Chest

Air where it not belongs - Pneumomediastinum
Obstructive airways - COPD
Thromboembolic disease - Incidental pulmonary embolus on abdominal CT, right atrial thrombus
Tube and line misplacement - Misplaced PICC
Pneumothorax - Large Pneumothorax
Trauma - Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma
Thromboembolic disease - Shower of pulmonary emboli
Technique - Normal Chest
Harmless - Calcified Granuloma
Harmless - Calcified lymph nodes
Cancer - Lung cancer
Technique - Proper technique important!
Pneumothorax - Large pneumothorax
Pneumothorax - Small pneumothorax
Pneumothorax - Small pneumothorax
Pneumothorax - Small costophrenic pneumothorax
Aorta - Aortic aneurysm
Fluid - Pleural effusion
Lung volume - Volume loss
Lung volume - Obstructive lung disease
Pneumonia - Left and right lower lobe pneumonia
Pneumonia - Right middle lobe pneumonia
CHF - Mild CHF
CHF - Moderate CHF
CHF - Severe CHF
CHF - Severe CHF (Batwing sign) & correct central line placement
Tube and line misplacement - Endotracheal tube and central line placement
Tube and line misplacement - ET tube misplacement
Tube and line misplacement - ET tube and central line misplacement
Tube and line misplacement - Central line misplacement
Foreign body - Coin in esophagus

Chest: Air where it not belongs

Diagnosis: Pneumomediastinum (CT, Radiograph)

Air is seen within the subcutaneous soft tissues of neck and chest as well as in the mediastinum - separating mediastinal structures, such as trachea, esophagus and aorta.

Air where it not belongs (Pneumomediastinum - CT, Radiograph)

Chest: Pneumomediastinum

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Chest: Obstructive airways

Diagnosis: COPD (Radiograph)

This patient has hyperinflated lungs: hyperlucent lungs, widened retrosternal space, flattened diaphragms, widened intercostal spaces.

Chest: COPD

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Chest: Thromboembolic disease

Diagnosis: Incidental pulmonary embolus on abdominal CT, right atrial thrombus (CT)

This pulmonary embolus has a more chronic appearance, since it is more wall adherend. Acute emboli are more centrally located within the vessel. Also right atrial thrombus.

Thromboembolic disease (Incidental pulmonary embolus on abdominal CT, right atrial thrombus - CT)

Chest: Incidental pulmonary embolus on abdominal CT, right atrial thrombus

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Chest: Tube and line misplacement

Diagnosis: Misplaced PICC (Plain film, Radiograph)

A right PICC has a somewhat serpiginous course with the tip projecting over the right lower neck. Also noted is a moderate right pleural effusion.

Tube and line misplacement (Misplaced PICC - Plain film, Radiograph)

Chest: Misplaced PICC

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Chest: Pneumothorax

Diagnosis: Large Pneumothorax (Plain film, Radiograph)

A single AP upright view of chest shows advanced left pneumothorax with associated advanced collapse of left lung.

Pneumothorax (Large Pneumothorax - Plain film, Radiograph)

Chest: Large Pneumothorax

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Chest: Trauma

Diagnosis: Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma (CT)

CT in soft tissue, bone and lung windows demonstrate acute fractures of the right sixth through ninth ribs laterally and posterolaterally and a tiny right hemopneumothorax.

$Trauma (Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma - CT)$

Chest: Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma

$Trauma (Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma - CT)$

Chest: Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma

$Trauma (Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma - CT)$

Chest: Serial rib fractures with hemopneumothorax, incidental lung adenocarcinoma

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Chest: Thromboembolic disease

Diagnosis: Shower of pulmonary emboli (CT)

Multiple luminal filling defects are seen in the segmental and subsegmental branches of bilateral pulmonary arteries, consistent with a shower of acute pulmonary emboli. The more central luminal location of the emboli speaks more for an acute event.

Thromboembolic disease (Shower of pulmonary emboli - CT)

Chest: Shower of pulmonary emboli

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Chest: Technique

Diagnosis: Normal Chest (Plain film, Radiograph)

Proper technique important:
PA + lateral, erect, good inspiration
Check for heart, lungs, upper airways, bones
Heart diameter < ? of thorax diameter

Technique (Normal Chest - Plain film, Radiograph)

Chest: Normal Chest

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Chest: Harmless

Diagnosis: Calcified Granuloma (Plain film, Radiograph)

Dense calcification
Well defined
Sharp margins
Size < 1cm

Harmless (Calcified Granuloma - Plain film, Radiograph)

Chest: Calcified Granuloma

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Chest: Harmless

Diagnosis: Calcified lymph nodes (Plain film, Radiograph, CT, Computed tomography)

Calcified lymph nodes (from histoplasmosis)
(Bi)hilar calcifictions
Sometimes �lymph node� shaped
History helpful (Histoplasmosis, Sarcoidosis, Tuberculosis, etc.)

Harmless (Calcified lymph nodes - Plain film, Radiograph, CT, Computed tomography)

Chest: Calcified lymph nodes

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Chest: Cancer

Diagnosis: Lung cancer (Plain film, Radiograph)

Poorly (if not) calcified
Well � poor margins
Size > 1cm
History (smoker, Asbestos exposure)
Here: RLL tumor (SCC)

Cancer (Lung cancer - Plain film, Radiograph)

Chest: Lung cancer

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Chest: Technique

Diagnosis: Proper technique important! (Plain film, Radiograph)

Importance of good inspiration and erect technique
Portable (AP) films:
Lungs underairated (mimicking, tumors or infiltrates)
Heart larger

Technique (Proper technique important! - Plain film, Radiograph)

Chest: Proper technique important!

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Chest: Pneumothorax

Diagnosis: Large pneumothorax (Plain film, Radiograph)

Look along the pleural margins!
No vascular markings beyond pleural line
Ipsilateral lung collapsed/ more dense (depends on size)
Can hide behind ribs
History (central line placement, emphysema, trauma, tumor)
Look for tension pneumothorax (mediastinal shift away from pneumo)

Chest: Large pneumothorax

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Chest: Pneumothorax

Diagnosis: Small pneumothorax (Plain film, Radiograph)

Pneumothorax (Small pneumothorax - Plain film, Radiograph)

Chest: Small pneumothorax

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Chest: Pneumothorax

Diagnosis: Small pneumothorax (Plain film, Radiograph)

Chest: Small pneumothorax

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Chest: Pneumothorax

Diagnosis: Small costophrenic pneumothorax (Plain film, Radiograph)

Pneumothorax (Small costophrenic pneumothorax - Plain film, Radiograph)

Chest: Small costophrenic pneumothorax

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Chest: Aorta

Diagnosis: Aortic aneurysm (Plain film, Radiograph, CT, Computed tomography)

Thoracic aortic aneurysm
Prominence of aortic arch and/or descending aorta

Aorta (Aortic aneurysm - Plain film, Radiograph, CT, Computed tomography)

Chest: Aortic aneurysm

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Chest: Fluid

Diagnosis: Pleural effusion (Plain film, Radiograph, CT, Computed tomography)

Small (blunting of costophrenic angle) to
Large (partial/complete opacification of the lung)
Multiple etiologies (CHF, trauma, postoperative, malignant, infectious)
If unsure, do decubitus view (fluid moves � solid lesions don�t!)
Here: Large pleural effusion

Fluid (Pleural effusion - Plain film, Radiograph, CT, Computed tomography)

Chest: Pleural effusion

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Chest: Lung volume

Diagnosis: Volume loss (Plain film, Radiograph)

Multiple etiologies (surgical, atelectasis, pneumothorax) Mediastinal shift towards the lesion (traction) Compared to space occupying lesions: Mediastinal shift away from lesion (mass effect)
Here: Status post left pneumonectomy

Lung volume (Volume loss - Plain film, Radiograph)

Chest: Volume loss

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Chest: Lung volume

Diagnosis: Obstructive lung disease (Plain film, Radiograph)

Etiologies: COPD, Asthma etc.
Hyperinflated lungs
Flat diaphragms
Wide intercostal spaces
Horizontal oriented ribs
Wide retrosternal space
�Relatively� small heart

Lung volume (Obstructive lung disease - Plain film, Radiograph)

Chest: Obstructive lung disease

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Chest: Pneumonia

Diagnosis: Left and right lower lobe pneumonia (Plain film, Radiograph)

Lung infiltrate
Air bronchogram
Physical correlation important (fever, leucocytosis, cough)
Lower lungs (right > left) likely due to aspiration

Pneumonia (Left and right lower lobe pneumonia - Plain film, Radiograph)

Chest: Left and right lower lobe pneumonia

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Chest: Pneumonia

Diagnosis: Right middle lobe pneumonia (Plain film, Radiograph)

Lung infiltrate
Air bronchogram
Physical correlation important (fever, leucocytosis, cough)
Lower lungs (right > left) likely due to aspiration

Pneumonia (Right middle lobe pneumonia - Plain film, Radiograph)

Chest: Right middle lobe pneumonia

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Chest: CHF

Diagnosis: Mild CHF (Plain film, Radiograph)

Enlarged heart
Prominent central vessels
Kerley B lines
Patchy lung opacifications
Cephalization (upper vessels prominent)

Chest: Mild CHF

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Chest: CHF

Diagnosis: Moderate CHF (Plain film, Radiograph)

Enlarged heart
Prominent central vessels
Kerley B lines
Patchy lung opacifications
Cephalization (upper vessels prominent)

CHF (Moderate CHF - Plain film, Radiograph)

Chest: Moderate CHF

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Chest: CHF

Diagnosis: Severe CHF (Plain film, Radiograph)

Enlarged heart
Prominent central vessels
Kerley B lines
Patchy lung opacifications
Cephalization (upper vessels prominent)

CHF (Severe CHF - Plain film, Radiograph)

Chest: Severe CHF

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Chest: CHF

Diagnosis: Severe CHF (Batwing sign) & correct central line placement (Plain film, Radiograph)

Enlarged heart
Prominent central vessels
Kerley B lines
Patchy lung opacifications
Cephalization (upper vessels prominent)

CHF (Severe CHF (Batwing sign) & correct central line placement - Plain film, Radiograph)

Chest: Severe CHF (Batwing sign) & correct central line placement

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Chest: Tube and line misplacement

Diagnosis: Endotracheal tube and central line placement (Plain film, Radiograph)

ET tube tip between sternoclavicular joint and carina

Central line tip between proximal and distal SVC

Tube and line misplacement (Endotracheal tube and central line placement - Plain film, Radiograph)

Chest: Endotracheal tube and central line placement

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Chest: Tube and line misplacement

Diagnosis: ET tube misplacement (Plain film, Radiograph)

ET tube in right mainstem bronchus
Opacification of left lung 2nd to hypoventilation

Tube and line misplacement (ET tube misplacement - Plain film, Radiograph)

Chest: ET tube misplacement

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Chest: Tube and line misplacement

Diagnosis: ET tube and central line misplacement (Plain film, Radiograph)

ET tube in right mainstem bronchus
Central line in right atrium
Central line in IVC

Tube and line misplacement (ET tube and central line misplacement - Plain film, Radiograph)

Chest: ET tube and central line misplacement

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Chest: Tube and line misplacement

Diagnosis: Central line misplacement (Plain film, Radiograph)

Left IJ and PICC line in left brachiocephalic vein

Tube and line misplacement (Central line misplacement - Plain film, Radiograph)

Chest: Central line misplacement

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Chest: Foreign body

Diagnosis: Coin in esophagus (Plain film, Radiograph)

Don't be confused by all the other lead buttons! There is a coin shaped foreign body projecting over the lower neck. On the lateral view it projects over the esophagus/trachea. However, it HAS to be in the esophagus, because it is en face on the PA view. If it would be in the trachea it would be en face on the lateral vie. The reason is, that the posterior wall of the trachea is membranous and has the least resistance, allowing the esophagus to orient in a AP position. Once again: en face on the PA view: in the esophagus - en face on the lateral view: in the trachea.

Foreign body (Coin in esophagus - Plain film, Radiograph)

Chest: Coin in esophagus

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