100 Chest X Rays for Study Group
by Dr. Suneet Khurana
Approach to - Chest X Ray (shadow of the viscera on a photographic plate)
• Gas appears Black
• Fat appears Dark Grey
• Water Appears as Light Grey
• Bone appears White
Approach to Chest X Ray
• Views
1)Postero – Anterior (PA) - Standard
2)Antero – Posterior (AP)
3)Apical Lordotic (Apex of lungs)
4)Oblique
5)Lateral Decubitus (pleural effusions)
Steps to Systematic Approach
1) Scan patient data and Determine the Film Quality ( Exposure, Inspiration, Position)
2) Examine the Chest Wall
a) Vertebral Column
b) Ribs
c) Clavicles & Proximal Humeri
d) Skin and Subcutaneous Tissues + Soft Tissues
e) Breasts
Steps to Systematic approach
3) Examine the Abdomen
4) Examine the Diaphragm
5) Examine the Pleura
6) Examine the Heart
7) Examine the Mediastinum
8) Examine the Hila
9) Examine the Lungs
Mediastinal Masses
• Thyroid goitre/carcinoma, Lymphoma, Neural tumours
• Tuberculosis, Histoplasmosis Metastatic lymphadenopathy
• Germ cell tumours, Sarcoidosis
• Thymoma, Hiatal hernia, Aortic aneurysm
• Pericardial fat, Esophageal diseases
• Metastatic lymphadenopathy
Case 1 – Foreign Body Right Lower Lobe
Case 2 – Foreign Body – Sword Swallow
Case 3 – Bilateral Hilar Adenopathy
Case 4 – Previous Thoracotomy Left Lung
Case 5 - B/L Lower Lobe Pneumonia
Case 6 – R Lower Lobe Consolidation – TB in HIV
Case 7 – TB with Cavitation
Case 8 – Ruptured Liver Abscess in Pleural Cavity
Case 9 – Ruptured Liver Abscess (Shock, Fever x 4 days)
Case 10 – Retrosternal Goiter (Asymptomatic 70 y F)
Case 11 – Retrosternal Goiter
Case 12 – Pneumonia (Fever, Cough, Sputum 35y M)
Case 13 – Mediastinal Emphysema
Case 14 – Mediastinal Emphysema
Case 15 – Interstitial Emphysema
Case 16 – Mediastinal & Interstitial Emphysema
Case 17 – Mediastinal Lipomatosis
Case 18 – Anomalous Pulmonary Venous Drainage
Case 19 – Posterior Mediastinal Mass – Neurogenic Origin
Case 20 – Posterior Mediastinal Mass – Sarcomatoid Carcinoma
Case 21– Active Pulmonary Tuberculosis
Case 22 – Squamous Cell Carcinoma with Malignant Pleural Effusion (arising from R bronchus)
Case 23 – Broncholithiasis in Previously Treated TB
Case 24 – Displaced Pulmonary Artery Catheter (MI management in CCU)
Case 25 – Bronchiolitis Obliterans Organizing Pneumonia
Case 26 – Bamboo Spine – Ankylosing Spondylitis
Case 27 – Mediastinal Hematoma (Malpositioned Central Venous Catheter, Neck Hematoma)
Case 28 – Silicosis with Massive Pulmonary Fibrosis
Case 29 – Bronchiectasis
Case 30 – AML with Pulmonary Angio – Invasive Aspergillosis
Case 31 – Invasive Pulmonary Aspergillosis
Case 32 – Right Upper Lobe Collapse (Golden’ Sign)
Case 33 – Westmark Sign of Acute Pulmonary Embolism
Case 34 – Left Primary Spontaneous Pneumothorax
Case 87 – Radiation Fibrosis of R Lung
Case 31 – Miliary Tuberculosis
Case 35 – Right Pneumothorax (COPD with bullae)
Case 36 – 100 Pack yr (5y Dyspnea) COPD (hyperinflation)
Case 37 – B/L First Rib Fractures
Case 38 – Mediastinal Lipomatosis
Case 39 – Bronchogenic Cyst
Case 40 – Dissecting Thoracic Aortic Aneurysm
Case 41 – Chronic Eosinophilic Pneumonia (Cough, Fever, Raised Eosinophils x 3 months)
Case 42 – L Upper Lobe Collapse due to Lung Cancer (Hemoptysis, Loss of Wt x 2 months)
Case 43 – Severe Pneumonia
Case 44 – Osler Weber Rendu (AVM, Epistasis)Hereditary Hemorrhagic Telengiectasia
Case 45 - Pulmonary Edema
Case 46 – Eisenmenger Syndrome due to PDA
Case 47 – Right Pleural Effusion (Cirrhosis of liver)
Case 48 - Hamartoma
Case 49 –Asbestosis
Case 50 – Acute Respiratory Distress Syndrome (Secondary to Pancreatitis)
Case 51 - Acute Respiratory Syndrome
Case 52 - Massive Left Pleural Effusion
Case 53 – Chiladiti Sign (Transverse Colon between Liver and Right Hemidiaphragm)
Case 54 – Malignant Mesothelioma
Case 55 - R Lower Lobe Consolidation due to TB in HIV
Case 56 – Right Sided Aortic Arch
Case 57 - Chronic Eosinophilic Pneumonia
Case 58 – Eventration of Right Hemidiaphgram
Case 59 - Traumatic Aortic Disruption
Case 60 – Pneumothorax
Hydatid Cyst (Echinococcosis)
Case 61 – Posterior Mediastinal Mass -Neuoroblastoma
Case 62 – Bronchiectasis
Case 62 – Solitary Pulmonary Nodule
Case 63 – Lung Sequestration Right Heart Border (Hemoptysis)
Case 64 – Crush Injury - Left Diaphgramatic Hernia
Case 65 – Calcified Left Ventricular Aneurysm (Post MI)
Case 66 - Metastasis from Colorectal Cancer
Case 67 - Dextrocardia
Case 68 – Fracture Clavicle & Scapula
Case 69 - Boerhaave’s Syndrome
Boerhaave’s Syndrome (Esophageal Perforation)
Case 70 - Phrenic Nerve Palsy
Case 71 – Tracheal Tumor (Adenoid Cystic CA)
Case 72 - Pulmonary Pesudo-nodules due to Nipple Shadows
Case 73 – Cryptogenic Fibrosing Alveolitis
Case 74 – Pericardial Cyst
Case 75 – Cardiac Tamponade
Case 76 - Mediastinal Lymphadenopathy secondary to Lymphoma
Case 77 - Malpositioned Nasogastric Tube
Case 78 – Azygous Lobe (Tear drop shaped accessory lobe of the R Lung)
Case 79 – Silicosis (Sand Quandry Worker)
Hydropneumothorax Vs Pleural Effusion
Case 80 – B/L Calcified Pleural Plaques (Asbestosis)
Case 81 – Lytic Lesion Right Humerus
Case 82 - Loculated Pleural Effusion R Lung
Case 83 – Hiatus Hernia
Case 85 - Massive Cardiomegaly (End Stage Valvular Ds) D/D of Pleural Effusion – (Thoracentesis Contraindicated)
Case 86 – Left Lower Lobe Lobectomy
Case 87 - Chronic Calcific Pericarditis
Case 88 – Collapse of Left Lung
Case 89 – Aspergilloma (Post Rx TB R Lung)
Case 90 - Fractured Ribs with Callus
Case 91 – Oligemia of R Lung (Carcinoid tumor of Right Main Stem Bronchus)
Case 92 – Pneumoperitoneum
Case 93 - Cardiomegaly
Case 94 – Thoracoplasty (1950 – removal of upper TB infected lung, with subsequent pleural calcification)
Case 95 – Left Lower Lobe Collapse
Case 96 – Tracheal Stenosis due to Tracheopathia Osteochondroplastica
Case 97 – Mass in Bronchus (Collapse of Middle, and Lower Lobe R Lung
Case 98 – Primary Pulmonary Hypertension
Case 99 – Lung Abscess
Case 100 - Lung Cancer with Lymphangitis Carcinomatosis
Case 101– Pneumocystis Carinii Pneumonia
Case 102 – Pericardial Fat Pad (No Change in cardiac shadow over a period of 16 months)
Case 103 – Accessory Cervical Ribs
Thank You