Chest x-rays

 

C82CXR.jpg

CLINICAL DETAILS:

Ca lung. Change in bronchoscopy one week ago. Left-sided back pain.

CHEST:

There is a dense consolidation distal to the central lesion at the right hilum. A right pleural effusion is also present. The widening of the superior mediastinum and old left-sided healed rib fractures are noted.

C82CXRPA.jpg

CLINICAL DETAILS:

Ca lung. Change in bronchoscopy one week ago. Left-sided back pain.

CHEST:

There is a dense consolidation distal to the central lesion at the right hilum. A right pleural effusion is also present. The widening of the superior mediastinum and old left-sided healed rib fractures are noted.

C83CXR.jpg

CLINICAL DETAILS:

Fractured left rib 1 week ago. ? Intrapulmonary lesion.

CHEST:

There is discontinuity of the posterior aspect of the 10th rib. No associated sclerosis is seen, in fact the bone appears slightly lucent in comparison with the remainder of the ribs. Heart and mediastinal contour are normal. There is evidence of volume loss within the left lower lobe manifest as depression of the ipsilateral hilum, and increased opacity behind the cardiac silhouette. Alternating lucent and soft tissue dense bands are seen in this region consistent with dilated bronchi with adjacent fibrosis/consolidation. Some tram lining and evidence of bronchial wall thickening is seen within the right lower zone, and there are several small semi-confluent zones of increased opacity likely to represent superadded airspace consolidation. The features are consistent with bronchiectasis (as described previously) together with superadded airspace consolidation which is likely to be infective.

A repeat chest x-ray may be helpful, as these appearances may be due to technical factors. If a non-traumatic fracture is suspected, a bone scan may be helpful to see if there are any other bony lesions.

c84cxr.jpg

CLINICAL DETAILS:

Ca of the thyroid.

CHEST + LATERAL:

There are multiple rounded soft tissue densities projected within both lungs predominantly in the lower zone. The largest nodule measures approximately 2cm in diameter and this is projected over the right lower zone. The pleural spaces are clear.

The heart is mildly enlarged in transverse diameter (CTR 13/23.5). There is soft tissue density projected in the aortopulmonary window which may represent either overlying pulmonary nodule or lymphadenopathy. The upper mediastinal contour is normal.

COMMENT:

Multiple pulmonary nodules likely represent pulmonary metastases from a known carcinoma of the thyroid.

C85CXR.jpg

CLINICAL DETAILS:

Sarcoidosis.

CHEST:

The hila are bulky with a lobular appearance which would be consistent with hilar lymph adenopathy. There is no evidence of any parenchymal lung disease. The heart is of normal size. No bony or soft tissue abnormalities are noted.

C86CXR.jpg

CLINICAL DETAILS

Immunocompromised.

CHEST + LATERAL:

There is a fine reticular nodular pattern of opacity present bilaterally in the perihilar and lower zones of the lungs bilaterally. The cardiomediastinal and hilar contours are appear normal and the pleural spaces are clear.

INTERPRETATION:

In an immunocompromised patient, the appearances are highly suggestive an atypical infection, in particular tuberculosis, fungal or viral aetiology would need to be considered. The differential for these appearance is wide and causes other than infection would include neoplastic infiltration or sarcoidosis. A high resolution CT scan would be the next investigation of choice to further evaluate the pulmonary parenchyma.

C87CXR.jpg

CLINICAL DETAILS:

Ca oesophagus initially 1993. Had chemo on radiotherapy. Mediastinal mass on CT.

CHEST:

The heart is not enlarged. There is vague opacity in the distribution of the right middle lobe. This may well represent a degree of radiation pneumonitis involving the right middle lobe. The left lung field remains clear.

C88CXR.jpg

CLINICAL DETAILS:

Valve replacement. Hypertension.

CHEST:

The caval and left brachiocephalic stents and aortic valve replacement are demonstrated. Gross ectasia and tortuosity of the thoracic aorta is seen. The lungs are clear. The right hemidiaphragm is moderately elevated. The reason for this is not clear as there is no obvious evidence of lobar collapse.

C89CXR.jpg

CLINICAL DETAILS:

Aplastic anaemia. ? fungal pneumonia.

CHEST + LATERAL:

There is a small ill-defined trabecular soft tissue attenuation opacity projecting over the left upper. The oesophagus is moderately distended and presents with a distinct air fluid level at the junction middle 3rd distal 3rd ? scleroderma ? other. There is evidence of old Scheuermann's disease at the mid dorsal spine.

C8CXR1.jpg

CLINICAL DETAILS:

Renal transplant IC lymphoma severe opportunistic pneumonia ? cause.

CHEST:

The hila appear prominent. There is a reticular nodular shadowing in a perihilar distribution affecting mostly the upper and mid zones. Appearances are worse on the right compared to left. The right hemidiaphragm is slightly raised.

COMMENT:

The appearances are consistent with atypical pneumonia pnuemocystis carinii or pneumonia is a likely causes in view of her immunosupression.

C8CXR2.jpg

CLINICAL DETAILS:

Renal transplant IC lymphoma severe opportunistic pneumonia ? cause.

CHEST:

The hila appear prominent. There is a reticular nodular shadowing in a perihilar distribution affecting mostly the upper and mid zones. Appearances are worse on the right compared to left. The right hemidiaphragm is slightly raised.

COMMENT:

The appearances are consistent with atypical pneumonia pnuemocystis carinii or pneumonia is a likely causes in view of her immunosupression.

C8CXR3.jpg

CLINICAL DETAILS:

Renal transplant IC lymphoma severe opportunistic pneumonia ? cause.

CHEST:

The hila appear prominent. There is a reticular nodular shadowing in a perihilar distribution affecting mostly the upper and mid zones. Appearances are worse on the right compared to left. The right hemidiaphragm is slightly raised.

COMMENT:

The appearances are consistent with atypical pneumonia pnuemocystis carinii or pneumonia is a likely causes in view of her immunosupression.

c90cxr.jpg

CLINICAL DETAILS:

Left upper zone nodule on chest X-ray. ? Ca lung. For bronchoscopy.

CHEST + LATERAL:

There is a nodule in the left upper zone which has a slightly spiculated margin with no calcification or cavitation. This lesion lies peripherally in the posterior segment of the left upper lobe and is highly likely to represent a small peripheral neoplasm. The lungs remain hyperinflated consistent with COAD. There are no other significant features.

C91CXR.jpg

CLINICAL DETAILS:

Metatastic disease ?

CHEST:

changes post thoracotomy are demonstrated on the right side of the chest wall. No focal metastatic disease is visible. The heart size is normal unfolding of the thoracic aorta is again seen. A pulmonary vascular pattern is within normal limits.

C91CXR2.jpg

CLINICAL DETAILS:

Previous mets. Left hepatectomy for liver secondary. Right lower lobectomy for lung secondary. ? further recurrence.

CHEST:

The heart is of normal size. The upper mediastinal contour is widened by unfolding of the thoracic aorta. Subsegmental linear atelectasis is seen in the right base.

C93CXR.jpg

CLINICAL DETAILS:

?Lymphadnopathy ?Azygos vein.

CHEST + LATERAL:

There is a soft tissue opacity within the right trachea-broncheal angle. This is highly suspicious for enlargement of an azygos node. No focal lung lesion is identified. The left costophrenic angle is clear.

COMMENT:

A CT scan is advised for further assessment.

C94CXR.jpg

CLINICAL DETAILS:

Ca breast. Left pleural effusion. Post attempted aspiration.

CHEST:

There is a left pleural effusion. No pneumothorax seen. Allowing for the poor inspiration, no active lung lesion identified.

Old left clavicle fracture noted. The texture of the left humerus and scapula is markedly abnormal with a permutive pattern extending through the humerus from its head along the shaft. This may represent bone metastasis and if clinically relevant a bone scan is recommended in further assessment.

c95cxr.jpg

CLINICAL DETAILS:

Previous Ca colon. Right lobe resection. ?radiation pneumonitis in right base, ?improvement since last x-ray.

CHEST:

Surgical clips are noted from the previous hepatic resection and these indicate elevation of the anterior aspect of the right hemidiaphragm.

There is volume loss in the right hemithorax with depression of the horizontal fissure which appears thickened. Air bronchograms are also seen in the middle and lower lobes.

The features are those of a degree of collapse, possibly with superadded consolidation.

In view of the distribution of these changes, radiation pneumonitis could give this appearance and further followup is advised.

The left lung and pleural space is clear.

c96cxr.jpg

CLINICAL DETAILS:

Renal transplant patient. Dyspnoea with cough, green sputum.

CHEST + LATERAL:

AP erect 

Even allowing for the projection, the heart appears enlarged. There is pulmonary venous hypertension without frank pulmonary oedema. No focal consolidation is evident.

c96cxr2.jpg

CLINICAL DETAILS:

Renal transplant patient. Dyspnoea with cough, green sputum.

CHEST + LATERAL:

AP erect.

Even allowing for the projection, the heart appears enlarged. There is pulmonary venous hypertension without frank pulmonary oedema. No focal consolidation is evident.

c98cxr.jpg

CLINICAL DETAILS:

Had haemoptysis, now settled. Smoker 12/day. Mild COPD. Previous infection slow to resolved

CHEST + LATERAL:

The left hilum is prominent and increased in density suggesting a mass at the hilum. Perhaps a CT would be helfpul.

C9CXR.jpg

CLINICAL DETAILS:

Chronic renal failure. SOB. Heart failure.

CHEST:

Right subclavian line in situ. There is a small right pleural effusion. The heart is enlarged. The nodular pleural shadowing along the left lower chest wall, laterally medially and inferiorly is likely loculated fluid and/or thickening.

ct1cxr.jpg

CLINICAL DETAILS:

Past history of type I aortic resection.

CHEST:

There is marked abnormality of the contour of the descending thoracic aorta which is lobulated and enlarged and has a thin rim of atheromatous calcification in the lateral wall. There does appear to be some increase in prominence of this aortic dilatation when compared with the earlier radiographs. The heart size is not significantly enlarged. Bilateral lower zone opacity is consistent with nipple shadows noted. The lungs are hyperinflated consistent with COAD and the pleural spaces are clear.

INTERPRETATION:

Increase in prominence of the descending aortic aneurysm when compared with the earlier radiograph.

ct1cxr2.jpg

CHEST(CXR)

CLINICAL DETAILS:

Abdominal pain, an AAA 7cm. Dissecting thoracic aneurysm.

CHEST:

There is aneurysmal dilatation of the descending thoracic aorta from the level of the aortic arch. Atheromatis calcification is noted in the left lateral wall which is lying a couple of mm from the aneurysmal margin. The lungs and pleural spaces appear clear.