The Chest X-Ray Database
The Chest X-Ray Database
This radiograph demonstrates a right pneumothorax without evidence of tension physiology. This case was iatrogenic due to an inadvertently damaged diaphragm during an abdominal surgery. Linear subsegmental atelectasis is also noted projecting over the left heart.
This radiograph demonstrates a large hiatal hernia projecting over the mediastinum. In this case there is air within the gastric lumen which greatly aids in identification. In situations where air is not present within the herniated stomach, it can have the appearance of an abnormal cardiomediastinal silhouette. Review of prior images may assist with identification of a hernia, if available.
The exam is otherwise 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 a malpositioned enteric tube which is looped in the oropharynx/hypopharynx. There are a number of incidental findings including an appropriately positioned endotracheal tube, a loop recorder projecting over the left chest wall, postsurgical changes of sternotomy with a prosthetic aortic valve, and a Watchman left atrial appendage occlusion device which is difficult to see on the default window and level. The lung volumes are low overall with some linear subsegmental atelectasis in the left lung base.
This radiograph demonstrates a malpositioned left upper extremity PICC (peripherally inserted central catheter). The tip is turned upward within the superior vena cava and is beginning to course medially, consistent with placement in the azygous vein. A lateral radiograph may be helpful to confirm, if available. The study is otherwise unremarkable for the patient’s age.
This radiograph demonstrates an endovascular left atrial appendage closure device, in this case a Watchman™ device, projecting over the left heart. This prevents clot formation in the left atrial appendage in atrial fibrillation patients, which could otherwise embolize to the brain and cause stroke. The exam is otherwise unremarkable for the patient’s age.
This radiograph demonstrates a vagal nerve stimulator generator pack projecting over the left hemithorax with a thin lead tracking to the left base of neck. At first glance this may be mistaken for a pacemaker, but the course and caliber of the lead indicate that this is a different device. The exam is otherwise unremarkable.
This radiograph demonstrates a paramedian mass in the right lung apex, colloquially referred to as a Pancoast tumor. The lateral margin of the mass is visible above the clavicle, which localizes the mass to the posterior mediastinum (negative cervicothoracic sign). The patient is slightly rotated to the left. Multiple chronic bilateral rib fractures are present. A nipple ring projects over the left chest wall.
This radiograph demonstrates an incidentally discovered right aortic arch in an asymptomatic patient. The exam is otherwise unremarkable for the patient’s age.