of Atelectasis
- Shift of structures
- Over-inflation of unaffected lobes/lung
- Increased retrosternal clear space
- Depression of hemidiaphragm
Type of atelectasis:
- Most likely due to deactivation of surfactant - collapse of airspaces in a nonsegmental or nonlobar pattern
- Pts have splinting pain = incomplete inhalation
Subsegmental/Discoid/Platelike
MC type of atelectasis
Obstructive
RUL Atelectasis has what sign
“S Sign of Golden”
Massive Pleural Effusion XRay: pushes heart and mediastinal structures _____ from side of involvement.
Away
Increased rate of fluid formation
Example: CHF, pneumonia
Pleural Effusion
Common cause of bilateral elevated diaphragm
Mimics elevated hemidiaphragm
Subpulmonic Effusion
Blunting of Costophrenic Angles DDx
Pleural Effusion
Tumor
Fibrosis
What sign is strongly suggestive of pleural effusion?
On the lateral view, it is usually high on both the anterior & posterior aspects (U-shape)
Meniscus Sign
Sharply marginated collections of pleural fluid b/t the layers of a fissure or in a subpleural location just beneath the fissure.
MC: CHF
Vanishing/Pseudo Tumors