1. Abnormal Chest Radiograph
– part 1
B Widaja
Awesomemedicalnotes.wordpress.com

2. Describe the abnormality

3. Collapse
 Compare with previous films if available (new or
long standing?)
 Lung fields – right lung should be larger than
left. If not, suspect area of right sided collapse
 Diaphragms – right diaphragm should be higher
than left. Distortion may suggest left sided
collapse
 Horizonal fissure in right lung – If pulled up,
suspect right upper lobe collapse. If pulled down,
suspect right lower lobe collapse
 Trachea – pulled towards area of collapse
 Heart – deviated towards side of collape
 Borders (diaphragm, heart or mediastinum) –
blurred if lung adjacent to it is collapsed
(silhouette sign)

4. Case 1

5. Case 1
 Right upper lobe
collapse
◦ Shadowing in upper
zone of right lung (1)
◦ Horizontal fissure is
elevated
◦ Tracheal deviation
towards the right (2)
◦ Ribs over
shadowing are
closer together than
normal

6. Case 2

7. Case 2
 Right middle lobe
collapse
◦ Right diaphragm
may be slightly
raised (1)
◦ Horizontal fissure
may be slightly lower
than usual (2)
◦ Upper part of lower
zone may have hazy
shadowing (3)
◦ Right heart border
may be indistinct

8. Case 3

9. Case 3
 Right lower lobe
collapse
◦ Whiteness
immediately above
the diaphragm (1)
causing loss of its
outline
◦ Right heart border
maintained

10. Case 3

11. Case 3
 Left upper lobe
collapse
◦ Most left upper lobe
lies in front of lower
lobe
◦ Collapse of upper
lobe causes a haze
to appear over the
whole left lung field

12. Case 4

13. Case 4
 Left lower lobe
collapse
◦ Left lower lobe
collapses behind
heart
◦ Heart shadow
appears whiter
◦ Double left heart
border (sail sign)
◦ Left hemidiaphragm
border can’t be
followed to spine

14. Describe the abnormality

15. Volume loss -
pneumonectomy
 Mediastinum
◦ tracheal deviation towards side of pneumonectomy.
◦ Heart border not visible
 Contralateral lung field
◦ Hyperinflation of contralateral lung due to mediastinal shift.
◦ Appears darker (unaffected lung over-inflate, causing vessels to
become more spread out, hence reduced vascular markings)
 Diaphragm
◦ Upper border obliterated
 Ribs
◦ Pneumonectomy usually involve cutting or removing ribs during
operation. Look for rib deformity or absence of rib. Usually 5th rib
 Note extensive hypoplasia or congenital absence of one lung
may cause similar appearance

16. Case 5
 Left sided
pneumonectomy
◦ Left hemithorax
white
◦ Left mediastinal shift
◦ Lft ribs crowded
together
◦ Slight curvature of
spine
◦ Right lung
hyperinflated +
crosses over midline

17. Case 6

18. Case 6
 Right upper lobe
lobectomy
◦ Volume loss of right
lung
◦ Right tracheal
deviation
◦ Remaining right lung
hyperinflated, appea
rs darker
◦ Right diaphragm –
diagphragmatic
tenting

19. Case 7

20. Case 7
 Mass lesion in
mediastinum
?enlarged thyroid
gland
◦ Tracheal deviation
caused by mass
◦ Long volume, ribs
and diaphragms are
normal