The Chest X-Ray Database
The Chest X-Ray Database
This is a patient who received a unilateral lung transplant for idiopathic pulmonary fibrosis. Fibrosis is evident in the right lung with resultant bronchiectasis and volume loss. While pulmonary fibrosis can be identified on radiographs, classification of the pattern of fibrosis requires CT. The transplanted left lung is clear.
This radiograph shows severely dilated pulmonary arteries. The differential for this finding includes pulmonary hypertension, flow abnormalities from shunting or valvular disease, and connective tissue diseases, among others. This a young patient with Eisenmenger Syndrome, a condition resulting from a longstanding uncorrected left-to-right shunt. The shunt causes pulmonary hypertension, which eventually becomes so severe that the direction of flow through the shunt reverses resulting in significant hypoxemia.
The exam is otherwise normal.
This radiograph demonstrates multiple bilateral calcified pulmonary nodules and mediastinal/hilar lymph nodes. This is usually due to a remote history of granulomatous inflammation. Sarcoidosis and fungal infections (in endemic areas) are common causes. The calcifications do not resolve but are of no clinical consequence. This patient reported a history of histoplasmosis, and the extent of the calcifications suggest it was a more advanced case. However, in areas of the United States where Histoplasma capsulatum is endemic, it is common to have a few calcified nodules and/or lymph nodes without a reported history of significant infection. The differential for calcified nodules does include a few more serious entities including calcified metastases (such as from osteosarcoma) and tuberculosis infection.
This radiograph demonstrates osteopetrosis (also known as marble bone disease and Albers-Schönberg disease), a disorder of osteoclasts which leads to unopposed osteoblastic activity. The bones are diffusely thickened and sclerotic. Multiple rib fractures are noted, highlighting the fragility of the disorganized bone.
The lungs and mediastinum are unremarkable.
This radiograph demonstrates several findings:
First, this is a COPD patient with very few lung markings seen in the right upper lobe due to severe emphysema.
Second, this patient has undergone endobronchial valve placement leading to complete lobar atelectasis in the left upper lobe. The valves themselves are visible projecting over the left hilum. There is expected volume loss in the left hemithorax, with increased opacity in the left lung due to superimposition of the collapsed left upper lobe and aerated left lower lobe.
Third, a named sign is demonstrated: The luftsichel sign (German for “air crescent”), which is seen as a crescentic lucency in the paramedian left upper lung and indicates left upper lobe collapse. The lucency is created by a portion of the aerated left lower lobe that insinuates itself between the mediastinal wall and the collapsed upper lobe.
Fourth, there is an incidentally noted small hiatal hernia seen as a rounded opacity projecting just to the left of midline at the level of the diaphragm. Diaphragmatic eventration is also noted.
This radiograph demonstrates severe cylindrical bronchiectasis, also referred to as tubular bronchiectasis, in an adult patient with cystic fibrosis. This patient has symmetric upper lobe disease which is a common pattern in this condition, though other distributions are not uncommon.
An implanted port is also seen with the tip terminating in the superior vena cava. The port reservoir is placed in the inferior chest wall in this patient, which is an unusual location.