Consolidation

Radiological Characteristics

• Opacification
• Lobar/Segmental distribution
• Air bronchogram
• No significant loss of lung volume

Etiology

• Streptococcus
• Legionella
• Mycoplasma
• Post obstructive

 

 

 

 

 

 

 

Atelectasis

Radiological Characteristics

1. Opacity (airless lung)
2. Signs of loss of lung volume.          

• Mediastinal shift
• Elevated diaphragm
• Movement of fissures
• Shift of hilum
• Change of proportion of lungs
• Smaller hemi thorax

       3. Compensatory hyperinflation

Etiology

• Cancer
• Foreign body
• Benign tumor
• Granuloma

 

 

 

 

 

 

 

 

Pneumothorax

Radiological Characteristics

• Dark  field with no vascular markings in the pleural space
• Visible collapsed lung 
• Larger hemi thorax

Etiology

All Lung Diseases

Trauma

• Procedures
• Accident
• Barotrauma (Ventilator)

"Normal Lungs"

• Bullous lesions
• Marfan's syndrome
• Ehler Danlos syndrome
• Catamenial Pneumothorax

Lung Mass

• Radiological criteria

  • Homogenous liquid density

  • Density >5 CMS in diameter  (less than 5 cm is called solitary pulmonary nodule)

  • Sharp margins

  • No respect for segments or fissures

• Etiology

  • Lung cancer

  • Granulomatous infections (TB, Histo, Blastomycosis)

  • Wegners Granuloma

  • Rheumatoid lung

  • Metastasis

Pleural effusion

Radiological Characteristics

• Loss of costophrenic angle
• Loss of diaphragmatic shadow
• Homogenous opacification
• Shift of mediastinum to opposite side
• Ellis line

Etiology (common diseases)

• Congestive heart failure
• Cancer
• Tuberculosis
• Empyema
• Hem thorax

 

Cavity

Etiology

• Lung cancer  :  Squamous cell Cancer Lung (Thick wall, Irregular lumen, Stalactites and Stalagmites) 
• Metastasis
• Wegners Granuloma
• Rheumatoid lung
• Cystic fibrosis
• Granulomatous infections TB, Histo
• Lung abscess
• Necrotizing Pneumonia
• Coccidiomycosis
• Fungous ball (Mobile ball inside a cavity)

Radiological Characteristics

• Number ( single or multiple)
• Size
• Site (apices of lobes for TB, classical segments for aspiration)
• Thickness of wall (thick, thin)
• Content (fluid level, fungous ball)
• Lumen (irregular)
• Associated findings

Congested lungs

.In CHF radiological there is progression from

• Vascular congestion precedes congestion and can be recognized as prominent pulmonary veins. There will be cephalisation.
• In the next phase the interstitial edema and increased lymph flow manifests itself as Kerley lines.
• Next you see basal congestion with smaller lungs due to increased elastic recoil . Congested boggy Liver also pushes the diaphragm up.
• Full blown pulmonary edema is the last stage when you recognize acute diffuse alveolar pattern in CXR.

Chest wall lesion

Radiological Criteria

• Peripheral density
• Sharp inner margin
• Indistinct outer margin
• Cat under the rug appearance with shallow concave edges.

Etiology

• Expanding rib lesions
  • Fracture with hematoma
  • Callus
  • Metastasis
  • Plasmacytoma
• Parietal pleural masses (Mesothelioma)
• Neurofibroma
• Plumbage

Solitary pulmonary nodule

Radiological criteria

• Liquid density
• Distinct margin
• Between 2-5 CMS in diameter
• Oval or round
• no other lesions

 Common lesions that can give you the Solitary pulmonary nodule

• Cancer
• Benign tumor
• Granulomas
• Rare but characteristic conditions
• AV fistula
• Hydatid cyst

Lymphadenopathy

Radiological criteria

• Polycyclic margin
• Clear space between heart and the nodal density with Hilar nodes
• Extra pleural sign with Mediastinal nodes
• Widening of mediastinum

Common etiology

• Cancer Lung
• Lymphoma
• Granulomatous diseases
  • TB
  • Sarcoidosis
  • Histoplasmosis
  • Silicosis

Diffuse lung disease is categorized into

• Alveolar
• Interstitial
• Vascular

Most of the time it is mixed and difficult to categorize into one pattern.

Diffuse interstitial pattern

Radiological features

1. Lines (Kerley lines)
2. Nodules
3. Honeycombing

Common etiology

• Granulomatous disease
  • Miliary TB
  • Sarcoidosis
  • Silicosis
• Lymphangitic spread
• Idiopathic fibrosis
• Drug induced fibrosis

Diffuse alveolar pattern

Radiological criteria

• Butterfly or medullary distribution
• Lobar or segmental densities
• Soft fluffy coalescing densities
• Air bronchogram
• Alveologram

Common causes

Acute

Water
Blood
Inflammatory exudates

Chronic

Alveolar proteinosis
Alveolar form of Lymphoma
Alveolar form of Sarcoidosis
Alveolar form of TB
Fungal infections
Mineral oil aspiration
Desquamative interstitial pneumonia

Mediastinal mass

Radiological criteria

Mass because

• Homogeneous liquid density
• Distinct margin

Mediastinal because

• Has Extra pleural sign (peripheral, absence of one of the margins both in PA and lateral view)
• Location is suggested by x-rays to be anterior mediastinum

Common Mediastinal masses in the anterior mediastinum

1. Thymoma
2. Teratoma
3. Thyroid
4. Testicular metastasis
5. Terrible lymphoma