X Ray Findings

Question 1

Air space opacification (more spec than consolidation)

Answer 1

Infection or pulmonary oedema

Question 2

Types of opacification

Answer 2

Hazy or patchy

Question 3

Differentiating between pulmonary oedema and infection

Answer 3

PO typically bilateral and spares the upper lobes, infection can be unilateral and lobar of any part of the lung

Question 4

Atelectasis

Answer 4

Collapse of a part of the lung due to a decrease in the amount of air - creates increased volume and increased density

Question 5

Key findings of consolidation

Answer 5

ill-defined homogenous opacity obscuring vessels, silhouette sign, air bronchogram, no volume loss, extension to pleura or fissure but doesn’t cross it

Question 6

Silhouette sign

Answer 6

Loss of lung/soft tissue interface - blurring of lines

Question 7

White out

Answer 7

Whole lung dense opacification

Question 8

Clips on trachea/ hilum

Answer 8

surgical clips

Question 9

Checking for hyperinflation

Answer 9

Count anterior ribs - 5-7th rib should intersect diaphragm. Is Diaphragm normal curved shape? flat = hyperinflation

Question 10

Meniscus sign

Answer 10

Pleural effusion - concave surface of white opacification

Question 11

Looking for rotation

Answer 11

Look at clavicle and spinous processes are they in line - clavicle moves away from spine on side of rotation

Question 12

AP portable film be aware

Answer 12

Patient sick bed bound - technical quality likely poor

Question 13

Look thoroughly around the edge of the pleura for

Answer 13

Pneumothorax

Question 14

Pushed tracheal deviation

Answer 14

Anything that increases pressure or volume in the hemithorax - will push trachea and mediastinum - hyperinflation and pneumothorax

Question 15

Pulled tracheal deviation

Answer 15

Any disease which causes volume loss in one hemithorax will pull the trachea over towards that side - collapse

Question 16

Bilateral symmetrical hilar enlargement suspicious of

Answer 16

Sarcoidosis - particularly when there is paratracheal enlargement, or lung parenchymal shadowing. DDx - pulmonary arterial hypertension

Question 17

Asymmetric hilar enlargement

Answer 17

TB importantly

Question 18

Lung infarction

Answer 18

PE usually has a normal CXR, could see peripheral consolidation in region of emboli - haemorrhage

Question 19

Congestive heart failure

Answer 19

bilateral perihilar consolidation with air bronchograms and ill-defined borders
an increased heart size
subtle interstitial markings
probably a large vascular pedicle (distance from lateral border of SVC and subclavian artery origin)

Question 20

Bronchopneumonia

Answer 20

multi focal, ill-defined densities progresses to diffuse consolidation

Question 21

Batwing appearance

Answer 21

Bilateral perihilar consolidation - sparing at the peripheries due to better lymphatic drainage

Question 22

Stage 0 sarcoidosis

Answer 22

Normal CXR

Question 23

Stage 1 sarcoidosis

Answer 23

Hilar or mediastinal nodal enlargement (white opacities around hilar rest of lung normal)

Question 24

Stage 2 sarcoidosis

Answer 24

Nodal enlargement and parenchymal disease (opacities are more diffuse into pulmonary vessels - larger white area)

Question 25

Stage 3 sarcoidosis

Answer 25

Parenchymal disease (less intense opacity in centre, still diffuse opacity)

Question 26

Stage 4 sarcoidosis

Answer 26

Pulmonary fibrosis (reticular shadowing, small lung volume)

Question 27

Idiopathic pulmonary fibrosis (usual interstitial pneumonia)

Answer 27

Reticulonodular infiltrates on chest xray -basilar, peripheral, bilateral, asymmetrical

Question 28

Non-specific interstitial pneumonia

Answer 28

Ground glass opacity

Question 29

Pneumoconiosis - silicosis and coal worker's lung

Answer 29

progressive upper zone calcified 'egg shell calcification', progressively affects all zones

Question 30

Pneumoconiosis - silicosis and berilliosis

Answer 30

Upper zone linear interstitial fibrosis

Question 31

Acute and sub-acute hypersensitivity pneumonitis (low specificity)

Answer 31

patchy nodular infiltrates

Question 32

Chronic HSP (low specificity)

Answer 32

Fibrosis

Question 33

TB

Answer 33

Fibronodular opacities in upper lobes (sharply defined opacities found in clusters) with or without cavitation.

Question 34

Atypical TB

Answer 34

Opacities in lower lobes

Question 35

HAP

Answer 35

opacity, blurring of diaphragm or heart borders

Question 36

CAP

Answer 36

consolidation, effusion, cavitations

Question 37

bronchiectasis

Answer 37

round black circles surrounded by dense opacity - thin walled ring shadows. tubular opacities. may be normal, or show skewed hemidiaphragm

Question 38

lobectomy

Answer 38

changed shape or volume of the lung - typically raised

Question 39

Lung abscess

Answer 39

consolidation in lobar distribution with central cavitation cavity wall thick and irregular,

Question 40

Asthma

Answer 40

normal or hyper inflated - excludes other pathologies

Question 41

COPD

Answer 41

rules out other pathologies. Hyperinflation, flattened diaphragm, increased intercostal spaces, hyperlucent lungs

Question 42

small cell lung cancer

Answer 42

central mass, lymphadenopathy, pleural effusion

Question 43

non-small cell lung cancer

Answer 43

single or multiple pulmonary nodules, mass, pleural effusion, lung collapse, mediastinal or hilar fullness

Question 44

tension pneumothorax

Answer 44

heart trachea and mediastinum can be shifted to one side, in combination with a black space containing no lung markings and a collapsed lung - grey shape with convex border

Question 45

pneumothorax

Answer 45

a black space containing no lung markings and a collapsed lung - grey shape with convex border(plueral line)

Question 46

pleural effusion

Answer 46

a dense white shadow with a concave upper edge.

Question 47

small pleural effusion

Answer 47

can cause no more than blunting of a costophrenic angle

Question 48

large pleural effusion

Answer 48

can cause a 'white out' of an entire hemi-thorax, with shift of the mediastinum to the opposite side

Question 49

If patient is only able to be in supine when imaging PTX or pleural effusion..

Answer 49

a lateral decubitus film should be performed

Question 50

Sail sign

Answer 50

Left lower lobe diagonal line like a sail obscuring portion of heart - suggests lower lobe collapse