3. POSITION
PA AP
QUALITY
ROTATION PENETRATION INSPIRATION
LESION
Homo
Densityinfiltratio Heterogenous Centralperiph Silhouet
n
Wellill defined Zone eral
Necrotic sign
MEDIASTINAL
Central deviasionwided
COSTO-PHRENIC ANGEL
Freeoblitern
OTHER
Bone soft tissuediaphragm
5. Lymphoma
Radiological features:
CXR :
•mediastinal and hilar soft tissue mass in keeping with
lymphadenopathy.
•Lymphadenopathy may extend confluently into the neck
or abdomen.
•Splenic enlargement may be demonstrated by increased
soft tissue density under the left hemidiaphragm.
•Rarely primary lung lymphoma may be present.
•This manifests as diffuse air space opacification, or
occasionally parenchymal nodular disease.
7. Wegener’s granulomatosis
Radiological features:
CXR :
• pulmonary nodules of varying size.
•They can cavitate and can occur anywhere in
the lung.
•Patchy, sometimes extensive consolidation or
ground glass change (which may reflect
pulmonary haemorrhage).
•Pleural effusions in one-third
8. Wegener’s granulomatosis
Differential diagnosis:
•Churg–Strauss syndrome –
•this is asthma associated with a small vessel vasculitis,
•p-ANCA positive.
• Rheumatoid arthritis (RA) –
• some forms of RA can mimic Wegener’s granulomatosis.
•Infection –
•particularly fungal infections, TB or septic emboli from
disseminated infection.
•Cryptogenic organising pneumonia.
• Metastatic disease.
9. CASE-1
•A 40-year-old man with a history of substance
abuse and HIV infection.
•complaints of fever, weight loss, production of
foul smelling sputum, and shortness of breath
for 2 wk.
•On physical exam he is tachypneic and has
clubbing of his digits.
•Lung exam reveals diffuse rhonchi and an area
of egophony with whispering pectoriloquy in the
right chest posteriorly.
•ABGs reveal PaO2 of 59 mm Hg on room air.
10. CASE-1
What is the most likely
diagnosis?
a. Pneumococcal
pneumonia
b. PCP pneumonia
c. Lung abscess
d. Squamous cell
carcinoma
11. POSITION •PA CXR
QUALITY •Good Technical Quality
•Round opacitiy with air-fluid level
•In right upper zone near hilum
LESION •Ill-defined linear opacity surrond it
•Central trachea and mediasteinal.
MEDIASTINAL
ANGELS •Free costo-phrenic angels.
OTHER •No
12. Case-2
•A 42-year-old black man with a history of IVDA develops
low-grade fever, night sweats, weight loss, cough, and
hemoptysis.
•On physical examination, vital signs are: pulse 109 bpm;
temperature 100°F; respirations 22/min; blood pressure
110/70 mm Hg.
•On general exam, the patient appears ill and has palpable
nodes in the anterior and posterior cervical triangle.
•Laboratory data: Hb 11 g/dL; Hct 32%; WBCs 7.2/μL; BUN
12mg/dL; creatinine 0.3 mg/dL; sodium 129 mEq/L;
potassium 3.2 mEq/L; LDH 217 IU/L;
•PPD negative.
• ABGs on RA: pH= 7.4; PCO2= 34 mm Hg; PO2=66 mm Hg.
13.
14. POSITION •PA CXR
QUALITY •Poor Technical Quality
•(PENETRATION,ROTATION?)
•Cavitary lesion in left upper zone.
•Ill-defiened nodules most in right lung
LESION that conluenced in middle zone.
•Hyperlucency area in right lower zone.
•Trachea pulled to left
MEDIASTINAL
ANGELS •Left angel is obliterated.
OTHER •No
15. Case-2
• 1. What is the most likely diagnosis?
• a. TB
• b. Lymphoma
• c. Sarcoidosis
• d. Mycetoma
• 2. What is the next management option?
• a. Obtain ACE level
• b. Start four-drug anti-TB treatment
• c. Start antifungal treatment
• d. Repeat PPD and start INH chemoprophylaxis
16. Case-3
• A 56-year-old male smoker is admitted with
shortness of breath, rightsided chest wall pain,
and productive cough.
• He has a past history of seizure disorder and is on
anticonvulsants.
• Dilantin level is within therapeutic range.
• On examination, there is dullness to percussion in
the right upper zone with decreased breath
sounds.
• Sputum for AFB and fungi are negative on initial
smear and cultures are pending.
18. POSITION •AP CXR
QUALITY •Poor Technical Quality
•(PENETRATION,ROTATION?)
•Homogeneous density in right upper
lobe(right upper lobe collapse).
LESION •No air-bronchogram.
•S,sign.
•Trachea pulled to right
MEDIASTINAL
ANGELS •free
OTHER •No
19. Case-3
• 1. The most likely diagnosis is:
• a. Bronchogenic cancer
• b. Aspiration pneumonia
• c. Fungal pneumonia
• d. TB
• 2. The next step in the management of this
patient should be:
• a. Start anti-TB medications till cultures are final
• b. Start Rx with itraconazole
• c. Place patient on antireflux and aspiration
precautions
• d. Consult for bronchoscopy
20. Case-4
• A 32-year-old female nonsmoker is admitted with a 5-wk history of
• intermittent hemoptysis. She denies any sputum production, fever,
or repeated infections.
• There is no history of contact with TB.
• On physical examination, the patient is afebrile; she has dullness on
percussion and decreased breath sounds in the LLL zone posteriorly.
CV exam is normal.
• PPD is 4-mm induration.
• Bronchoscopy :shows a polypoid lesion partially obstructing the left
lower lobe orifice. This lesion bled easily during the procedure.
• Bronchial washings are negative for malignancy and the biopsy is
pending.
22. POSITION •PA CXR
QUALITY •Poor Technical Quality
•(ROTATION?)
•Homogeneous density overlap left
heart broder without silhout sign
•(Sail sign)double density in
LESION retrocardiac aerea
•No air-bronchogram.
•Elevate Left hemidiaphragm .
MEDIASTINAL •Central trachea,mediastinal
ANGELS •free
OTHER •No
23. Case-4
• 1.What is the radiological diagnosis?
• a. LLL pneumonia
• b. LLL atelectasis
• c. Pneumothorax
• d. Pleural effusion
• 2. The clinical, radiological, and endoscopic
features described are consistent with:
• a. Endobronchial carcinoid
• b. Bronchiectasis
• c. Bronchoalveolar cell carcinoma
• d. Primary TB
24. discussion
• The presence of a polypoid lesion obstructing the left lower lobe
orifice is the cause of the left lower lobe atelectasis seen on the x-
ray.
• The absence of air bronchograms is evidence against pneumonia,
• and failure to see the visceral pleural line with a collapsed lung rules
out pneumothorax.
• There is no evidence of pleural disease and no pleural effusion is
seen.
• The clinical and radiological features are consistent with
endobronchial carcinoid.
• The absence of cystic or multicystic opacities and the lack of
sputum rule out bronchiectasis and alveolar cell carcinoma.
• Primary TB usually presents as pneumonia and is inconsistent with
the x-ray shown.
25. Case-5
• A 26-year-old woman with a past history of seizure disorder
is admitted to the medical ICU with status epilepticus.
• Due to continued seizures, she is placed in a barbiturate
coma.
• As part of supportive measures, she is intubated, placed on
a mechanical ventilator, and given IV fluids through a
central line.
• She remains stable overnight.
• In the morning, however, the respiratory therapist reports
that she has had excessive muco-purulent secretions
throughout the night and that her peak and plateau airway
pressures have risen 20 cm.
• She is febrile with a temperature of 100.2°F the next
morning.
27. POSITION •AP CXR
QUALITY •Poor Technical Quality
•(penetration?)
•Homogeneous density at right upper
zone obscured right upper heart border.
LESION •No bronchogram.
•Elevate horizontal fissure(s,sign).
•RUL,ATELECTASIS.
•Central trachea,mediastinal
MEDIASTINAL
ANGELS •free
OTHER •No
28. Case-5
• 1,Based on the clinical history, what is the
likely etiology of the CXR abnormality?
• a. Right-sided hemothorax
• b. Lung abscess
• c. Aspiration pneumonia with right upper lobe atelectasis
• d. Lung contusion
• 2. An important step in management of this
patient would be:
• a. Chest tube placement
• b. Thoracotomy
• c. Fiberoptic bronchoscopy, antibiotic therapy, and chest
physiotherapy
• d. Abrupt cessation of barbiturates
