Chest X-rays - Findings

Pulmonary hyperinflation

Bronchial wall thickening

Pulmonary oedema (rare)

Hyperinflation – Horizontal ribs, flattened diaphragm

“floating” heart sign

Bullae

Large central pulmonary arteries

Infective – Opacities/“consolidation” suggestive of pneumonia

Air bronchogram

Opacities/“consolidation” poorly defined in zones

No loss of costo-phrenic angle

?pleural effusions

Upper lobe opacities

Miliary disease

Hilar lymphadenopathy

Cavitation

Calcification

Seen as a hilar/perihilar mass

Mediastinal widening due to lymph node enlargement

?pleural effusions – loss of costophrenic angle “mensicus”

Unilateral pleural effusion

Irregular pleural thickening

Reduced lung volumes, and/or parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)

?pleural plaques

Rib destruction

Lower zone linear interstitial fibrosis

Progressively involves the entire lung

Diffuse pleural thickening

Pleural plaques

Elevation of the ipsilateral hemidiaphragm

Crowding of the ipsilateral ribs

Shift of the mediastinum towards the side of atelectasis

Crowding of pulmonary vessels or air bronchograms

Visible visceral pleural edge is seen as a very thin, sharp white line

No lung markings are seen peripheral to line

Peripheral space is radiolucent compared to adjacent lung

Lung may completely collapse

Mediastinum should not shift away from the pneumothorax

Subcutaneous emphysema and pneumomediastinum may also be present

Ipsilateral increased intercostal spaces

Mediastinal shift to contralateral side

Depression of hemidiaphragm

Mediastinal shift  with hyperinflation of contralateral lung

Increasing fluid and decreasing gas within pneumonectomy space

Tram-track opacities in cylindrical bronchiectasis

Air-fluid levels in cystic bronchiectasis

Increase coarse in bronchovascular markings

Bronchi seen end on may appear as ring shadows 

Pulmonary vasculature appears ill-defined - peribronchovascular fibrosis

Loss of heart contours

Widespread lung fibrosis, leading to lung volume loss

Less lung volume – smaller lung fields, raised diaphragm

Well defined peri-hilar shadows most probably lymph nodes

DDx: Lymphoma, TB, glandular fever, disseminated malignancies, sarcoidosis.

Blunting of the costophrenic angle

Bllunting of the cardiophrenic angle

Fluid within the horizontal or oblique fissures

Meniscus sign

Mediastinal shift occurs away from the effusion with large volumes

protein concentration

-       >30g/l

-       total protein fluid: serum >0.5

lactic acid dehydrogenase (LDH)

-       >20 IU/L

-       LDH fluid: serum >0.6

specific gravity >1.016

Bronchial carcinoma

Mesothelioma

Pneumonia, TB

protein concentration

-       <30g/L absolute

-       total protein fluid: serum <0.5

lactic acid dehydrogenase (LDH)

-       <20 IU/L

-       LDH fluid: serum <0.6

specific gravity <1.016

CCF

Nephrotic syndrome

Asbestos