The x-ray beam is horizontal, and the x-ray tube is 6 feet from the film or detector. Placing the part to be x-rayed close to the x-ray cassette film receptor also reduces magnification and increases sharpness. See for yourself: Place your hand, palm down, 3 or 4 inches from a desktop, preferably under a desk lamp bulb type. Observe the shadow. That finger also appears foreshortened. The patient is supine or sitting in bed. The heart is an anterior structure. Which is the PA?
How did you decide? The heart is on the left. By convention, the left side of the chest is held against the x-ray cassette. We just call it a lateral view. The nodule, superimposed on the heart, is easily seen on the lateral view.
On the frontal PA view, it is hard to see along the left heart border. The opposite occurs in the left anterior oblique. Free fluid in the pleural cavity is affected by gravity. I looked it up. This is normal. Gravity can help us find the cause. The x-ray beam is parallel to the x-ray table. This is your first x-ray diagnosis. The left diaphragm appears high because there is fluid between the lung base and the diaphragm.
Figure , in a different patient, shows air between the lung and the left ribs in the right lateral decubitus position. On expiration, the lung markings become more crowded. One is an inspiration and one is an expiration. These changes may simulate disease. What causes the x-ray film to be black or white? An unexposed x-ray film is housed in a lightproof cassette, sandwiched between two phosphorescent screens.
X-rays hit the phosphorescent screens, the screens give off light, and the light exposes the film. Heavy light exposure e. Little light exposure e. Film is now being replaced by sophisticated digital receptors that offer many advantages; however, the basic image formation remains the same. Digital data are more flexible; data can be transmitted, stored, and processed to alter contrast and brightness. More technical stuff is in Chapter 6—try to resist peeking.
An expiratory film can be used to detect focal air trapping from asymmetrical emphysema or a partial bronchial obstruction that impedes airflow on expiration air trapping. In Figure B, an expiratory film, the left deflates normally and gets whiter, while the right remains inflated and black. This was due to air trapping behind an aspirated foreign body.
Clinical Pearl: If you hear a unilateral wheeze, order an expiratory film to look for air trapping. What views are illustrated in Figure A-F? AP supine F. The apical lordotic radiograph is a frontal view taken with the x-ray beam angled upward to project the clavicles above the lung apex to display disease hidden behind the clavicles. Tomography is a complex technique that uses an x-ray tube and cassette that move in opposite directions, keeping only the area of interest in focus.
Both techniques have been largely replaced by better quality chest radiographs and computed tomography CT —two fewer things you have to learn! Fluoroscopy, which is a real-time x-ray viewed on a video monitor, provides information about moving organs.
The x-ray beam contains x-ray photons of differing energies. As the x-ray photons pass through the patient, some are absorbed completely A , some penetrate directly to the x-ray film P , and some are deflected scattered SS. Some of the scattered photons continue toward the x-ray film S Figure Absorption and penetration are the reciprocal of each other. The differential absorption of radiation by different tissues or diseases is responsible for all radiographic images.
Air, fat, soft tissue muscle, fluid , and metal bone absorb progressively more radiation. The thicker the tissue, the more it absorbs.
A grid G is a large thin plate composed of thin parallel strips of metal and wood. II Which view or technique, other than the routine PA and lateral, would give the most information in the following situations? Fluid effusion, blood, pus is more radiodense. The heart and the fluid c are the same radiodensity. In all conventional x-ray techniques, the x-ray beam passes through the patient, superimposing all structures in its path onto an x-ray film or detector projection image.
These images are the product of multiple digital readings, from multiple angles, synthesized into a digital image. The digital data can be processed to improve tissue contrast and brightness or to view the anatomy in various planes. Figure B shows the relationship of the sagittal, coronal, and oblique planes to the axial plane.
Axial images are viewed as if you were looking up from below. CT provides the most useful cross-sectional imaging of the chest. The patient is supine on a mobile table that passes through a cylindrical tunnel or gantry. In the gantry wall, an x-ray tube T revolves around the patient Figure The x-ray beam hits multiple small radiation detectors in the opposite gantry wall.
Radiation is detected, quantified, and synthesized into a digital image. CT density is expressed in Hounsfield units HU. Figure shows the various CT densities in HUs. Iodinated contrast medium is often given intravenously during the scan to increase the radiodensity of blood. In Figure B, intravenous contrast medium was given during scanning.
Note the change in the density of the aortic arch A and the superior vena cava S. Figure C is a left anterior oblique two-dimensional reconstruction, from the same digital data. Note the radiodense calcified c aortic plaque in Figures A and C. The radiolucent areas are the air-containing lung parenchyma. They create three-dimensional images that can be viewed from any direction. Figure A is a three-dimensional view of the aorta. Compare with the two-dimensional reconstruction of the same aorta Figure C.
This is virtual bronchoscopy. MRI uses an entirely different set of physical properties. To oversimplify, the patient is exposed in a gantry to a high-intensity magnetic field, and radiofrequency pulses are applied.
Images are based on the absorption and emission of radiofrequency energy. Different kinds of pulses create different kinds of images so that a substance that appears white on one set of images may appear black on a different set of images. Multiple sets of images are acquired with each study, and the combined information from all of the different images helps characterize tissues. It is not necessary to learn what T1 and T2 mean, but it may be helpful to know that simple fluid tends to be bright on T2-weighted images and dark on T1-weighted images.
Note: Cerebrospinal fluid is bright on T2-weighted images. In the axial image, Figure A, the paratracheal mass is intermediate signal i. In the coronal image, Figure B, the paratracheal mass is high signal i. Note the low signal i. MRI has the advantage of avoiding ionizing radiation and iodinated contrast material. The gadolinium-based contrast materials used in MRI also are much less likely to cause adverse reactions.
MRI is contraindicated, however, for patients with pacemakers, defibrillators, and a wide variety of implanted metallic clips or devices. Each MRI sequence is relatively time-consuming, and multiple sequences are necessary for each examination. Patients often experience claustrophobia in the tubelike MRI gantry. MRI tends to be better able to answer specific questions than to provide a broad survey of anatomy because of the wide variety of available pulse sequences.
It is generally less valuable for imaging the lung than CT because the air within the lung provides relatively little MRI signal. MRI is best used for imaging of the heart and vascular structures and to answer a wide variety of neurologic, musculoskeletal, and abdominal imaging questions. The sound waves reflect differently off different tissues.
The transducer detects reflected sound waves and synthesizes them into diagnostic images. Fluid causes minimal reflection, so it appears as a homogeneous low-signal area low echogenicity. Soft tissue absorbs, reflects, and deflects the signal, causing a heterogeneous echogenic area. Sound waves travel poorly in air and bone.
Bone-soft tissue and air-soft tissue interfaces are hyperreflective. Air-filled lung and bone are difficult to evaluate with US. US is relatively inexpensive, portable, and especially suited for imaging pleural or pericardial fluid and cardiovascular structures in real time. Figures A and B are US of the pleural space. The diaphragm arrow separates the liver L from the pleural space.
Note the signal difference between the transudate T and an empyema E. This permits evaluation of dynamic physiologic processes such as cardiac motion and blood flow. Figure , an echocardiogram US , shows the four cardiac chambers. 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.
The major risks are genetic damage and potential cancer induction. Conventional chest radiographs produce very, very low radiation exposure, whereas studies such as CT, fluoroscopy, and angiography give considerably higher doses. Patient radiation dose should be kept to a minimum. This is especially true during the reproductive years, during pregnancy, and during childhood because rapidly dividing cells are more sensitive to radiation damage.
The best way to reduce patient exposure is to choose the correct imaging examination. If you are unsure, discuss it with the radiologist. Match the areas with their approximate Hounsfield units: A. This chapter reacquaints you with the normal anatomy and helps you develop a search pattern that you can apply to every radiograph. Learn this ordered approach and then stick to it case after case.
You will look like a pro. Mentally, you must fuse two projection images PA and lateral into a three-dimensional understanding of the anatomy. Study these diagrams until you could give these answers in your sleep perhaps you are already doing that. PA radiograph A. Start reading every radiograph—chest or otherwise—by scanning the areas of least interest first, working toward the more important areas.
You are less likely to miss secondary but important findings this way. 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. Look at each lung individually, then compare left lung and right lung. Normal gas-containing structures are the stomach and the hepatic and splenic flexures of the colon. The liver is always visible, and the spleen is often visible.
The right diaphragm is higher. Similarly, basilar lung disease pneumonia, pleurisy may mimic upper abdominal disease. This is real! Finish by reversing the order down the left side. These structures are represented in Figure B. Note that the posterior ribs tend to be horizontal, while the anterior ribs descend from lateral to medial.
Start with a global look at the mediastinum for contour abnormalities i. The lungs are so important that we search them twice. The second look involves a side-by-side comparison of the lungs Figure B. This also should give you a second look at costophrenic angles and the hilum. Practice this search pattern in Figure A.
Are There Many Lung Lesions? The abnormality is subtle. Compare side to side. The change should be obvious it is to me anyway. Clinical Pearl: The old x-ray is your best friend. Radiologists always look at old films when available. You should, too. They help you detect new disease and evaluate for change in preexisting disease.
In Figure B, obtained 1 year earlier than the x-ray in Figure A, the nodule was barely visible arrows. How do you tell who looked at the images last? A radiologist: The PAs and laterals are in chronologic order. An internist: The PAs are in chronologic order, and the laterals are in random order.
A surgeon: All are in random order. An orthopedist: Half are missing. In Figure A, start by searching below the diaphragm A. Continue at the lower spine B , searching the soft tissues and bones posteriorly, then anteriorly C. Return to the trachea and work your way down the mediastinum D. In Figure B, crisscross the superimposed lungs and costophrenic angles E. This was inside. In the simplest terms, the lung parenchyma consists of air sacs and supporting structures.
Figure shows alveoli arranged into acini around terminal airways. Several acini form a secondary pulmonary lobule, the basic unit of lung function and gross morphology. On a normal chest x-ray, the branching pulmonary arteries and veins are our only look at the interstitium. They appear white. Because the air in the alveoli is hardly affected, the lung still appears well aerated.
Compare with normal interstitium in Figure The lungs appear homogeneously white. They are not aerated. Try to analyze each abnormal x-ray with these patterns in mind. In Figure A, the alveoli are aerated black and the interstitium is more prominent white. Figure B and Figure B are a match. II aerated; thick more prominent ; invisible hidden ; airless consolidated radiodense III Search Figure systematically. Then answer the following questions below. Which lung is more radiolucent? What is the cause of the density difference?
III A. Search Figure systematically. Then answer the following questions. If you got these answers, great, you searched systematically. If not, review questions We spend time synthesizing the superimposed anatomy on the PA and lateral into a three-dimensional understanding.
CT is the opposite task. The anatomy is not superimposed. We have to integrate the axial images mentally to get the overall picture. Your knowledge of the radiographic anatomy will help you understand CT scans.
Conversely, CT anatomy will help you better understand radiographic anatomy. First, we need to master the CT anatomy and then develop ways to integrate the information. Every CT scan starts with a scout view, a projection image that looks like a second-rate x-ray. As you scroll through the axial images on a monitor, a line on the scout view tells you the level you are at.
Figure A shows that the axial images Figures B through E were done at the level of the aortic arch. How did you know? So, we will learn with intravenous contrast. That is, they absorb more radiation after intravenous contrast injection. The three lines indicate the scan locations of Figures B, C, and D.
The pleura is seen as a very thin white line lining the thoracic cavity posterior arrow. The pericardium sits between two layers of fat as it encircles the heart anterior arrow. Normally, there is no visible fluid in the pleural space, but there may be some fluid in the pericardial space. Encyclopedia Britannica—unused.
Have two teenagers who know everything. The anatomy is easy. Small vessels and bronchi are beyond the resolution of the CT image. To achieve the high resolution, the image is [1. Note the difference in detail. Other bones are easier to follow. It is an unrequested bonus, but is often helpful. High quality axial images can be reconstructed in any plane desired, giving us alternative looks at the intrathoracic anatomy.
Review Figure It is lateral to the heart and great vessels. Brzywanoski III. Figure A is a diagram of air in the alveoli black and the normal interstitium white , which compares with a normal high-resolution CT scan Figure B.
Figure B B. Figure C C. IV What might this represent in a: A. Figure C B. Figures A and B C. Some diseases have lobar or segmental distributions; others do not. Understanding the lobar anatomy also is important for planning bronchoscopy, surgery, radiation therapy, and postural drainage. Because the visceral pleura is less than 1 mm thick, the x-ray beam must strike it parallel to its surface if it is to be visible on the radiograph.
Figure B is a parasagittal CT reconstruction showing the left major fissure arrows. There are two exceptions. If a lobe is consolidated, the fissure appears as an edge, delineating that lobe. In Figure A, the lower fissure is a line arrowheads , but the upper fissure is an edge arrows because the upper lobe is consolidated or airless.
If pleural fluid enters a fissure, the fissure thickens. Note the thick major fissure arrowheads and normal minor fissure arrow in Figure B. In an erect patient, the minor fissure is usually horizontal. In others, the minor fissure is anatomically incomplete and not visible in one or both views. Watch for it. This often helps you distinguish the right from the left major fissure on the lateral view.
Here is a simple method: The left major fissure ends on the left diaphragm Figure arrow. The left diaphragm is usually lower, usually has the stomach bubble immediately beneath it, and is not visible anteriorly because the bottom of the heart rests on it.
The upper portion of the lower lobes superior segment is superior to the hilum. Mycoplasma and Legionella infections also may cause lobar consolidation.
On radiographs, fissures are seen when parallel to the x-ray beam. On CT, structures are best seen when perpendicular to the scan plane. The major fissures arrows are usually visible on axial CT images Figure The minor fissure is parallel to the scan plane and not visible. There are three accessory fissures seen occasionally in normal individuals.
The azygos fissure Figure A is formed by an anomalous development of the azygos vein. Figure B shows a CT scan of an azygos fissure and lobe. I just need a second opinion. I need another view. Figure shows the inferior accessory fissure arrow. They help to localize disease in the lung. As we shall see, displacement of the fissures is the most reliable sign of lobar collapse.
II minor; superior accessory Parallel to beam in both projections both horizontal III An unlucky seamstress gasped at the wrong moment. Carefully scan Figures A and B, then answer the following questions: A. What is the abnormality? In what lobe is it located? We can use these changes to help us detect and localize disease in the lung. This chapter discusses how disease in different lobes affects the appearance of adjacent organs. Calcium is the prime example of metal density normally found in the body.
Note the sharp interface between each density. These four basic densities keep the radiologist in business. Figure is a normal chest x-ray. The fat planes between the muscles are barely visible. The inner stomach wall is visible because air contacts the soft tissue wall. Converseley, the liver and right diaphragm are not seen separately because they are both of water density. So is diseased airless lung. Two substances of the same density, in direct contact, cannot be differentiated from each other on an x-ray.
This phenomenon, the loss of the normal radiographic silhouette contour , is called the silhouette sign. Figure shows three x-rays of a model of the heart and aorta. In Figure A, the heart and ascending aorta are in one empty box, and the descending aorta is in a second empty box, behind the first.
In Figure B, some water has been poured into the anterior box. The lower heart borders have disappeared. In Figure C, the water has been removed and placed in the posterior box. The right heart border, still in contact with aerated right middle lobe, is visible. The left heart border is normal.
Right diaphragm B. Right heart C. Left diaphragm D. The silhouette sign helps diagnose and localize lung disease. If you know the position of intrathoracic structures, you can precisely localize the lung disease.
The heart and ascending aorta A are anterior, and the descending aorta D is posterior. Figure B is a CT scan taken through the aortic arch as it passes from right anterior to left posterior. In Figure C, the ascending aorta A is anterior, and the descending aorta D is posterior. In Figure A, we see two diaphragms posteriorly, but only one anteriorly.
How can this be useful? In Figure B, the CT scan shows the consolidated lingula adjacent to the left heart. They are not in anatomic contact with the heart borders, which are anterior structures. On the right, there is a silhouette sign of the right heart and the diaphragm, indicating right middle and lower lobe disease. The left diaphragm is not visible because of a left lower lobe consolidation. The left heart border is sharp; the lingula is aerated.
Compare with Figures and Check the diaphragm and descending aorta through the heart on every film for a silhouette sign. Figure shows right upper lobe consolidation obscuring the upper mediastinum and ascending aorta.
Figure shows the silhouette sign in left upper lobe consolidation. Sometimes it actually helps detect disease. Study Figure carefully. Note: Both heart borders are indistinct. You would need a lateral film or CT scan to confirm. A negative silhouette sign does not ensure that a given lobe is disease-free because it may be partially aerated and not cause a silhouette sign. Be careful! You have learned that the silhouette sign applies to radiodense lung lesions.
It also applies to soft tissue density mediastinal and pleural lesions. It applies whenever two structures of the same density are in contact. What does it do to the tracheal width? Figure is an underpenetrated film. The left diaphragm and descending aorta are not visible through the heart. If you cannot see the spine through the heart, the film is underpenetrated, and a silhouette sign may be misleading. The density of the spine hides the lung-heart interface.
This helps distinguish the left from the right diaphragm on the lateral. The anterior one is due to the heart, and the posterior one is due to pneumonia P in the left lower lobe.
The entire right diaphragm is visible. The silhouette sign is nearly always an abnormal finding. It is usually due to lung disease. It may be present even when you cannot see the disease causing it. On every chest film you see from now on, look for the silhouette sign.
Without a lateral, determine which lobe s is are consolidated. III right middle lobe, right lower lobe, lingula B. In the lungs, however, the bronchi are not visible. The only branching structures visible in the lungs are the pulmonary vessels water density surrounded by air. In Figure A, the branching pulmonary vessels are visible in the lung. The trachea and proximal main bronchi arrows are surrounded by mediastinal soft tissue and are visible.
The peripheral bronchi are not visible. On CT, the bronchi are normally visible through much of the lung. In Figure B, right lower lobe bronchi appear tubular in plane and left lower lobe bronchi appear circular perpendicular to plane.
Figure C, a coronal CT reconstruction, shows the distal trachea, carina, and intraparenchymal bronchi in plane. CT has replaced bronchography. In a different patient, Figure B shows multiple dilated bronchi in cross section on the left and relatively normal bronchi on the right. Figure C is a coronal CT scan that shows the left lower lobe bronchiectasis. Sure we do! When the lung is consolidated and the bronchi contain air, the dense lung delineates the air-filled bronchi.
Visualization of air in the intrapulmonary bronchi on a chest roentgenogram is called the air bronchogram sign. Straw V vessel contains water, and straw B bronchus contains air. They are x-rayed in air. If you missed this, review questions The bronchi appear as branching black tubes in the consolidated lung behind the heart.
In Figure , the CT scan shows a right middle lobe air bronchogram. Mild consolidation elsewhere does not give an air bronchogram. Not seeing the lung vessels is a variation of the silhouette sign. Many bronchi are visible, but the pulmonary vessels are not. Arrows indicate air bronchograms in both upper lobes and the right lower lobe.
Because there is an air bronchogram sign, we know the lesion is in the lung and not in the mediastinum. Individual vessels are not visible because they are surrounded by water density. Conditions that hyperinflate the lungs do not cause air bronchograms. Compare with Figure In Figure , there is no air bronchogram in the consolidated lingula because a tumor obstructs the proximal bronchus, and the bronchial air has been replaced by secretions or resorbed. Sometimes an air bronchogram seen through the cardiac shadow is the most definitive sign of left lower lobe consolidation.
In Figure , air bronchograms arrows are visible through the density of the heart. There is also a silhouette sign of the medial diaphragm. Remember, consolidated lobes may not show an air bronchogram if: A. In Figure , the bronchi are normally spaced, whereas in Figure , they are crowded. Figure shows dilated bronchi arrows at the lung base. Figure shows dilated, thickened bronchi. Bronchi running in the axial plane are tubular straight arrows , and bronchi running across perpendicular to the axial plane are circular curved arrow.
Figure shows dilated bronchi completely filled with secretions in plane straight arrows and in cross section curved arrow. II Which of the following conditions may show an air bronchogram? IV Figures A and B are two postoperative patients with shortness of breath. Which patient would benefit little from endobronchial suction or bronchoscopy? Figure A; air bronchogram D.
For us, it is also a good way to reinforce the anatomy. The terms are fuzzy and interchangeable hard to believe. In Figure , the left lung is consolidated and collapsed. Look at Figures A and B and decide which lobe has collapsed.
The accompanying CT scan shows collapse of the right upper lobe, and the arrow points to an endobronchial tumor obstructing the right upper lobe bronchus. There is a triangular density over the heart. Changes on the frontal radiograph are often subtle. The minor fissure is elevated. The right upper lobe is partially collapsed. There is a silhouette sign of the right diaphragm, and the heart has moved to the right, indicating right lower lobe collapse.
The right middle lobe remains aerated. We see the undersurface of the minor fissure and the right heart border because the right middle lobe is aerated. It is common for an endobronchial lesion tumor, foreign body, mucus to obstruct them together. In Figure A, the upper arrow is at the level of the upper lobe, and the lower arrow is at the level of the lingula.
These two lobes often collapse together. Figure shows dense consolidation at the right base. Crowding of pulmonary vessels or bronchi and movement of parenchymal landmarks e. If the lung is consolidated, the air bronchogram sign might show us the bronchi. The collapsed lung is difficult to see behind the heart.
There is a silhouette sign of the left diaphragm. The nodule moved medially because there is now air in the pleural space pneumothorax arrow. Yes, I did the biopsy. There are several less specific signs, such as shift of adjacent structures and change in lung density.
Hilar shift is a reliable indirect sign of atelectasis. Figures are based on normal chest x-rays studied by Dr. By the way, which diaphragm is usually higher? Similarly, mediastinal structures may shift. With upper lobe collapse, the trachea shifts toward the lesion see Figure The airless, atelectatic lung is more radiopaque, and adjacent lobes may hyperinflate to fill the void. Various physiologic mechanisms keep the lung expanded. When one or more fails, the lung tends to lose volume.
There are five basic mechanisms that cause volume loss: 1 resorption of air as a result of obstruction of a bronchus; 2 relaxation of the lung as a result of air or fluid in the pleural space; 3 scarring, causing lung contraction; 4 decreased surfactant reducing lung distensibility adhesive atelectasis ; and 5 hypoventilation as a result of central nervous system depression or pain.
Obstruction may be central i. In adults younger than 40 years old, it is usually due to a mucous plug, a foreign body, or a low-grade endobronchial tumor adenoma, carcinoid. In adults older than age 40, bronchogenic carcinoma is a frequent cause of postobstructive collapse. Collapse must be due to peripheral mucous plugging or hypoventilation. The central lucency C is the collapsed right lung.
The minor tissue is elevated arrows. Diminished surfactant promotes volume loss. It most often involves the lung base. Atelectasis also can occur at the segmental level or in random small areas of the lung parenchyma.
This usually presents as a linear band of dense lung, often referred to as plate or bandlike atelectasis. Figure shows bandlike atelectasis at the lung base caused by hypoventilation. This is a chance for you to pull together what you have learned in the last several chapters. Which lobes are collapsed? Direct signs? Indirect signs? Silhouette sign—where? We now look at other patterns of diffuse and focal lung disease. The lung reacts to disease in a limited number of ways.
The interstitium can thicken or thin, and the alveoli can fill with fluid or extra air. These changes may be focal or diffuse. They may be acute or chronic. We concentrate only on the most common combinations. These four basic variables help us analyze the chest x-ray and form a differential diagnosis.
Review Figures A and B. If the interstitium thickens, it can be seen more peripherally on the x-ray or CT scan. If the interstitial thickening is generalized, the pattern is linear reticular Figure A. If the thickening is discrete, it forms multiple nodules Figure B. If the alveoli fill with fluid, the fluid-filled area becomes radiodense, and the interstitium is enveloped in the dense white lung and is not visible Figure C.
If the markings are hazy ill defined and not distorted i. If the lung markings are sharp well defined and distorted i.
Neither is cheating. It is synthesizing information to arrive at the best possible answer for the patient. In Figure B, the CT scan shows distorted and sharp interstitium and aerated lung.
Figures A and B show an x-ray and CT scan with honeycombing. Most alveolar disease airspace consolidation , whether focal, multifocal, or diffuse, is acute. With alveolar disease, the airspaces are filled with fluid e. The alveolar pattern may be relatively homogeneous a lobe or segment or patchy and scattered throughout the lung. There is also focal consolidation of the right lower lobe without an air bronchogram or silhouette sign.
The most frequent cause of acute focal alveolar consolidation is also infection. Subacute alveolar consolidation is often granulomatous infection tuberculosis, fungal. History is helpful but less reliable. Figure A shows focal left upper lobe alveolar consolidation and diffuse interstitial thickening in a patient with silicosis.
Figure B shows the two patterns nicely. Note the interstitium is sharp and distorted. In patients older than age 40, cancer becomes a major concern.
When the patient is erect, the fluid settles to the bottom, and the air rises to the top. Which was taken with a horizontal x-ray beam? In Fig. The top of the water column is wider than the bottom. One is looking down at two edges not quite superimposed. The glass is just too big. From geekswithblogs. Figure shows an air-fluid level arrow in a cavitary right upper lobe pneumonia. Compare with Figure , where there is no fluid in the cavities. Granulomas frequently calcify. Figure A shows a nodule in the left mid lung.
Figure B shows the same granuloma on CT. Healed tuberculosis and histoplasmosis are the most frequent causes of lung granulomas. High-quality images and diagrams are accompanied by multiple-choice review questions to reinforce key concepts. Additional online images plus self-assessment tests help you sharpen your skills and build confidence! This site comply with DMCA digital copyright. We do not store files not owned by us, or without the permission of the owner.
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