Radiological Differential Diagnosis of Chest Diseases

An Incomplete List Devesh Chauhan

Anterior Mediastinal Masses

Thymoma Teratoma Sub-sternal thyroid Lymhoma

Opacified Hemithorax

Atelectasis Pneumonia Pleural effusion Post-pneumonectomy

Pneumomediastinum
Ruptured esophagus. Ruptured trachea/bronchus. Iatrogenic. Asthma. Pneumoperitoneum.

Acute Alveolar Infiltrate

Pulmonary edema Pneumonia Aspiration Hemorrhage

Chronic Alveolar Disease

Alveolar cell carcinoma. Alveolar sarcoid. Lymphoma. Alveolar Proteinosis.

Large Cavitary Lung Lesion

Abscess Carcinoma. Tuberculosis.

Bibasilar Interstitial Disease

Bronchiectasis. Aspiration Desquamative Interstitial Pneumonitis (DIP). Asbestosis. Sickle Cell Disease. Scleroderma.

Upper Lobe Disease

Post primary Tuberculosis. Silicosis. Eosinophilic Granuloma. Ankylosing Spondylitis.

Micro-nodular Lung Disease

Metastasis. Sarcoid. Pneumoconiosis. Miliary Tuberculosis.

Chronic Interstitial Disease

Pulmonary Fibrosis

Pneumoconiosis. Interstitial Pneumonia. Granulomatous Disease. Neoplastic disease. Idiopathic fibrosis. Collagen vascular disease

Small Cavitary Lung Lesions

Septic emboli. Rheumatoid nodules. Squamous or transitional cell metastasis. Wegeners Granulomatosis.

Lymphangitic Spread to the Lungs

Lung Carcinoma. Breast Carcinoma. Stomach Carcinoma. Pancreas carcinoma. Laryngeal Carcinoma. Cervical Carcinoma.

Multiple Lung Nodules

Metastasis. Wegeners granulomatosis. Rheumatoid nodules. Arterio-venous malformations. Septic emboli.

Pulmonary Interstitial Edema

Congestive heart failure. Lymphangitic spread. Allergic reaction.

Shifting Infiltrates
Loefflers Syndrome. Allergic broncho-pulmonary Aspergilosis. Asthma. Polyarteritis. Viral Pneumonia.

Unilateral Hyperlucent Lung.

Swyer-James syndrome. Pulmonary embolism. Pneumothorax. Obstructive Emphysema.

Rapidly Clearing Alveolar Infiltrate

Hemorrhage. Pulmonary edema. Aspiration. Pneumococcal pneumonia.

Cavitating Pneumonia
Staphylococcus. Streptococcus. Mycobacterium Tuberculosis. Gram negative (Klebsiella).

Middle Mediastinal Masses

Lymphadenopathy. Aneurysm. Esophageal Duplication. Bronchogenic cysts.

Masses with Air Bronchogram

Lymphoma. Alveolar cell carcinoma. Pseudolymphoma (MALToma Mucosa associated pseudolymphoma)

Hilar Lymphadenopathy
Sarcoidosis. Tuberculosis. Lymphoma. Bronchogenic Carcinoma. Metastasis.

Cavities Containing Masses

Aspergillosis. Cavitating bronchogenic carcinoma. Tuberculosis. Hydatid Cyst.

Infiltrates with Effusion

Staph Pneumonia. Strep Pneumonia. TB. Pulmonary Infarct.

Mass + ipsilateral Lymphadenopathy

Bronchogenic Carcinoma. Lymphoma. TB.

Solitary Pulmonary Nodule

Bronchogenic Carcinoma. Hamartoma. Histoplasmoma. TB Granuloma. Bronchial Adenoma. Solitary Metastasis. Round Pneumonia. Rounded atelectasis.

Pleural Effusion
CHF. Metastasis. Pancreatitis. Pulmonary embolism. Trauma. Empyema. Collagen Vascular Disease. Ovarian Tumor (Meigs Syndrome). Chylothorax.

LT sided Pleural Effusion

Boerhaaves Syndrome. Dissecting Aortic aneurysm. Pancreatitis. Distal thoracic duct rupture.

Multiple Small Calcifications

Histoplasmosis. Silicosis. Chicken pox pneumonia. Metastatic calcification. Secondary Amyloidosis. Alveolar Microlithiasis.

Posterior Mediastinal Masses

Neurogenic Tumors. Lymphadenopathy. Extra-medullary hematopoesis.

Mediastinal Adenopathy
Bronchogenic Carcinoma. Lymphoma. TB Metastasis. Sarcoid.

Lung disease & Rib Destruction

Bronchogenic CA Pancoast tumor. Actinomycosis. Blastomycosis. Multiple myeloma.

Pleural Calcification
Old TB empyema. Asbestos exposure. Hemothorax.

Masses in Cardio-phrenic Angle

Sequestration. Diaphragmatic hernia. Pericardial cyst.

Unilateral Pulmonary Edema

Aspiration. Disease in other lung e.g. COPD. Postural. Rapid expansion of pneumothorax.

Reverse Pulmonary Edema

Eosinophilic lung disease, e.g. Loefflers . Sarcoidosis. Pulmonary Contusions.