- Humane approach to CXR interpretation : be curious, satisfy the need for search, KISS ( keep it simple, stupid !! )
- When assessing for airway position, do not forget to look at the esophagus !! Air fluid level + thickened retrotracheal line and displaced trachea to front is suspicious of esophageal stasis
- Rib notching w/o hypertension - do not diagnose coarctation of aorta
- If a mass overlies the ribs, assess whether there is any lytic lesion. You are done with your diagnosis if you could identify any bony involvements
- Pay attention to the spine and intervertebral disc when you are suspecting bone metastasis. Ivory vertebrae, collapsed disc are your clues that metastasis has happened
- Extrapulmonary mass must have distinct borders and forms obtuse angle with the lung. Another important sign is incomplete border sign.
- Pleural mass has in addition peripheral location and blunted costophrenic angle if located inferiorly
- A rounded atelectasis can be suggested if there is volume loss and the mass is located peripherally, pleural thickening and curvilinear vessels leading to it
- Always look in costophrenic angle and along the diaphragm for any nodular lesion ( in addition for effusion )
- A calcified nodule is likely to be benign
- A localized mass with air fluid level is highly suggestive of malignancy ( Squamous cell carcinoma )
- Always compare the position of left and right hilum. Left hilum usually is located between aortic knob and superior border of heart; right hilum just at the level of superior border of heart. A pulled up/down hilum suggests volume loss in that lung
- LLL collapse - sail sign, flat waist sign; LUL collapse - juxtaphrenic peak sign; Lufsichel sign
- Lufsichel sign is not only found around aortic knob, it can be a band of hyperlucency anywhere in the upper lobe of left lung
- If inspiratory and expiratory films are done, it is important to know before interpretation, which phase is pathological !!
- Congenital bronchial atresia is not uncommon. An area of hyperlucency with tubular density ( mucous impaction ) is suggestive
- Only 3 things cause tubular densities in lung - mucous, vascular lesions and herniated bowel loops
- The most common cause of lung collapse is cancer !!
- Fibrous dysplasia is not uncommon, seen as solitary lesion in a rib in a young patient
- Bulging of any of the mediastinal lines suggest mediastinal mass. Confirm with lateral X ray
- Always consider vascular pathology in ANY of the mediastinal mass ( mediastinum is made up of basically vessels )
- Look at the anterior clear space at lateral X ray for anterior mediastinal mass
- Superior mediastinal mass can be in anterior or posterior compartment. A superior mediastinal mass located posteriorly is likely a vascular lesion. It will show what is called cervicothoracic sign ( the mass will extend above clavicle )
- Always assess the centrality of the trachea. A displaced trachea in a S shaped manner suggests mass effect. Remember a trachea usually ends just at the beginning of the aortic arch. A displaced trachea at lateral film suggests mass effect
- Ddx of middle mediastinal mass depends on the location of the mass.
- When assessing for airway position, do not forget to look at the esophagus !! Air fluid level + thickened retrotracheal line and displaced trachea to front is suspicious of esophageal stasis
- Rib notching w/o hypertension - do not diagnose coarctation of aorta
- If a mass overlies the ribs, assess whether there is any lytic lesion. You are done with your diagnosis if you could identify any bony involvements
- Pay attention to the spine and intervertebral disc when you are suspecting bone metastasis. Ivory vertebrae, collapsed disc are your clues that metastasis has happened
- Extrapulmonary mass must have distinct borders and forms obtuse angle with the lung. Another important sign is incomplete border sign.
- Pleural mass has in addition peripheral location and blunted costophrenic angle if located inferiorly
- A rounded atelectasis can be suggested if there is volume loss and the mass is located peripherally, pleural thickening and curvilinear vessels leading to it
- 3 complications of chronic pleural disease : malignancy, empyema necessitantis and bronchopleural fistula.
- Malignancy can be distinguished by being a solid in CT scan.
- Empyema necessitantis is a condition characterized by pus boring its way to the chest wall.
- Bronchopleural fistula is characterized by an abnormal connection between the visceral pleura and the lung
- Always look in costophrenic angle and along the diaphragm for any nodular lesion ( in addition for effusion )
- A calcified nodule is likely to be benign
- A localized mass with air fluid level is highly suggestive of malignancy ( Squamous cell carcinoma )
- Always compare the position of left and right hilum. Left hilum usually is located between aortic knob and superior border of heart; right hilum just at the level of superior border of heart. A pulled up/down hilum suggests volume loss in that lung
- LLL collapse - sail sign, flat waist sign; LUL collapse - juxtaphrenic peak sign; Lufsichel sign
- Lufsichel sign is not only found around aortic knob, it can be a band of hyperlucency anywhere in the upper lobe of left lung
- If inspiratory and expiratory films are done, it is important to know before interpretation, which phase is pathological !!
- Congenital bronchial atresia is not uncommon. An area of hyperlucency with tubular density ( mucous impaction ) is suggestive
- Only 3 things cause tubular densities in lung - mucous, vascular lesions and herniated bowel loops
- The most common cause of lung collapse is cancer !!
- Fibrous dysplasia is not uncommon, seen as solitary lesion in a rib in a young patient
- Bulging of any of the mediastinal lines suggest mediastinal mass. Confirm with lateral X ray
- Always consider vascular pathology in ANY of the mediastinal mass ( mediastinum is made up of basically vessels )
- Look at the anterior clear space at lateral X ray for anterior mediastinal mass
- Superior mediastinal mass can be in anterior or posterior compartment. A superior mediastinal mass located posteriorly is likely a vascular lesion. It will show what is called cervicothoracic sign ( the mass will extend above clavicle )
- Always assess the centrality of the trachea. A displaced trachea in a S shaped manner suggests mass effect. Remember a trachea usually ends just at the beginning of the aortic arch. A displaced trachea at lateral film suggests mass effect
- Ddx of middle mediastinal mass depends on the location of the mass.
- A superiorly located - vascular mass; the most common is aortic aneurysm ; aortic aneurysm is also the most commonly mass that calcifies
- A middle-ly located - lymph nodes or duplication cyst ; look for bulging in azygoesophageal fissure
- An inferiorly located - esophageal pathology ( achalasia, stricture that leads to esophageal stasis )
- Always include esophageal pathology in ANY of the middle mediastinal lesions
- We only see the outer contour of aorta and it's impossible to see the inner wall because it blends with mediastinal structures; a dilated aorta may not be dilated !!
- A dilated descending aorta + normal ascending aorta suggests type B aortic dissection
- Look in aortopulmonary window. A bulging window is suggestive of mass
- Unilateral lymph node and cavity - the top two ddx is TB and carcinoma
- Lymphoma causes anterior mediastinal lymphadenopathy as seen on CT
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