Diagnosis: Put the x-ray findings and history together for a logical diagnosis. The costophrenic angles are sharp. That finger also appears foreshortened. In just 12 short, interactive and occasionally humorous chapters, you will learn a systematic approach to reading the normal anatomy of the thorax and the basic patterns of lung disease. Look at each lung individually, then compare left lung and right lung.
One is an inspiration and one is an expiration. That is, they absorb more radiation after intravenous contrast injection. Remember, they are identical paper clips. Similarly, basilar lung disease pneumonia, pleurisy may mimic upper abdominal disease. It is often helpful to check with the radiologist. Middle mediastinal adenopathy is most often due to sarcoidosis in young patients and lung cancer in older patients.
With alveolar edema, rales are audible. See for yourself: Place your hand, palm down, 3 or 4 inches from a desktop, preferably under a desk lamp bulb type. What does it do to the tracheal width? Note: Both heart borders are indistinct. Figure 9-10B shows the two patterns nicely. Because there is an air bronchogram sign, we know the lesion is in the lung and not in the mediastinum. Figure 7-14A; air bronchogram D.
See also Silhouette sign Air trapping, expiratory film for, 14f, 15 Air-fluid level, 148f, 149 after lung removal, 188f, 189 in hydropneumothorax, 188f, 189 in pneumonia, 148f, 149 Alveolar edema, 202f, 203 Alveolar filling disease, 50f, 51, 52f, 53, 136f, 137, 138f, 139 acute, 145 diffuse interstitial disease and, 144f, 145 focal, 146f, 147 lobar sites of. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Signs include rapid onset of respiratory failure, decreased breath sounds, deviated trachea, and jugular venous distention. Understanding the lobar anatomy also is important for planning bronchoscopy, surgery, radiation therapy, and postural drainage. Diagnostic levels of radiation are generally considered safe for the individual, with the potential diagnostic benefits outweighing the barely measurable, but real, population risks associated with diagnostic levels of ionizing radiation. Figure 6-2 is a normal chest x-ray. The lateral radiograph shows the mass predominantly in the anterior mediastinum.
The azygos fissure Figure 5-9A is formed by an anomalous development of the azygos vein. In Figure 8-6A, the upper arrow is at the level of the upper lobe, and the lower arrow is at the level of the lingula. If there is a discrepancy between them, believe the lateral. Generally, it is difficult to differentiate one anterior mediastinal mass from another on the chest x-ray. You will look like a pro. If you can, you will be ahead of most of your peers. In Figure 11-2A, the lateral costophrenic sulcus is normal.
Label the cardiovascular structures on the lateral Figure 12-1B. Emanuelle Fedrea Universitá delgi Studi di Milano, Milan, Italy Q-12 Dr. There are three accessory fissures seen occasionally in normal individuals. The entire right diaphragm is visible. Additional online images plus self-assessment tests help you sharpen your skills and build confidence! There are several methods of dividing the mediastinum.
Iodinated contrast medium is often given intravenously during the scan to increase the radiodensity of blood. Individual vessels are not visible because they are surrounded by water density. Bilateral dense consolidation, air bronchograms, silhouette signs of diaphragms, blunt right costophrenic angle. See also Collapse adhesive, 131 bandlike, 130f, 131 cicatricial, 130f, 131 hypoventilation, 130f, 131 mechanisms of, 131 mediastinal shift and, 182f, 183 obstructive central, 126f, 127, 129, 129f, 131 peripheral, 127 passive relaxation , 129, 129f postoperative, 128f, 129 resorptive, 127 structure shift in, 124f, 125, 182f, 183 Atrial septal defect, 200f, 201 Atrium. There are no significant signs of left heart failure.
In Figure 6-6C, the ascending aorta A is anterior, and the descending aorta D is posterior. For the chest x-ray, start in the upper abdomen, then look at the thoracic cage soft tissues and bones , then the mediastinal structures, and finally the lung. Diagnosis: Can you combine the history and x-ray findings to suggest a diagnosis? Then, and only then, answer all questions before you turn to the answers on the next page. The fat planes between the muscles are barely visible. Clinical Pearl: The old x-ray is your best friend.
The right middle lobe remains aerated. Mediastinal diseases can be difficult to detect on chest x-ray because most diseases are of soft tissue density and are surrounded by other soft tissue structures. It is an unrequested bonus, but is often helpful. Review Figures 9-1A and 9-1B. See Aorta, ascending Aspiration, of abscess, 215f, 216 of pin, 84f, 85, 85f Atelectasis, 113, 229f, 230. The left diaphragm appears high because there is fluid between the lung base and the diaphragm.
You are less likely to miss secondary but important findings this way. Figure 12-8A shows mild left heart failure. The three lines indicate the scan locations of Figures 4-2B, 4-2C, and 4-2D. A Abdomen gas-containing structures of, 38f, 39, 40f, 41 on computed tomography, 62f, 63 search pattern for, 40f, 41 Abscess, pulmonary, 215f, 216 Accessory fissures, 80f, 81, 82f, 83 Acini, 50f, 51, 134f, 135. The Air Bronchogram Sign -- 8.