Linear lung density x ray dr ahmed esawy include different cases for oral radiodiagnosis examination all over the world Linear lung markings CT /MRI Plain X ray images 1-Kerley’s lines 2-Plate atelectasis ( Fleischner Lines) etc 3-Pulmonary infarcts 4-Thickened fissures 5-Pulmonary / pleural scars 6-Bronchial wall thickening 7-Sentinel lines 8-Anamolous vessels 9-Artefacts 10-Curvilinear shadows (Bullae/Pneumatocoele /Bronchoceles)

1. LINEAR LUNG MARKINGS
Dr /AHMED ESAWY
Dr Ahmed Esawy

2. LINEAR AND BAND SHADOWS
► Normal structures such as
the blood vessels and
fissures form linear
shadows within the lung
fields.
► However, there are many
disease processes which
may result in linear
shadows.
► Linear shadows are less
than 5 mm wide,
► Band shadows are greater
than 5 mm thick .
Dr Ahmed Esawy

3. Causes for linear shadows
• 1-Kerley’s lines
► 2-Plate atelectasis ( Fleischner Lines) etc
• 3-Pulmonary infarcts
• 4-Thickened fissures
• 5-Pulmonary / pleural scars
• 6-Bronchial wall thickening
• 7-Sentinel lines
• 8-Anamolous vessels
• 9-Artefacts
► 10-Curvilinear shadows (Bullae/Pneumatocoele
/Bronchoceles)
Dr Ahmed Esawy

4. Linear interstitial patterns
Linear interstitial patterns are seen in processes that thicken the axial
(bronchovascular) interstitium or the peripheral pulmonary interstitium
axial: diffuse thickening along the bronchovascular tree seen as parallel
opacities radiating from the hila (seen transversely) or peri-bronchial cuffing
(seen en-face)
peripheral: thickening of the peripheral interstitium (either medially or
laterally) produces Kerley lines
Axial interstitial thickening is difficult to distinguish from airways disease that
result in bronchial wall thickening, (e.g. bronchiectasis, asthma) and most often
seen ininterstitial pulmonary oedema.
Peripheral interstitial involvement is seen in interstitial pulmonary
oedema, lymphangitis carcinomatosis and acute viral or atypical bacterial
pneumonia
Dr Ahmed Esawy

5. ATELECTASIS
Dr Ahmed Esawy

6. Impaired diaphragmatic motion
Underventilation
Collapse of small pulmonary sub divisions
Disk atelectasis
Fleischner line formation
Dr Ahmed Esawy

7. Dr Ahmed Esawy

8. Plate-like atelectasis
Plate-like atelectasis is a common finding on chest x-rays and detected almost
every day.
They are characterized by linear shadows of increased density at the lung
bases.
They are usually horizontal, measure 1-3 mm in thickness and are only a few
cm long.
In most cases these findings have no clinical significance and are seen in
smokers and elderly.
They are seen in patients, that are in a poor condition and who breathe
superficially, for instance after abdominal surgery
Plate-like atelectasis is frequently seen in patients in the ICU due to poor
ventilation.
Platelike atelectasis is also frequently seen in pulmonary embolism, but since it
is non-specific, it is not a helpful sign in making the diagnosis of pulmonary
embolism
Dr Ahmed Esawy

9. Plate-like atelectasis due to poor inspiration in a patient who had abdominal
surgery
Dr Ahmed Esawy

10. plate-like atelectasis in a patient with pulmonary embolism
Dr Ahmed Esawy

11. .
Dr Ahmed Esawy

12. Bronchial thickening
Dr Ahmed Esawy

13. Peribronchial cuffing results when fluid-thickened bronchial walls become visible
producing ”doughnut-like” densities in the lung parenchyma
Dr Ahmed Esawy

14. THICKENED BRONCHIAL WALLS
► Parallel TRAMLINE shadows
► Ring shadows on end-on view
► They are common finding in
Bronchiectasis,
Recurrent asthma,
Bronchopulmonary aspergillosis ,
Pulmonary oedema
Lymphangitis carcinomatosis. Dr Ahmed Esawy

15. Peri-Bronchial Cuffing
Peribronchial cuffing represents extravasated water surrounding the
bronchus.
Pre-diuresis: note the
cuffing (large arrow)
Post diuresis
Dr Ahmed Esawy

16. SENTINEL LINES
Dr Ahmed Esawy

17. Sentinel lines"--an unusual sign
of lower lobe contraction
► Mucus-filled bronchi
► Coarse lines lying
peripherally in contact with
the pleura and curving
upwards.
► Often left-sided and
associated with left lower
lobe collapse.
► They may develop due to
kinking of bronchi adjacent
to the collapse.
Dr Ahmed Esawy

18. the various densities occurring in the lower zones of the standard postero-anterior
chest radiograph, one sign has been ignored.
Coarse linear densities at the bases may be due to adjacent lower lobe contraction.
usually the superior and inferior branches of the lingular bronchi.
The densities are probably due to mucus-filled bronchi or alveolar atelectasis distal to
the kink. resulting from poor bronchial drainage, and may indicate more extensive
disease.
The left lower lobe collapse may not be visible on the chest radiograph but the
presence of these densities should alert the observer to the more important
associated abnormality.
Dr Ahmed Esawy

19. (a) There is a linear density at the left base. The line is semihorizontal, concave
upwards. The lower lobe is collapsed. (b) The line is no longer present. The lower
lobe has re-aerated
Dr Ahmed Esawy

20. There is several horizontal line densities at left base .the traingular shadowe of the contrac
Lower lobe is just visible through heart shadowe
Dr Ahmed Esawy

21. Several long horizontal densities are present at the left base. 7'he upper horizontal line
is crossed by a curved oblique line concavity facing the mediastinum.Dr Ahmed Esawy

22. There is a group of horizontal curved lines
at the left base concavity facing upwards.
Dr Ahmed Esawy

23. (a) There is a linear density at the left base. The line is semihorizontal, concave
upwards. The lower lobe is collapsed. (b) The line is no longer present. The
lower lobe has re-aerated. Dr Ahmed Esawy

24. .
Dr Ahmed Esawy

25. (a) Several long horizontal densities are present at the left base. 7'he upper horizontal
line is crossed by a curved oblique line concavity facing the mediastinum. (b) The lower
lobe is contracted and bronchiectatic. The inferior division of the lingular bronchus is
displaced inwards and kinked. Its distal branches correspond to the horizontal and
curved oblique lines of the plain film. The lingula is well aerated.
Dr Ahmed Esawy

26. (a) There is a group of horizontal curved lines at the left base concavity facing
upwards. (b) The lower lobe is collapsed and fails to fill with contrast medium.
The lingular bronchi are bronchiectatic but the lobe is only partially contracted.
The curved lines are the unfilled subdivisions of the lingular bronchi
Dr Ahmed Esawy

27. Mucous filled bronchi
bronchocele with typical gloved-finger branching
patteren
Dr Ahmed Esawy

28. KERLEY LINES
Dr Ahmed Esawy

29. Kerley lines Septal lines in lung
► Pulmonary lymphatics are usually not visible
► Lymphatics drain the interstitial fluid and foreign
particles
► They run in the interlobular septa and drain to the hilum
► Thickened lymphatics and surrounding connective tissue
= Kerley lines
► Divided into 3 types
 Kerley A lines – thickened deep septa
 Kerley B lines – thickened interlobular septa
 Kerley C lines
Dr Ahmed Esawy

30. Acinus
 5 - 6 mm in diameter
 alveoli, alveolar duct, resp. bronchiole
3 - 5 acini = secondary
pulmonary lobule
Each lobule is separated
by septa (interlobular
septa)
Thickening of these septa = Kerley B
lines
Formation of Kerley B lines
Dr Ahmed Esawy

31. Kerley B Lines
These are horizontal lines less than 2cm long, commonly found in the lower zone
periphery.
These lines are the thickened, edematous interlobular septa.
Causes of Kerley B lines include; pulmonary edema, lymphangitis carcinomatosa and
malignant lymphoma, viral and mycoplasmal pneumonia, interstital pulmonary fibrosis,
pneumoconiosis, sarcoidosis.
They can be an evanescent sign on the CXR of a patient in and out of heart failure.
Dr Ahmed Esawy

32. Dr Ahmed Esawy

33. Types
Kerley A line Kerley B line Kerley C line
Thin Thin, transverse, faint Fine
Non branching Non branching Interlacing lines
2 – 6 cm long 1 -3 cm long Seen throughout lung
1 – 2 mm thick 1- 2 mm thick “Spider web” like
appearance
Radiating from hila Lateral part of lung base
extending to pleura
(common in costophrenic
angle)
not following course of
artery, vein or bronchi
Frequently seen than A
&C lines
Lines arranged in step
ladder like pattern (0.5
to 1 cm apart)
ALWAYS perpendicular to
pleural surfaceDr Ahmed Esawy

34. he patient above is suffering from congestive heart failure resulting in
interstitial edema.
Notice the Kerley's B lines in right periphery (arrows).
Dr Ahmed Esawy

35. Kerley A lines are approximately cm in length and are most
conspicuous in the upper and mid portions of the lung.
They are deep septal lines (lymphatic channels) that radiate
from the hila into the central portions of the lungs but do not
reach the pleura.
Their presence normally indicates a more acute or severe degree
of oedema.
Dr Ahmed Esawy

36. : Kerley A, B and C lines (arrowed)
Dr Ahmed Esawy

37. A chest radiograph showed an enlarged cardiac silhouette, a dilated azygos vein, and
peribronchial cuffing, in addition to Kerley's A, B, and C lines.. These radiologic signs and physical
findings suggest cardiogenic pulmonary edema
Kerley's A lines (arrows) are linear
opacities extending from the periphery to
the hila; they are caused by distention of
anastomotic channels between peripheral
and central lymphatics
.. Kerley's B lines (white arrowheads) are
short horizontal lines situated
perpendicularly to the pleural surface at
the lung base; they represent edema of
the interlobular septa
Kerley's C lines
(black
arrowheads) are
reticular opacities
at the lung base,
representing
Kerley's B lines en
face
Dr Ahmed Esawy

38. ►Kerley B lines can be:
►They are present in the base of the lung
due to hydrostatic pressure and gravity
Transient Persistent
Pulmonary edema Dilated lymphatics
Chronic interstitial edema
Hemosiderin dust
deposition
Interstitial fibrosis
Dr Ahmed Esawy

39. Difference between Kerley B
lines and blood vessels
Dr Ahmed Esawy

40. KERLEY LINES
Kerley's A lines (arrows) :
• Linear opacities extending from the periphery to the hila
• Due to distention of anastomotic channels between
peripheral and central lymphatics.
Kerley's B lines (white arrowheads) :
• Short horizontal lines situated perpendicularly to the
pleural surface at the lung base
• Due to edema of the interlobular septa.
Kerley's C lines (black arrowheads): Reticular opacities at
the lung base representing superimposed Kerley's B lines.
Dr Ahmed Esawy

41. KERLEY LINES
B
A
C
Dr Ahmed Esawy

42. ► Pulmonary oedema
► Pneumoconiosis
► Infections (viral, mycoplasma)
► Lymphangiectasia
► Mitral valve disease
► Lymphangitis carcinomatosis
► Interstitial pulmonary fibrosis
► Lymphatic obstruction
► Congenital heart disease
► Sarcoidosis
► Alveolar cell carcinoma
► Lymphangiomyomatosis
► Pulmonary venous occlusive disease .
CAUSES OF KERLY LINES
Dr Ahmed Esawy

43. Differentiation
Fleischner’s lines Kerley B lines Linear scars
Fewer in number (1 -2) More in number May show fine strands
emanating from borders
Irregularly placed Regularly placed (0.5 to
1 cm gaps)
Associated pleural
effusion
Located deep in lung Superficial Permanent
Thicker Thin
Dr Ahmed Esawy

44. Vascular linear
Dr Ahmed Esawy

45. Vascular Indistinctness
Water is the same density as vessels, and so as it leaves
vasculature for interstitium the margins become fuzzy.
EdemaCrisp vessel margins, no edemaDr Ahmed Esawy

46. Vascular Indistinctness
Crisp margins, no edema EdemaDr Ahmed Esawy

47. Cephalization
The upper lobe vascular caliber is greater than lower vessels.
Dr Ahmed Esawy

48. Cephalization means pulmonary venous hypertension, so long as the person
is erect when the chest x-ray is obtained.
Dr Ahmed Esawy

49. There is a curvilinear density
adjacent to the right superior
mediastinum with an
ovoid lower density at its lower
end (the azygous vein). The
azygous lobe is the
commonest CXR normal
variant seen in up to 0.4% of
individuals. This is an
embryologic variation which
results in an accessory lobe at
the right upper lobe.
The fissure is due to the
invagination of the azygous
vein and the condition is of no
clinical significance
Dr Ahmed Esawy

50. CASE 18 HEREDITARY HEMORRHAGIC TELANGIECTASIA OR
OSLER WEBER RENDU DISEASE
The CXR shows a mass in the right lower zone. The mass has a sharp margin and
two vessels (supplying artery and draining vein) leading to the mass ). The
CT shows marked enhancement of the “mass” with contrast confirming
the presence of pulmonary arteriovenous malformation (pAVM). Of patients with
pAVM, 60% have Osler’s disease, and 10% of patients with Osler’s disease have
pAVM. This condition is autosomal dominant. Other sites of involvement include
skin, nose (epistaxis), gastrointestinal (GI) system (bleeding GI and anemia).
Paradoxical embolism can occur resulting in cerebral vascular accidents or brain
abscess. Pulmonary angiogram and embolotherapy are recommended if the pAVM
is more than 2 mm. Dr Ahmed Esawy

51. ANOMALOUS PULMONARY VENOUS DRAINAGE –SCIMITAR SIGN
The curvilinear shadow in the right lower zone is called a Scimitar sign. This is due
to aberrant drainage of the right inferior pulmonary vein into the inferior
vena cava. This is a congenital anomaly and is usually associated with a small
ipsilateral hemithorax and a small or hypoplastic pulmonary artery. This condition is
usually of no clinical significance. The CT scan shows the enhancing vein
Dr Ahmed Esawy

52. Intravascular Volume Status
The vascular pedicle (mediastinal width above top of aortic
arch) represents the superior vena cava on the patient’s
right and the left subclavian artery on the left.
If it is wide, that indicates greater intravascular volume.
Look at the example on the following slide.
Dr Ahmed Esawy

53. Intravascular Volume Status
Pre-dialysis Post-dialysis
Dr Ahmed Esawy

54. pulmonary infarction
Linear density
Dr Ahmed Esawy

55. Westermark sign – Dilatation of pulmonary vessels proximal to embolism along
with collapse of distal vessels, often with a sharp cut off.
Dr Ahmed Esawy

56. “Melting” sign of healing
Heals with linear scar
Dr Ahmed Esawy

57. Pleural thickening /scar
Dr Ahmed Esawy

58. Dr Ahmed Esawy

59. Dr Ahmed Esawy

60. Dr Ahmed Esawy

61. Dr Ahmed Esawy

62. Dr Ahmed Esawy

63. Dr Ahmed Esawy

64. OLD PLEURAL AND PULMONARY SCARS
► Scars are unchanged in
appearance on serial film.
► Thin linear shadow often
with associated pleural
thickening and tenting of
the diaphragm.
► Apical scarring is a
common finding with
healed tuberculosis,
sarcoidosis and fungal
disease
Dr Ahmed Esawy

65. Diffuse extensive pleural calcification adjacent to mediastinum heart diaphragm
As well as thoracic wall usually parietal
Dr Ahmed Esawy

66. Coarse parenchyma fibrosis with right interlobar visceral plaque
.
Dr Ahmed Esawy

67. Bilateral
symmetrical
basal and
peripheral
plaques
Dr Ahmed Esawy

68. B/L Calcified Pleural Plaques (Asbestosis)
Dr Ahmed Esawy

69. Lung ScarsScars in the lung, like scars on the skin, are permanent and usually cannot be
removed. However, the lung is remarkably resilient and able to withstand small scars
without any ill effects. Granulomas are scars that are caused by previous infection
and can develop into calcified scars. Normally, these lesions are not treated and there
is neither treatment nor necessity for their removal. Much like a scar on the skin,
stable scars on the lung are generally not treated.
Calcified scars are usually caused by previous lung infections such as pneumonia. In
the Ohio River Valley specifically, there is a fungus in the soil known
as histoplasmosis that sometimes causes infection but rarely causes any health
problems. Tuberculosis infections can also cause granulomas. Other factors that can
cause calcified scars over time, include:
Silicosis (from inhalation of silica dust)
Asbestosis (from inhalation of asbestos)
Sarcoidosis
Cystic fibrosis
Prior infections (such as pneumonia, tuberculosis infections, or fungal infections)
In some cases, scar tissue can build up and escalate into issues such as interstitial
lung disease and pulmonary fibrosis (where swelling and inflammation occur).
Dr Ahmed Esawy

70. Dr Ahmed Esawy

71. Dr Ahmed Esawy

72. Radiation fibrosis
Dr Ahmed Esawy

73. Pulmonary fibrosis
Dr Ahmed Esawy

74. Thickened fissure
Linear density
Dr Ahmed Esawy

75. Normal major fissures. Lateral chest radiograph demonstrates the two major
fissures. Note that both fissures are seen as double lines and that the left fissure
(arrows) is behind the right fissure (arrowheads).
Dr Ahmed Esawy

76. Superolateral major fissures. (a) Posteroanterior radiograph shows the
superolateral major fissures as curving contours with lateral opacity and medial
lucency bilaterally (arrows). Note that the left fissure extends higher than the right
one. (b, c) High-resolution CT scans (c obtained at a lower level than b) show
extrapleural fat entering the lips of the major fissures (arrow).
Dr Ahmed Esawy

77. Vertical fissure line in a child with a ventricular septal defect. Chest radiograph
demonstrates the right major fissure as a curving line in the right lower lung field
(arrows).
(b) Vertical fissure line in a woman with abruptio placentae and transient heart failure.
Chest radiograph shows the left major fissure as a curving line in the left middle and
lower lung fields (arrows).
Dr Ahmed Esawy

78. Superomedial major fissure. (a) Chest radiograph shows a superomedial right
major fissure (arrows).
The minor fissure is seen as double lines. (b) High-resolution CT scan helps
confirm the direction of the medial portion of the right major fissure as tangential
to the x-ray beam (arrow).
Dr Ahmed Esawy

79. Intrafissural fat. (a) Lateral chest radiograph shows a triangular area of increased
opacity (arrows) mimicking right middle lobe collapse. (b) CT scan reveals that
this triangular area represents extrapleural fat extending into the right major
fissure (arrow).
Dr Ahmed Esawy

80. Minor fissure “crossing” a major fissure.
Lateral radiograph shows a minor fissure (arrowheads) that appears to cross
a major fissure (arrows) and extends further posteriorly
Dr Ahmed Esawy

81. Right middle lobe collapse (middle lobe syndrome). On a lateral radiograph (b) as well as two
CT scans (c, d), the major fissure (arrows) is anterior to the minor fissure (arrowheads).
Incorrect localization of a pulmonary nodule may result from the same mechanism.Dr Ahmed Esawy

82. Incomplete fissure sign. (a) Posteroanterior radiograph shows a curving interface
in the lateral part of the left lower lung field (arrows),with lateral opacity and
medial lucency.
(b, c) High-resolution CT scans (c obtained at a lower level than b) show bilateral
pleural effusion.The left pleural effusion is bounded by the lateral border of the
lower lobe (arrow), which may explain the appearance on the radiograph.
The major fissures are complete; thus, “incomplete fissure sign” may also be seen
in cases of complete major fissure.Dr Ahmed Esawy

83. Usually slightly higher than the right sided horizontal fissure Occcurs in
about 4% of the population May incline superiorly laterally
Dr Ahmed Esawy

84. Azygous fissure is formed by the anomalous development of the azygous vein
The vein migrates through the RUL dragging parietal and visceral pleura with it
Dr Ahmed Esawy

85. Azygous fissure (white arrow) and azygous vein (black arrow)
Dr Ahmed Esawy

86. A peak-like shadow along the medial aspect of the right hemidiaphragm is evident in some cases and is referred to as a "juxta-
phrenic peak." This finding is more common in left upper lobe collapse, however. The formation of the peak is thought to be related
to traction on the basal pleura by the inferior pulmonary ligament. It has also been ascribed to upward retraction of the inferior
accessory fissure or an intrapulmonary septum associated with the pulmonary ligament [9]. In severe cases the RUL becomes
pancaked against the lung apex or upper mediastinum and can be mistaken for apical pleural thickening.Dr Ahmed Esawy

87. Right inferior accessory fissure in an 88 year old male who presented to the ED
following fall onto his right shoulder.Dr Ahmed Esawy

88. Fluid in the major or minor fissure (shown here) produces thickening of the fissure
beyond the pencil point thickness it can normally attain
Dr Ahmed Esawy

89. Thickened right
interlobar fissure
partially calcified
diaphragmatic
plaque
Dr Ahmed Esawy

90. Interlobular Fissure Thickening
Edema in the lung along the fissure
Dr Ahmed Esawy

91. Dr Ahmed Esawy

92. Thickening of fissures
left side horizontal fissure
Dr Ahmed Esawy

93. Septal Lines
Thickened interlobular septae
Dr Ahmed Esawy

94. Pulmonary tuberculosis sequela, linear density
Dr Ahmed Esawy

95. Curvilinear shadows
(Bullae/Pneumatocoele
/Bronchoceles)
Dr Ahmed Esawy

96. Bullous Disease of the Lungs
Definition
o Thin-walled–less than 1 mm
o Air-filled space
o Contained within the lung
o 1 cm in size when distended
o Walls may be formed by pleura, septa, or compressed lung tissue
·
Dr Ahmed Esawy

97. DD
o Pneumatocoele
§ Thin-walled (< 1mm), gas-filled space in the lung developing in
association with acute pneumonia, such as staph, and frequently transient
o Cavity
§ Gas-containing space in the lung having a wall > 1 mm thick
o Cyst
§ Thin-walled, air- or fluid-filled, with a wall that contains respiratory
epithelium, cartilage, smooth muscle and glands
o Bleb
§ Intrapleural cystic space
Dr Ahmed Esawy

98. Type 1
§ Originate in a subpleural location usually in upper part of lung
§ Narrow neck
§ Produce passive atelectasis of adjacent lung tissue
§ Paraseptal emphysema
Type 2
§ Superficial in location
§ Very broad neck
§ Anterior edge of upper and middle lobes and along diaphragm
§ Contain blood vessels and strands of partially destroyed lung
§ Spontaneous pneumothorax
Type 3
§ Lie deep within lung substance
§ Like type 2, contain residual strands of lung tissue
§ Affect upper and lower lobes with same frequency
Dr Ahmed Esawy

99. Bullous disease of the lungs-conventional
radiograph and CT. Frontal and lateral views of
the chest demonstrate numerous thin-
walled,air-containing structures that represent
the walls of numerous bullae.
These lineal densities are characteristic for
bullae on conventional radiography. The CT
scan on the same patient (below) shows the
same thin-walled bullae.
Dr Ahmed Esawy

100. Pneumatocoeles are intrapulmonary air-filled cystic spaces that can have
a variety of sizes and appearances. They may contain air-fluid levels and are
usually the result of ventilator-inducted lung injury in neonates or post-
pneumonic. They should not be mistaken for a cavitating lung mass.
Dr Ahmed Esawy

101. Post pneumotic pneumatocoele
Dr Ahmed Esawy

102. POST Staphylococcal pneumonia pneumatocele
Dr Ahmed Esawy

103. traumatic pneumatoceles
Dr Ahmed Esawy

104. Bronchocoele, also termed mucoid impaction, refers to a
mucous-filled dilated bronchi surrounded by aerated lung.
Dr Ahmed Esawy

105. Bronchocoele
Allergic
bronchopulmonar
y aspergillosis
(ABPA)
Dr Ahmed Esawy

106. Bronchocele
Subtle
increased
opacification in
the right mid-
zone. Branchin
g pattern.
Dr Ahmed Esawy

107. Chest radiograph (PA & lateral view) showing tubular branching opacity in Rt lower
lung field.
Calcified Bronchocele
Dr Ahmed Esawy

108. Linear artifact
Dr Ahmed Esawy

109. This radiograph demonstrates a curvilinear opacity in the right side with radiolucent lung
lateral to that, simulating a pneumothorax. Ill defined opacification in the right mid and
left lower zones can also be seen. A repeat study performed few hours later did not
show the previously seen curvilinear opacity confirming this to be a skin fold.
Dr Ahmed Esawy

110. Another case of Artifact simulating pneumothorax in a patient following insertion of
left internal jugular line. One can see a lung margin on the left side suggestive of a
pneumothorax.
Dr Ahmed Esawy

111. Another case of axillary skin fold simulating loculated left pneumothorax in a
female patient with a known breast carcinoma. Extension of the presumed lung
edge into the axialla is a clue to its artefactual nature.
Dr Ahmed Esawy

112. Dr Ahmed Esawy

113. On closer inspection and windowing one can see lung markings in the lung lateral
to the presumed lung edge (arrows) caused by oxygen reservoir bag.
Dr Ahmed Esawy

114. edge of the reservoir bag simulating pneumothorax in an 84 year old unwell patient.
Presence of gas in the soft tissues caused by necrotising fasciitis in this patient could
cause diagnostic uncertainty.
Dr Ahmed Esawy

115. This chest radiograph demonstrates linear shadows in the upper lobe simulating
upper lobe diversion/ fibrosis. On closer inspection you can see linear band shadows
bilaterally which extend outside of the chest and represent the patient's long hair
projected over the lungs. Dr Ahmed Esawy

116. Dr Ahmed Esawy