Radiology Notes

X-ray and history Findings Diagnosis

1. Trachea is deviated to Right upper lobe collapse with suspicious underlying
the right malignancy of the right main bronchus.
2. Right upper zone (Atelectasis)
opacification – indicates
lung collapse

A 67-year-old man presented with shortness of breath for 5 months.

 1. Well-defined
homogenous opacity over
the right lower zone with
meniscus sign.
2. Right costophrenic angle
is blunted
3. Right cardiophrenic angle
is blunted
4. This might indicate there
is effusion of right lower
zone.
Right pleural effusion suspecting lung malignancy.
Transudative effusion more likely to be bilateral (eg
CCF), and exudative is unilateral (malignancy,
pneumonia)
Management:
1. Thoracocentesis
2. Pleural fluid analysis

A 71-year-old man develops chronic cough and weight loss for 6 months. X-ray was
taken and it is shown as above.
 1. Pacemaker device with
one electrode is noted at
the left hemithorax.
2. Both lungs are congested
with upper lobe pulmonary
vessels dilatation.
3. Prominent interstitial
lung markings.
4. Kerley’s B lines
5. Increased cardiothoracic
ratio
A 60-year-old man with known case of congestive cardiac failure presented with
shortness of breath for 3 days.
Cardiogenic interstitial pulmonary oedema
Theory of pulmonary oedema in congestive heart
failure:
1. LV failure → decreased cardiac output and
increase pulmonary venous pressure → dilatation of
pulmonary venous vessel → leakage of fluid into
interstitial and the pleural space → alveoli →
pulmonary oedema
Stages of congestive heart failure
Stage 1: Redistribution
- Increased width of the vascular pedicle
(mediastinum)
- Pulmonary vessel diversion
Stage 2: Interstitial edema
- Kerley’s B Line when fluid leaks into
interlobular septa
- Perihilar haze d/t leakage to peribronchial
interstitium
Stage 3: Alveolar oedema
- Continuous fluid leakage into the interstitium
and cannot be compensated by lymphatic
drainage.
- Alveolar edema (Bat’s wing)
- Pleural effusion
 Slightly rotated to the right.
A- Trachea is central
B -right upper zone mass
over the right first and 2nd
ribs. There are multiple
small pulmonary nodules
visible within the left
hemithorax.
Pleural thickening at right
lung apex.
Normal pulmonary
vascularity
C- Heart not enlarged. Right upper lobe primary lung cancer with lung
Heart borders are clear. metastasis.
Aorta normal.
Mediastinum is central, not Investigation FBC, CRP, LFT and CT thorax, abdomen
widened. Right hilum is with contrast
abnormally dense. It
appears higher than the Management: Refer to respiratory or oncology
left. Normal shape, size and department for biopsy.
position of left hilum.
D – normal appearance and
position of hemidiaphragm.
No pneumoperitoneum
E – no vascular lines, tubes
or surgical clips

A 60-year-old female presents to her GP with fatigue, weight loss and wheeze. There is
no significant past medical history. She is non-smoker. O/E there is wheezing at right
upper zone.
 Rotated to the right.
A- trachea is central
B- Right lower zone air
space opacification in
keeping with consolidation.
Remainder of the lungs are
clear and not hyperinflated.
There is blunting of right
costophrenic angle with
pleural effusion.
Normal pulmonary
vascularity.
C- heart is not enlarged. Pneumonia with right parapneumonic effusion and
Heart border is clear. Aorta pneumoperitoneum.
appears normal.
Mediastinum is central, not Management: 1. IV fluids and Abx for hospital
widened with clear borders. acquired pneumonia. 2. Follow-up x-ray to ensure
Normal size, shape and resolution of the consolidation. 3 USG to assess size
position of both hila. of parapneumonic effusion.
D- lateral aspect of right
hemidiaphragm is obscured
by pleural effusion.
Remainder of the
diaphragm is clear.
Lucent crescent below the
right hemidiaphragm
suggesting of small volume
of pneumoperitoneum

A 32-year-old female on surgical ward develops SOB and fever 36 hours post-
appendicectomy. There is no significant past medical history. On examination, she is
febrile, RR 25, and HR of 120. There is reduced air entry and crackles in the right lung
base.