The Chest X-Ray Database
The Chest X-Ray Database
This radiograph demonstrates a hazy right paramedian opacity with an indistinct right heart border. This is a typical radiographic appearance of pectus excavatum. A lateral radiograph or a prior CT (if available) could be used to confirm. The primary differential consideration would be a right middle lobe pneumonia or potentially a mediastinal mass if the sternal depression is severe enough to cause deformation of the mediastinal contours (not seen in this case).
This radiograph demonstrates typical findings of septic emboli. There are multiple bilateral nodules, many with cavitation. Metastatic disease would be within the differential for this finding, though in practice the clinical history is typically quite useful to distinguish between these two entities; In this case, the patient is young with a history of drug abuse (suggesting endocarditis as a source) and presents with sepsis. In addition, this patient has medium bilateral pleural effusions. In the setting of septic emboli this is concerning for empyema. CT is usually confirmatory.
Support devices include a central venous catheter in the right internal jugular vein, an endotracheal tube in the mid trachea, and an enteric tube entering the stomach and terminating inferiorly beyond the border of the study.
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 typical findings of pulmonary edema. The vessels are hazy with indistinct margins. Kerley B lines are seen peripherally. There are bilateral layering pleural effusions creating a gradient of opacification extending from the bases. Bibasilar opacities are silhouetting the diaphragm and the right heart border, representing a combination of pleural effusions and associated atelectasis.
A dual-lumen central venous catheter is also in place.
This radiograph demonstrates a left subpulmonic pneumothorax in the upright position. Typically pleural air would be expected to collect apically (anti-dependently) in this position. However, this patient has a history of wedge resection evident by the staple line seen in the apical left upper lobe. This was complicated by recurrent pneumothorax for which the patient underwent pleurodesis. The resultant pleural scarring is preventing the pleural air from rising, giving this appearance.
Other than the presence of EKG leads, the remainder of the exam is unremarkable.
This is a radiograph demonstrates peribronchial cuffing, which is increased density around the bronchioles when viewed end-on. This may represent thickening of the wall itself or fluid around the wall due to lymphatic congestion. The finding is nonspecific and can be seen in pulmonary edema, infectious and inflammatory bronchiolitis, and reactive airway disease. This particular case was a toddler with a previous diagnosis of asthma who presented to the emergency department with an acute asthma exacerbation.
This radiograph is of a premature infant in the first week of life. The right lung demonstrates diffuse microatelectasis typical of Neonatal Respiratory Distress Syndrome (RDS), also known as Surfactant Deficiency Disorder, caused by insufficient surfactant production in the setting of prematurity (typically <35 weeks gestation). The left lung is hyperinflated relative to the right lung, with diffuse linear lucencies radiating from the hilum. This appearance is typical for Pulmonary Interstitial Emphysema (PIE), a condition secondary to barotrauma from ventilation seen in premature infants in the first weeks of life. An NG/OG tube terminates in the body of the stomach. A second tube, thicker and denser than the NG/OG, with multiple rounded lucencies along the distal aspect is also seen. This is a NAVA tube (Neurally Adjusted Ventilatory Assist), which detects electrical activity of the diaphragm to improve synchrony with the ventilator.
This radiograph demonstrates obvious consolidation in the right lower lung field, with more subtle retrocardiac left lower lobe consolidation. There is a displaced left mid-clavicular fracture. Lines and tubes include an endotracheal tube, an enteric tube, and an esophageal temperature probe. Without additional history, the lung findings are not specific. The distribution is typical for aspiration, though infection is also high on the differential. Contusion is also a consideration in a trauma patient. In this case, the EMS report included witnessed aspiration which makes it the likely etiology.
This radiograph demonstrates a malpositioned endotracheal tube in the right main bronchus with resultant atelectasis of the entire left lung. The heart is shifted toward the left side. This supports the diagnosis of atelectasis over a large pleural effusion, which would look similar except that the heart would shift to the contralateral side. An enteric tube is also seen entering the stomach and terminating inferiorly beyond the border of the study. EKG wires, bra clasps, and bra underwires are seen externally.
This radiograph demonstrates a left pneumothorax without evidence of tension physiology. This was a spontaneous pneumothorax in a young patient, unknown etiology.