Abnormal X-Ray

Done By: Salman-Alotaibi

 What we will Discuss
• In this powerpoint we will discuss the most important Diseases we can See
on Chest X-Ray:
• 1- Lung Collapse
• 2- Pneumonia
• 3- Lung abscess
• 4- Tuberculosis
• 5- Lung Cancer
• 6- Tension Pneumothorax
• 7- Pleural Effusion
• 8- Emphysema
 Let’s Start
• First we will Discuss About Lung collapse
•Lung Collapse
 Lung collapse
• You need to know that there Are 5 Types of collapses you need to
know:
• 1- Right upper lobe collapse
• 2- Right middle lobe collapse
• 3- Right Lower lobe collapse
• 4- Left Upper lobe collapse
• 5- Left lower Collapse
 ‫قاعدة أساسية‬
‫‪• Collapse= There is NO Air in the lung‬‬
‫‪• This means the pressure is Reduced‬‬
‫الحين مثال لو في زيادة هواء‪ ,‬هالشي راح ينتج عنه زيادة ضغط‪ ,‬وبالتالي األعضاء راح •‬
‫تبتعد عن المكان اللي فيه ضغط‬
‫في هالحالة‪ ,‬الرئتين مافيهم هواء «مكان فارغ» معنى ذلك الضغط راح يقل واألعضاء راح •‬
‫تقرب من هالمكان اللي مافيه ضغط‬
 Trachea deviated towards
Juxta-phrenic peak the collapsed lung

This is a palce where the “collapse is”

We agreed in collapsed lungs, Organs will move

“towards” the Collapsed lung

Noth the Trachea is deviated towards the

collapsed lung

Note that: The right Crus of the diaphgram is

also Elevated “Towards” the collapsed lung

Also, there is something called “Juxta-phrenic” Peak

The diaphgram will form a peak
‫فالقاعدة األساسية إن اذا كان في نقص بالضغط‪ ,‬األعضاء راح تقرب تجاه الجزء اللي مافيه •‬
‫ضغط‬
‫أما في األمراض الثانية اللي ينتج عنها زيادة بالضغط‪ ,‬فاألعضاء راح تبتعد عن هالمكان •‬
‫بسبب تأثير الضغط‬
 This is opacity
Right hilum
is Higer than Right Upper lobe collapse
left hilum
To identify Right upper collapse:
A- You will see what is called “Opacity” On the
right upper lobe region “Opacity = White region
B- Also, You will notice the right Hilum
“Vessels” on the right side are higher than
the left Hilum
‫ واتفقنا ان األعضاء نقرب من المكان اللي‬,‫ألن الضغط قليل‬
‫الضغط فيه قليل‬

I
So, we Can see:
A- Opacity On the Right upper Lobe”
B- Right hilum is higher than left Hilum

Let’s take another picture on Right upper

collapse that will show other Presentations
Opacity
Continue “Right upper Lobe collapse”
Trachea is deviated towards
the collapsed lung A- So we said that that the main thig is that
there is Opacity” (‫ )بياض‬on Right upper lobe

B- Also There is Tracheal Deviation “Towards” The

collapsed lung
C- Note also That there is a Juxta-phrenic peak, in
which the Right diaphgram is elevated

This is the Juxta-phrenic peak

D- last thing, if you notice, the right lung volume is

Much Lower that Left lung volume
Question
Q: What is the diagnosis?
A: Right Upper lobe collapse

Q: give Three abnormal Features You see on

the Chest X-ray?
A: 1- Opacity seen on Right upper lobe
2- The trachea is deviated towards the
collapsed lung
3- The right Crus of diaphragm is slightly
elevated
4- Right Lung volume is decreased
Compared to Left lung
5- Juxta-phrenic peak
• So Remember, In right upper lobe collapse, We Find:
• A- Opacity on right upper side
• B- Trachea deviates towards the collapsed lung
• C- Diaphragm is deviated towards the collapsed lung
• D- The right Hilum is slightly elevated more than left Hilum
• E-Reduced Right lung Volume
• F- Juxta-phrenic peak
• Now, we have finished the right upper lobe collapse. Let’s Discuss the
Right Middle Lobe collapse.
•Right Middle Lobe collapse
Right Middle Lobe collapse

1- Right middle lobe collapse is usually seen

Better on “Lateral View” than the “Normal
View”

86
2- Notice the ”Opacity” Seen on The middle
lobe “arrows”
Right middle Lobe collapse

Here the opacity is Clearly seen in the middle view “Yellow

arrow”
 Right middle Lobe collapse

RUL
RLL RML

Right middle Lobe collapse in lateral Normal Lateral View Chest X-ray
view
Note the opacity seen in middle lobe
 B R
Question
Q: What is the diagnosis?
A: Right upper lobe collapse

Q: Identify Four Abnormal Features seen

A- Tracheal Deviation
B- Right upper lobe opacity
C- Diaphgram elevation
D- Juxta-phrenic peak

of B

C
 Question
What is the Diagnosis?
A: Right middle lobe Collapse

RML Opacity seen in middle

Lobe
• Now we will move to Right lower Lobe collapse
Right Lower lobe collapse
Note that:
1- The opacity is seen in Right Lower lobe
2- Note there is a triangle that is a characteristic of “right
lower lobe collapse”
3- When You see this Triangule, immediately it is “Right
lower lobe collapse

Triangle = Lower
lobe collapse
This is the Oblique fissure
of the Lung Seen
Right lower lobe collapse
What are the features seen in Right lower lobe collapse?
A:
1- Triangular Medial Basal Opacity
2- Question: How is this triangular formed?
A: The right Oblique fissure of lung will Rotate and appear on the chest
X-ray Creating this Triangle
3- Also Notice that the Right Lung Volume is Decresed Compared to left
Lung
Question
What is the diagnosis?
A: Right lower lobe Collapse

Idetify Two Features Seen on the Chest X-ray?

A:
1- There is basal Medial Triangular Opacity on the chest X-
ray
2- The Oblique Fissure of the Lung is seen
3- The Right Lung volume of the lung is reduced

‫ طالعوا الصورة وربطوا اللي كاتبه بالصورة‬,‫يا جماعة الخير‬

Question
What is the diagnosis?
A: Right middle lobe collapse
• So far we discussed these:
• 1- Right upper lobe collapse
• 2- Right middle lobe collapse
• 3- Right Lower lobe collapse
• Now, we will discuss the left lobe collapse
• Let’s discuss first about Left lower Lobe collapse
Left Lower lobe collapse
Again:
1- If we see the Triangle on the Left side, then it is
“Left lower Lobe collapse”

2- The oblique fissure of the lung is seen on the

Chest-xray
 Compare!

Left Lower lobe collapse Right lower lobe collapse

• We have finished from the Hard Section from the Chest X-ray
• The upcoming Diseases are much easier
• Let’s first Talk About “Pneumonia”
•Pneumonia
Pneumonia
I Know what You are thinking.
This looks similar to “Right upper lobe Collapse”

Yes I agree, there is “Opacity” Seen on the upper Side,

However, Note that there is what is called “Air-
Bronchiogram” and this is characteristic of pneumonia

,‫ يتخلله انابيب صغيرة سوداء‬,‫الحظوا ان داخل البياض اللي قاعدين تشوفونه‬

‫وهالشي يميز االلتهاب الرئوي‬

So, we can see Both:

A- Opacity
B- Air-bronchiogram
And this is called “Consolidation”
Lobar pneumonia = Consolidation
 Compare

Opacity + Air-bronchiogram Only Opacity

This Is Right Upper lobe pneumonia This is Right upper lobe collapse
Q: What is the diagnosis?
A: Pneumonia because of Consolidation seen on
upper Lobe

Q: Which lobe is affected?

A: Right upper lobe
Silhouette Sign

Middle lobe Pneumonia

1- In middle Lobe Pneumonia, The Right Atrium of
Heart will be Concealed from the “Consolidation” In
the middle lobe.
2- The Concealing of the heart bcz of Middle lobe
Consolidation is called “The Silhouette sign”

3- Remember:
We see both “Opacity + Air-Bronchiogram”,
which is a characteristic of Pneumonia

Silhouette sign =
Middle Lobe
Pneumonia
Pneumonia
Q: What is the diagnosis?
A: Pneumonia bcz of Consolidation “Air-Bronchiogram”

Q: Which lobe is affected?

A: Middle lobe

Q: What is the sign called When the Right border

of heart is not seen bcz of the Consolidation?
A: Silhouette sign
 Compare!

Right Middle Lobe Pneumonia

Right upper lobe Pneumonia “Silhouette Sign” Right Middle Lobe Collapse “Note:
Only Opacity, NO air Bronchiogram”
Q: What is the diagnosis?
A: Right lower lobe Collapse

Remember:
This is Only opacity, There is NO “air-
Bronchiogram” That’s Why this is NOT
Pneumonia
Q: What is the diagnosis? And what lobe is
affected?
A: Pneumonia “Note the Air bronchiogram”

A2: The right lower lobe is affected

Q: What is the diagnosis? What lobe is
affected?
A: Pneumonia “Note the Opacity with the Air-
bronchiogram”
A2: Left upper lobe
 What is the diagnosis? Which
lobe is affected?

LUL A: Pneumonia “bcz of Opacity +

Air-Bronchiogram”
A2: Left lower Lobe “See the
Yellow arrow”

LLL
Left lower Lobe Pneumonia Right upper Lobe Pneumonia
 Compare

Left lower Lobe pneumonia I

Note the “Opacity” without Air-bronchiogram
So this has to be “Left lower lobe Collapse”
• Now. We have finished from Both “Pneumonia & Lung collapse
• Remember:
• Opacity Only suggests Lung collapse
• Opacity with Air-bronchiogram Suggests Pneumonia
• Next, we will talking about Lung Abscess
•Lung Abscess
Cavity Seen in Lung
abscess
Lung abscess
1- Lung abscess Forms A “Cavity” Seen on Chest X-Ray
and it is very easy to Diagnose
2- For Spot diagnosis of Lung abscess, There is
something called “Air-Fluid” Level

This is “Air-Fluid Level”

Air Fluid Level =
Lung Abcess
Q: Is This Lung abscess? Justify your answer?
A: No this is NOT lung abcess, bcz I can see a
Cavity, But there is NO Air-fluid level
 Compare!

This is NOT lung Abscess This is Lung abscess

Note the air Fluid level seen in red arrow
If this is NOT lung abscess? So What is
the diagnosis then?
A: Lung Tuberculosis

Tuberculosis Forms A cavity in the

lung, BUT without Air fluid Level
•Tuberculosis
Cavity, without Air-Fluid Level

Simply:
If You see a Cavity in Chest X-ray Think of
Two things only:
A- Lung Abscess
B- Tuberculosis

In This Chest X-ray, there are Multiple

Cavities Seen. However, There is “No”
Air-Fluid Level
So Diagnosis will be “Tuberculosis”
 Compare!

Pulmonary Tuberculosis Lung Abscess

NO air-Fluid Level Presence of Air-Fluid Level
• Remember:
• 1- Both Lung abscess and Tuberculosis Forms “Cavity” seen on Chest
X-ray
• 2- In case of lung abscess, There is “Air-Fluid Level”
• 3- In case of Tuberculosis, There is NO “Air-Fluid Level”
• Now We will move On and Talk About Lung Cancer
•Lung Cancer
Solitary Pulmonary Nodule

Lung Cancer is Not hard To detect On Chest X-

ray.
We Might See a Nodule on Chest X-ray.
This Nodule Indicates “Lung Cancer”
 Q: What Can You see in Chest X-ray?
A: Solitary Pulmonary Nodule
Remember this Picture By

LUL What is the Diagnosis?

A: Lung Cancer
heart.
They ask About Which lobe
is affected. And yes they
Bring These kind of Qs in
Which Lobe is the Cancer Affecting? Exam
A: Left Upper Lobe
LLL

i
Q: What can you see on chest X-ray?
A: Multiple nodules is seen and masses

What does it indicate?

A: Lung cancer
Q: Is this on the tip of arrow a small nodule or
is it a mass?
A: It is a Mass

What Doest it Indicate?

A: It indicates Lung cancer
A nodule that indicates Lung cancer A mass that indicates Lung cancer
• Now we will move to another disease that is very important
• This disease is “Pneumothorax”
• Note: They brought this disease in Batch ‘13 Exam
• ‫ قلت لكم ان‬,‫حق اللي حضروا الدورة األولى‬
• Pneumothorax will lead to tracheal Deviation towards the affected
side
• ‫أتمنى تصلحون المعلومة ألني غلطت وقتها‬
•Pneumothorax
 Pneumothorax
• 1- What is Pneumothorax?
• A: We know that there are “Parietal pleura” And “Visceral Pleura”. And the
“Pleural Cavity” is between the parietal Pleura and Visceral Pleura.
• When there is Air in “Pleural Cavity”, This will seperates the Parietal Pleura
from Visceral Pleura. Also the lung will Shrink in size!!
• Also bcz there is Air, and Air will create Pressure..What will happen?
• A: Development of Tension Pneumothorax, In which the Trachea will
Deviate to Opposite side, and the mediastinum is Shifted to opposite side
• So bcz there is air, air will create pressure, which makes the Organs deviate
to the opposite side
Visceral Pleura is visible on
chest X-ray
Pneumothorax
1- This is a case of pneumothorax, in which
there is Air between Parietal Pleura and Visceral
Pleura. Which separates the Parietal Pleura
From Visceral Pleura

2- Note that the Visceral Pleura is Visible on the

X-Ray

3- Also Note that the Lung volume is extremely

Reduced. Bcz the air in pleural cavity will push the
lung and Make it reduced in size

This is only the Lung!! It is Extremely

reduced in size bcz of Air/pressure affect
Note that:
1- The lung is reduced in size
2- The visceral Pleura will appear

This is visceral pleura

 Tension Pneumthorax
• If The air Creates a pressure and pushes the Trachea and Heart to
opposite side, then we call this “Tension Pneumothorax” NOT only
“Pneumothorax”
• So in Tension Pneumothorax we can see:
• A- Visceral Pleura is visible
• B- Lung is Reduced in volume
• C- Tracheal deviation To opposite side
• D- Mediastinum Deviation
Tracheal Deviation

Tension Pneumothrorax
1-Look Carefully, You will notice that the visceral
Pleura is seen on the chest Xray

2- This is a very severe form of

Tension Pneumothorax

3- Note also That there is Tracheal

Deviation to opposite side

4- Also notice that the heart is slightly Pushed

more to the Left side “Not very clear in this
picture”
Tension Pneumothorax
Can You See it
This is the Lung!!
Look How severely
Shrunk it became!!
 Batch 13 Exam, the exact

1 picture Came. But of course

without the arrows

Q: Name two things You Can see on the chest

X-ray?
A:
1- The visceral pleura is visible
2- the Lung is Shrunk
3- there is very very clear Heart Deviation to
the Right side “Look at the red arrows”
4- Also there is tracheal deviation “Not very
clear here”

What is the Diagnosis?

A: Tension Pneumothorax
NOTE: please Don’t write Pneumothorax
alone, it has to be “Tension
pneumothorax”
Name 4 Main Abnormalities seen on this
chest X-ray?
A:
1- the Right lung volume is reduced
2- Right visceral Pleura is Visible
3- There is Tracheal Deviation Towards
the left side
4- The Heart is Deviated to the Left side

What is the diagnosis?

A: Tension Pneumothorax
• Now we will move on to talk about another important disease Which
is “Pleural effusion” (Batch’13 Exam)
•Pleural Effusion
 Pleural effusion
• 1- Very easy to diagnose. If you see the “Costophrenic angle” is fulled
with Opacity. Then this is Immediately pleural Effusion
• Opacity in Costophrenic angle = Pleural Effusion
 Note that:
1- There is Opacity
2- The Right Costophrenic angle is NOT visible

Visible Costophrenic angle

Non-visible Costophrenic angle

 Comapre!!

Pleural effusion & the Costophrenic angle Triangular Opacity is seen suggestive of
is not visible Right lower lobe collapse
Q: What is the diagnosis?
A: Pleural effusion
• Remember:
• Opacity + The costophrenic angle is NOT seen Pleural Effusion
• Now We will move on and talk about Pulmonary Fibrosis
•Pulmonary Fibrosis
 Pulmonary Fibrosis
• The Things that characterizes Pulmonary fibrosis are:
• A- There is Reticular Formation
• B- The Trachea & Bronchus will be dilated Bronchiectasis
• C- There are Cysts forming “Honeycomb's”
• D- The Honeycombs is formed bcz of “Bronchiectasis”
• E- Also Both Lungs will Be reduced in Size!
Tracheal Dilation & Deviation

Pulmonary Fibrosis
Note the:
A- The Chest X-ray Shows Reticular Formation

This Reticular Formation is Characteristic

of Pulmonary Fibrosis, and very easy to
diagnose

B- Also Note there are cavities Seen at the

tip of arrow

These Cavities Are called “Honeycomb Cavities”

Which also found in Fibrosis

C- Note also that there is Tracheal Deviation &

Bronchiectasis
D- Note also that Both Lungs Are reduced in Size
Question
Q: Name Four Abnormal Features Seen?
A:
1- Reticular formation
2- Honeycomb Cavities
3- Tracheal Dilation & Deviation
4- Reduced in lung volume

What is the diagnosis?

A: Pulmonary Fibrosis
• Last Thing we will Discuss about Emphysema
•Emphysema
 Emphysema
• 1- Diagnosis of Emphysema is very easy
• 2- If You See Hyper-inflated lung
• 3- if you see flattened diaphgram, then this is definitely Emphysema
Note that:
1- The lung is Hyper-inflated
2- the Diaphgram became flattened
 Comapre!!

1- Hyper inflated Lung Normal Chest X-ray

2- Flattened Diaphragm
• Now we will have random chest X-ray Pictures
• Try to solve them
• Hope you do well in this
• And please when You finish from this Power-point, Go and Open the
3rd Power-point. Which is the exam type of Qs
•Random
Q: What is the diagnosis?
A: Pneumonia because of Consilidation seen on upper
Lobe

Q: Which lobe is affected?

A: Right upper lobe
What is diagnosis?
A: Lung abscess
Question
Q: What is the diagnosis?
A: Right Upper lobe collapse

Q: give Three abnormal Features You see on

the Chest X-ray?
A: 1- Opacity seen on Right upper lobe
2- The trachea is deviated towards the
collapsed lung
3- The right Crus of diaphragm is slightly
elevated
4- Right Lung volume is decreased
Compared to Left lung
5- Juxta-phrenic peak
Question
What is the diagnosis?
A: Right lower lobe Diagnosis

Idetify Two Features Seen on the Chest X-ray?

A:
1- There is basal Medial Triangular Opacity on the chest X-
ray
2- The Oblique Fissure of the Lung is seen
3- The Right Lung volume of the lung is reduced
Q: What is the diagnosis?
A: Pleural effusion
Q: What is the diagnosis? And what lobe is
affected?
A: Pneumonia “Note the Air bronchiogram”

A2: The right lower lobe is affected

What is the diagnosis?
A: Tuberculosis
What is diagnosis?
A: Upper lobe Lung Cancer
Question
Q: Name Four Abnormal Features Seen?
A:
1- Reticular formation
2- Honeycomb Cavities
3- Tracheal Dilation & Deviation
4- Reduced in lung volume

What is the diagnosis?

A: Pulmonary Fibrosis
What is diagnosis?
A: Emphysema
Q: What is the diagnosis?
A: Pneumonia bcz of Consolidation “Air-Bronchiogram”

Q: Which lobe is affected?

A: Middle lobe

Q: What is the sign called When the Right border

of heart is not seen bcz of the Consolidation?
A: Silhouette sign
Thank You :D