Chest Radio Graphs

8/9/2019 Chest Radio Graphs

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Pulmonary aspergillosis is a fungal infection by the Aspergillus species, most commonly Aspergillus fumigatus . There are 4 distinct forms of pulmonary aspergillosis: allergic bronchopulmonary aspergillosis(ABPA), aspergilloma, chronic necrotizing aspergillosis, and angioinvasive aspergillosis. Chest radiograph

findings of ABPA include lobar infiltrates, perihilar 'glove-like' tubular shadows representing mucus-filledbronchiectasis, and tram-line bronchial walls due to edema. The characteristic features of anaspergilloma are a round mass with an adjacent crescent-shaped air space (arrow). The fungal ball itself may be freely mobile and move when the patient changes position. Chronic necrotizing aspergillosismay appear as segmental areas of consolidation, predominately in the upper lobes, that progresstoward cavitation. Angioinvasive aspergillosis most commonly appears as patchy areas of consolidationwith multiple nodules and peripheral wedge-shaped lesions due to hemorrhagic infarcts.


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Unilateral pleural thickening is the classic finding on chest radiographs in patients with malignantmesothelioma. The pleural thickening may be either plaque-like or nodular. Pleural effusions mayobscure the pleura, making it difficult to evaluate the thickness; however, the fissures may also becomethickened and irregular in contour, which can aid in diagnosis. The presence of calcified pleural plaquesindicates previous asbestos exposure, which is a risk factor for the development of mesothelioma. Theimage shown demonstrates thickening of the left lateral pleura (arrow) with lobulation and effusion.Other potential causes of unilateral pleural thickening are empyema, trauma, postoperative scarring,and metastatic disease.


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Asbestos-related disease is caused by inhalation of asbestos fibers, typically from industrial oroccupational exposures. The chest radiograph findings of bilateral calcified pleural plaques over thediaphragmatic, peripheral, or mediastinal pleura (white arrows) is indicative of prior asbestos exposure.Noncalcified pleural plaques are not readily appreciated on chest radiograph but fully displayed oncomputed tomography. Progression of asbestos-related disease to involve the lung parenchyma is

known as asbestosis. This predominantly affects the interstitial compartment of the lung and manifestsas increased interstitial markings, coarse parenchymal bands, rounded atelectasis (red arrows), andparenchymal distortion on chest radiographs. The appearance of pleural effusion -- particularly if associated with enlarging pleural mass and localized pain -- is indicative of development of amesothelioma.


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Pancoast tumors are pulmonary neoplasms located in the superior sulcus of the lung. They arepredominantly non-small cell carcinomas, particularly of the squamous cell histology. Theycharacteristically cross the pleural barrier to invade the chest wall, brachial plexus, and superiorsympathetic ganglion (resulting in Horner's syndrome). On chest radiographs, they may appear asunilateral apical opacity (arrow) or apical asymmetry. Local rib destruction, particularly the first rib, mayalso be present. Lordotic chest views may be helpful to clarify a suspected lesion.


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Pulmonary hypertension develops as a result of increased pulmonary artery pressure and vascularresistance. Primary pulmonary hypertension usually affects young women and is a disease of unknownetiology. Secondary pulmonary artery hypertension can be due to precapillary (eg, left-to-right shunt),capillary (eg, veno-occulsive disease), or postcapillary (eg, chronic lung disease) causes. The mostcommon findings on chest radiograph are enlarged pulmonary arteries (arrow) that taper distally(peripheral pruning). A dilated right ventricle with a decreased retrosternal space may also be seen onlateral images


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Sarcoidosis is a multisystem granulomatous disease that classically presents with pulmonary, eye, or skinlesions. Characteristic pulmonary radiographic appearances are present in 60%-70% of individuals withsarcoidosis. Bilateral symmetric hilar lymphadenopathy (arrows) is the most common pulmonaryradiographic finding. In more advanced (Stage 4) disease, fibrosis, hilar retraction, decreased lungvolumes, and honeycombing may develop.


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The chest radiograph is one of the most commonly ordered radiographs by healthcare providers and isfrequently first viewed by non-radiologists. Although there are many disease processes that are veryobvious at first glance on chest radiographs, healthcare providers must be careful not to miss moresubtle findings. The image shows a solitary pulmonary nodule (arrow) abutting the left uppermediastinum.

A solitary pulmonary nodule is defined as a single discrete pulmonary opacity surrounded by normallung and not associated with adenopathy or atelectasis. The list of potential differential diagnoses isextensive and broadly includes benign and malignant neoplasms, infections, noninfectious granulomas,developmental lesions, vascular lesions, and other systemic processes. Although the exact etiology may

not be discernable on a chest radiograph, failure to detect a lesion and obtain appropriate follow-up canlead to significant morbidity and mortality for the patient. Key features to identify are nodule size,location, growth rate, margin characteristics, cavitation, and calcification. Factors favoring malignancyare growth over time, large size, irregular or spiculated margin, and upper lobe location. It may be easyto miss a lesion that overlaps the ribs or clavicles. The image shown is from an individual with a solitarypulmonary nodule (arrow) found to be a pulmonary ateriovenous malformation.


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Tracheal stenosis is a narrowing of the trachea that may be caused by chronic inflammatory disease,neoplasm, trauma, iatrogenic, and extrinsic compression from lesions such as intrathoracic goiter(shown). On chest radiographs, the trachea and mainstem bronchi can readily be assessed for changesin caliber. The radiograph may also provide clues as to the cause of stenosis, such as tracheal deviationor a widened mediastinum, or other potential etiologies for shortness of breath, such as an aspiratedforeign body. The image shown is of a patient with a large intrathoracic goiter producing a widenedmediastinum (white arrows) with narrowing of the trachea (black arrows).


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Cavitary lung lesions on chest radiographs can be the result of an abscess, tuberculosis, carcinoma,Wegener's granulomatosis, metastatic cancer, or septic emboli. Key features to identify are size, wallthickness, air-fluid levels, and location as this may provide clues as to the potential etiology of the lesion.Lateral radiographs may be needed to help confirm location. Abscesses typically have thick walls andmay have air/fluid levels. Metastases are typically thin-walled but may have a variable appearance.Wegener's granulomatosis and septic emboli are typically smaller lesions. The image shows a thin-walled cavitary lesion without air-fluid level (arrow) in a patient with primary tuberculosis.


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Osteomyelitis is an infection of the bone and bone marrow. It may be easily missed on chest radiographsif one does not pay careful attention to the bones in addition to the lung fields. Typical findings of acuteosteomyelitis on plain radiographs are soft tissue swelling, periosteal reaction, cortical irregularity, anddemineralization. In chronic osteomyelitis, there is thick, irregular, sclerotic bone with radiolucenciesand an elevated periosteum. The image shown is from a patient with chronic osteomyelitis of the leftclavicle with bony expansion, sclerosis, and periosteal reaction (arrow). Note the size differencecompared to the right clavicle.


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Compression fractures of the thoracic spine occur whenever the spinal column is subjected to forcesthat exceed its strength and stability. They may be first detected on chest radiographs by carefullyevaluating the vertebral bodies. Typical findings on a plain radiograph for anterior compression fracturesinclude cortical impaction, loss of vertical height, buckling of the anterior cortex, trabecular compaction,and endplate fracture. Lateral radiographs may provide better views of the spinal architecture. The

image shown demonstrates kyphosis of the thoracic spine with an osteoporotic fracture of the T8vertebral body (arrow).

Malignant mesothelioma and localized fibrous tumor of the pleura are primary pleural neoplasms.Localized fibrous tumor of the pleura is a benign neoplasm of the pleura, not associated with asbestosexposure. Typical findings on chest radiographs are a well-circumscribed, homogeneous soft-tissue massclosely related to the pleura. Lesions may be found anywhere along the lung periphery (shown),pulmonary fissures, mediastinum, or diaphragm. Large lesions may be confused for lobar consolidation.


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Unilateral hyperlucent lung may be the result of Swyer-James syndrome, pneumothorax, obstructiveemphysema, or pulmonary embolism. Hyperlucency is typically the result of alveolar distension (airretention) and/or reduced arterial flow. Swyer-James syndrome is a manifestation of postinfectiousobliterative bronchiolitis found in children. On chest radiograph, the ipsilateral lung is hyperlucent andoverexpanded (left lung), compared with the contralateral lung, which is smaller (shown).

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Chest Radio Graphs