Chest radiology plain film patterns and differential diagnosis pdf


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Chest Radiology Plain Film Patterns And Differential Diagnosis Pdf

Chest Radiology: Plain Film Patterns and Differential Diagnoses, 6th ed. By James C. Reed. Philadelphia, PA: Elsevier, pp., $ hardcover (ISBN . Chest radiology continues to be a large part of medical imaging, and advances in Reed J.C. Chest Radiology: Plain Film Patterns and Differential Diagnoses. Файл формата pdf; размером 11,62 МБ and many exams permit a precise radiographic diagnosis but many more require additional studies. Ebook Chest Radiology Plain Film Patterns And Differential Diagnosis currently available at for review only, if you need complete ebook Chest.

Even symptomatic patients may have a normal chest radiograph initially or may show small opacities which may be nodular or reticulonodular usually in the basal areas. The shadowing is usually symmetric from side-to-side, but atypical distributions can occur. Another common pattern is hazy, ground-glass opacification which may be diffuse or patchy. Volume loss is characterized by diaphragmatic elevation and depression of the fissures. The loss of volume is usually concentrated in the lower lobes but may be generalized.

It is used to determine the localization of a lesion in the hilar region in chest X-rays. If hilar vessels can clearly be seen inside the lesion, the lesion is either anterior or posterior to the hilus. If the hilar vessels cannot be discriminated from the lesion, the lesion is at the hilus Fig. Deep sulcus sign The deep sulcus sign describes the radiolucency extending from From the Department of Radiology O.

When plain films are taken with the sub- received 24 October ; accepted 1 November In the supine position, the air accumulating at DOI Air bronchogram sign.

Reed J.C. Chest Radiology: Plain Film Patterns and Differential Diagnoses

Chest X-ray of a patient who had c radiotherapy for breast cancer. Consolidation with air bronchograms arrows due to radiation pneumonitis at the upper lobe of the right lung. Air bronchogram sign on CT. Illustration of air bronchogram sign. Continuous diaphragm sign The continuous diaphragm sign oc- b curs as a result of continuation of me- diastinal air accumulated at the lower border of the heart with both hemidi- aphragms Fig.

It is useful in differ- entiating pneumothorax from pneu- momediastinum 7. It is most frequently encountered in neutropenic patients with aspergillosis. In invasive aspergil- losis, nearly two weeks after the onset of the infection, neutrophils increase in number and separate necrotic tissue from the normal lung parenchyma.

Figure 2. Silhouette sign. Chest X-ray of a patient without any The separated area then fills with air, complaints; the lesion obscures the right border of the heart arrow. CT resulting in the air crescent sign. In image demonstrates a cystic lesion pericardial cyst arrow.

Hilum overlay sign.

Chest X-ray of a patient with hemoptysis demonstrating enlarged right hilus. Hilar vessels can be seen inside the lesion, which shows that the lesion is not at the hilus arrow. Lung CT, mass at the right upper lobe arrows and lymph nodes at the right hilus. Deep sulcus sign and continuous diaphragm sign.

Chest X-ray obtained in the supine position from a patient with trauma history. Pleural free air accumulating at the right costodiaphragmatic sinus and extending to the hypochondrium is depicted arrowhead.

Mediastinal air neighboring the lower border of the heart causes the continuous diaphragm sign by combining the hemidiaphragms arrow. Figure 5. Air-crescent sign.

Chest X-ray of a patient with invasive aspergillosis; crescent-shaped air density around the consolidation area is seen arrow. Chest X-ray of a patient with a centrally located mass. The reverse S sign due to right upper lobe atelectasis is clearly depicted. Golden S. Cervicothoracic b sign. Frontal radiograph of the chest demonstrating a mass with a distinct cranial border projecting above the level of the clavicles, supporting a posterior mediastinal location arrows.

T1-weighted coronal magnetic resonance image of the same patient. The left posterior mediastinal mass is a biopsy-proven ganglioneuroma. Other causes of the air can aid in distinguishing this condi- while the inferiorly and medially locat- crescent sign are intracavitary fungus tion from invasive aspergillosis. This sign is an important bronchial involvement, hematoma, of the patient helps in differentiating clue indicating a central mass obstruct- abscess, necrotizing pneumonia, cystic it from a malignant mass attached to ing the bronchus.

It can be seen in eve- bronchiectasis filled with mucus plugs the wall 2. Saprophytic for the right upper lobe The describe the location of a lesion at the tion. Air between the cavity wall and minor fissure migrates superiorly, and inlet of the thoracic cavity.

Normal host immunity mass forms Fig. The su- perior segment of the left lower lobe mi- grates superior and anteriorly between the arch of the aorta and the atelectatic lobe. The crescent-shaped radiolucency around the aortic arch is called the Luft- sichel sign Fig. Scimitar sign The scimitar sign indicates anomalous venous return of the right inferior pul- monary vein total or segmental directly to the hepatic vein, portal vein or infe- rior vena cava. A tubular-shaped opacity extending towards the diaphragm along the right side of the heart is seen Fig.

The scimitar sign is associated with congeni- tal hypogenetic lung syndrome scimi- tar syndrome Figure 8. Luftsichel sign. A patient with a centrally located mass at the left lung. Frontal chest radiograph demonstrates volume loss due to left upper lobe atelectasis and crescent-shaped Doughnut sign radiolucency around the aortic arch, formed by the upper segment of the left lower lobe arrows. The doughnut sign occurs when me- diastinal lymphadenomegaly occurs a b behind the bronchus intermedius in the subcarinal region 7, 12, Lym- phadenopathy is seen as lobulated densities on lateral radiographs Fig.

Hampton hump sign The Hampton hump sign occurs within two days as a result of alveolar wall necrosis accompanying alveolar hemorrhage due to pulmonary infarct 7. It is a wedge-shaped, pleura-based consolidation with a rounded convex apex directed towards the hilus Fig.

This sign was first described by Au- brey Otis Hampton 7. It is usually en- countered at the lower lobes and heals with scar formation. Westermark sign The Westermark sign describes a de- Figure 9.

Scimitar sign. Frontal radiograph of a patient with hypogenetic lung crease of vascularization at the periph- syndrome. The abnormal inferior pulmonary vein is seen as a tubular opacity paralleling the ery of the lungs due to mechanical ob- right border of the heart arrows. It was first described by Neil Westermark 7.

An increase in translucency on frontal riorly than the anterior portions Fig. For this reason, a lesion clearly vis- tissues at this level 7. This sign is seen scribes the triangular opacity project- below the level of the clavicles, it is lo- in severe left upper lobe collapse.

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Due ing superiorly at the medial half of cated at the anterior mediastinum 7. It is most The borders are not clearly delineated side, upper lobe collapse causes vertical commonly related to the presence of because the lesion is far from the air- positioning and anterior and medial dis- an inferior accessory fissure 7. Doughnut sign. Lateral radiograph of the chest demonstrates enlarged lymph nodes at both hila and the subcarinal region.

The described pattern is formed by the radiolucent area at the central portion and by the surrounding opacities due to the lymph nodes. Hampton hump sign. Chest X-ray of a patient with pulmonary embolism showing a peripherally located, wedge-shaped homogenous opacity consistent with the infarct area arrow. Hump of a camel. Figure Westermark sign. Frontal radiograph of a patient with pulmonary Figure Juxtaphrenic peak sign.

Frontal radiograph of a embolism, showing increased radiolucency in the upper and middle zones of patient with right upper lobe atelectasis arrowheads , superior the left lung due to decreased vascularization. CT halo sign. Invasive aspergillosis in a patient with acute leukemia: CT image shows halo sign arrows. Gloved finger sign. CT images of a patient with lung cancer, showing bronchi filled with mucus. Gloved hand. Computed tomography CT halo sign The CT halo sign represents an area of ground-glass attenuation surround- ing a pulmonary nodule or mass on CT images Fig.

Reed J.C. Chest Radiology: Plain Film Patterns and Differential Diagnoses

It is seen most commonly in the early stage of inva- sive aspergillosis in immunocompro- mised patients. The CT halo sign has also been described in patients with eosinophilic pneumonia, bronchioli- tis obliterans organizing pneumonia BOOP , candidiasis, Wegener granu- lomatosis, bronchoalveolar carcinoma, and lymphoma 16— Formation of mechanism is not known with cer- fissure is responsible The juxta- the halo sign varies according to the tainty; according to one theory, the phrenic sign can also be seen in com- disease.

Signet b ring sign. A patient with bronchiectasis. Dilated bronchus and the adjacent pulmonary artery are seen in the left lower lobe arrow.

Signet ring.

Comet tail sign. Prone CT image of a patient with tuberculosis pleuritis history. Subpleural atelectasis arrow and bronchovascular structures extending toward the hilum arrowheads are seen.


Gloved finger sign tion. In asthma and asthma with bronchial dilatation 7.

The signet This sign is characterized by branch- ABPA, there is increased airway hy- ring sign can be seen anywhere in the ing tubular or finger-like soft tissue persensitivity and mucus production. It is an adjunct finding that can densities Fig. This appearance Also, in APBA, the cause of bronchial help in differentiating bronchiectasis is formed by dilated bronchi filled impaction is saprophytic prolifera- from other cystic lung lesions On tion of aspergillus organisms within Accompanying findings such as peri- CT images, mucus-filled bronchi are the dilated bronchi.

In cystic fibrosis, bronchial thickening, lack of bronchi- seen as Y- or V-shaped densities 20, the cause of mucoid impaction is im- al tapering, and visualization of bron- Any obstructing lesion can lead paired ciliary action and abnormally chi within 1 cm of the pleura are all to distal bronchiectasis and mucoid thick secretions 20, Benign and malignant diagnosis 7. It con- mucoid impaction of a bronchus. Al- occurs when the bronchoarterial ratio sists of distortion of vessels and bronchi lergic bronchopulmonary aspergillo- is increased 7 Fig.

This sign is that lead to an adjacent area of rounded sis ABPA , asthma, and cystic fibrosis usually seen in patients with bron- atelectasis. This sign is a characteristic can cause this sign without obstruc- chiectasis or irreversible abnormal feature of round atelectasis Fig.

There is volume loss in the affected lobe. However, there are two hypotheses regarding the for- mation of the rounded atelectasis: an underlying pleural effusion that causes local atelectasis in the adjacent lung and a local pleuritis caused by irritants such as asbestos, tuberculosis, non- specific pleuritis or Dressler syndrome As in the other atelectasis types, the homogeneous enhancement oc- curs after the intravenous administra- tion of contrast material.

The rounded atelectasis is sometimes impossible to differentiate from peripheral lung can- cer. Biopsy is indicated in cases that are equivocal CT angiogram sign. A patient with bronchoalveolar carcinoma. Enhancing enhancing pulmonary vessels in a ho- pulmonary vessels in a low-attenuating mass are seen. This sign has been described in the lobar form of bronchoalveolar cell carcinoma 17, Another important cause of the CT angiogram sign is pneumonia.

The low- attenuating area has been considered to be the result of mucus production by tumor cells. The CT angiogram sign has also been reported in pulmonary edema, obstructive pneumonitis due to central lung tumors, lymphoma, and metastasis from gastrointestinal carci- nomas 25, Crazy paving pattern The crazy paving pattern consists b of scattered or diffuse ground-glass attenuation with superimposed inter- lobular septal thickening and intral- obular lines Fig.

It was initially described in cases of alveolar proteinosis In alveolar protei- nosis, the ground-glass attenuation reflects the low-density intraalveolar material glycoprotein , whereas the superimposed reticular attenuation is due to infiltration of the interstitium by inflammatory cells This find- ing can be caused by Pneumocystis cari- nii pneumonia, mucinous bronchoal- veolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneu- Figure Crazy paving pattern.

Patient with situs inversus and Kartagener syndrome monia, adult respiratory distress syn- showing diffuse ground-glass attenuation with superimposed interlobular septal thickening and drome, and pulmonary hemorrhage intralobular lines in both lungs.

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