PTCUT

IMAGING

LECTURE 4 - RADIOLOGICAL SIGNS

By :

ed
Adham Moham
 Radiological signs
Tracheal shifting :
radiologically it is slightly shifted to the right side, this occurs due to
presence of the aortic arch. pathologically it is shifted towards the
site of diseases in cases of ( fibrosis and collapse ) and away from it
in cases of ( pneumothorax, pulmonary effusion,....etc.)
trachea shifted away ‫ نالقي ال‬lung ‫يعني من االخر اي مشكلة تكبر حجم ال‬
. trachea shifted towards it ‫ و اي مشكلة تصغر حجها نالقي ال‬from it

Tracheal shifting X-ray

Cardiac silhoutte :
Means cardiac borders in plain X-ray. Silhoutte sign is a radiological
sign in it cardiac borders are disappeared due to lung patology.
+Ve silhoutte sign : there is an opacity shades the cardiac borders in
P-A view, this opacity indicated for middle lobe pathology.
-Ve silhoutte sign : there is an opacity BUT not hide the cardiac
borders which is an indication for posterior lobe pathology as it is
located behind the heart.

-Ve silhoutte sign +Ve silhoutte sign

Boot-shaped heart sign : ( Coeur en sabot )
Occurs in children born with congenital defect called tetralogy of
fallout which is characterized by ; inter-ventricular septal defect
which is leading to mixing of oxygenated and deoxygenated blood
and all of the blood is pumped into aorta which causes aortic
overriding and Pulmonary stenosis and so on hypertrophy of the
right ventricle to withstand against peripheral resistance of the
systemic circulation which makes the apex of the heart to shift
upward and appear as a boot in plain X-ray. in this cases the child
represented by episodes of crying and loss of breathing called (Tet
spell) or cyanotic spell.
for more info. click the link https://youtu.be/RU0PNu_6rZw

Boot shaped heart sign

Dextrocardia :
is a congenital condition in which the heart is situated on the right
side of the body (dextroversion) with the apex pointing to the right.
the heart has been mal-rotated during embryogenesis.
‫ او كل‬dextrocardia situs inversus ‫ده ممكن يبقا القلب لوحده ساعتها هنسميه‬
dextrocardia situs inversus ‫ و هنا هنسميه‬viscera ‫ اللي موجودة في‬organs
totalis

Dextrocardia situs inversus

totalis as the left copula of
the diaphragm is elevated
due to presence of the liver
in the left side
Coarctation of the aorta : ( Figure 3 sign or E
sign )
Narrowing of the aorta at ductus arteriosus, pre-ductal or post-
ductal
‫ اسمه‬aorta ‫ و‬pulmonary trunk ‫الطفل لما بيتولد بيبقا عنده جزء متوصل بين‬
‫ ساعة فساعات بقا بيحصل ضيق في‬48 ‫ بيختفي بعد الوالدة ب‬ductus arteriosus
.xray ‫ في‬E ‫ او حرف‬3 ‫ زي رقم‬aortic arch ‫ عنده او قبليه او بعديه فيبان شكل‬aorta

Figure 3 sign

Congestive heart failure : CHF

One of the most common cases detected by CXR which shows
cardiomegaly with increased cardio-thoracic ratio >50% , Loss of
cardio-phrenic angle and homogenous opacity extended to lung
fields

X-ray for CHF

Fat pad sign : ( Pericardial effusion )
a soft tissue stripe wider than 2mm between the epicardial fat and
the anterior mediastinal fat can be seen anterior to the heart on a
lateral view. 400-500 ml of fluid must be in the pericardium to lead
to a detectable change in the size of the heart shadow on PA CXR.

Pericardial effusion Fat pad sign

Patent ductus arteriosus : PDA

A congenital disorder occurs when the ductus arteriosus does not
close. Appears as cardiomegaly in CXR
For more info. click the link https://youtu.be/appH3nzSZWg

Ductus arteriosus diagram Chest radiograph in PDA

Wester mark sign : a dilatation of the pulmonary artery above the
embolism

Rheumatic heart disease:

Radiological signs :
Cardiomegaly
Double density sign (Double right heart border)
prominent left atrial appendage.
Loss of heart waist due to mitralization of the heart.( Mitral
stenosis).

Rheumatic heart disease X-ray

Costophrenic angle :
these are the places where the diaphragm (-phrenic) meets the
ribs (costo-). Each costophrenic angle can normally be seen as
downward indentation (dark) between each hemi-diaphragm
(white) and the adjacent chest wall (white). A small portion of each
lung normally reaches into the costophrenic angle. The normal
angle usually measures thirty degrees. In pleural effusion fluid
accumulates in costophrenic angles ( if its volume less than 75 ml it
accumulated in the posterior costophrenic angle which can be
seen from lateral view , while blunting lateral costophrenic angle
needs at least 175 ml of fluid and it can be as much as 500 ml .
Larger pleural effusion may cause mediastinal shifting , if the fluid
is more than 4L it cases complete opacification of the lung.

Right pleural effusion with Right pleural effusion with

blunted the right lateral blunted posterior costophrenic
costophrenic angle (seen in ( seen in lateral view )
P-A view )
 Left lung collapse after pacemaker installation

Hyperinflation of the both lungs indicated for emphysema as it is

bilateral with flattened of the diaphragm dome, hyperlucent lungs
(blackened) with horizontal ribs and widening of retrosternal angle
 ‫‪A- Left pleural effusion‬‬ ‫‪B- Right pneumonectomy‬‬

‫‪C- Right pneumonectomy‬‬

‫"‪"after 4-5 years‬‬

‫واحدة واحدة بقا كدا عايزين نعرف الفرق بين اخر كام صورة اللي شبه بعض دول نبدأ برقم‬
‫( ‪ ) A‬قولنا عليها ‪ pleural effusion‬ده علشان انا مش شايف اي ‪ ribs‬و كمان في‬
‫‪ homogenous opacity‬اللي حصل هنا ان المياة غطت علي كل اللي تحتها ف‬
‫مكنش باين‪.‬‬
‫( ‪ ) B‬قولنا عليها ‪ pneumonectomy‬العيان الرئة بتاعته اشالت بالتالي بقا مكانها‬
‫فاضي عشان شايف ال ‪ ribs‬بوضوح و قادر احددهم‪.‬‬
‫( ‪ ) C‬دي بقا زي اللي قبلها بالظبط بس الفرق ان العيان مر عليه وقت طويل عرفت لما‬
‫شوفت ‪ crowded ribs‬و ‪ narrowing of intercostal spaces‬من االخر العيان بقا‬
‫مايل في الجنب اللي فاضي اللي اتشال منه الرئة‬
Meniscus sign : In cases of
pleural effusion there was
fluid level inside the pleura
appears in X-ray film as white
meniscus on lung field.
‫ لما يحصل‬meniscus ‫بيبقا شبه ال‬

‫دي بصراحة مش عارفها و مش فاكر‬

‫الدكتورة قالت عليها ايه ف اللي يعرف‬
‫يبقا يقولي‬