The Chest X-Ray Database
The Chest X-Ray Database
This patient underwent bilateral mastectomies for breast cancer. Surgical clips from an axillary lymph node dissection are seen on the right side. The bilateral rounded metallic devices are tissue expanders. They are attached to a radiolucent inflatable bladder that can be progressively filled with saline to stretch the overlying soft tissues, creating redundant tissue that can later be used for reconstruction. The underlying lungs are clear.
This case demonstrates multiple poorly defined opacities in the right lung. In a clinical setting suspicious for infection, this finding is most consistent with multifocal pneumonia as was the case here.
This case demonstrates both a right pneumothorax and pneumopericardium. In this case, the cause was iatrogenic during a bronchoscopy. A right chest tube is in place, though a small apical pneumothorax is still visible.
Clamshell sternotomy closure hardware is also seen, indicating that this is a lung transplant patient.
This radiograph demonstrates a lobulated mass in the left perihilar region. Also of note is the presence of a unilateral implant in the left breast, suggesting a history of mastectomy and breast reconstruction. Together these findings are highly suggestive of pulmonary metastatic disease from breast cancer. However, tissue diagnosis would be required for confirmation as a primary lung malignancy and metastatic disease from a different, unknown primary are also possible.
The exam is otherwise unremarkable.
This radiograph demonstrates a lingular consolidation concerning for pneumonia. The location of the consolidation can be localized to the lingula even without a lateral radiograph using silhouette sign. There is a loss of sharpness and definition, or “silhouetting,” of the left heart border at the location of the consolidation, indicating that the consolidated lung makes direct contact with the left heart. Anatomically the pulmonary lobe that has the greatest area of contact with the left heart is the left upper lobe, specifically the inferior left upper lobe (the lingula), making the silhouette sign a reliable method of localization. The lingula is a relatively common location for pneumonia.
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 a misplaced right IJ Swan-Ganz catheter. Not only is the catheter too deep in the right pulmonary artery, the course of the catheter extends all the way into the abdominal IVC before looping back into the right atrium and crossing the tricuspid valve. Other lines and devices include a left upper extremity PICC with the tip terminating in the SVC, and an intra-aortic balloon pump (IABP) with the distal marker appropriately located just inferior to the aortic knob.
The cardiac silhouette is prominent and there is mild interstitial edema, which makes sense in the context of an IABP indicating that the patient is in heart failure.
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 unilateral pulmonary edema in the right lung. The differential for this appearance is limited and includes severe mitral regurgitation (such as a papillary muscle rupture), unilateral pulmonary venous obstruction, and lymphangitic spread of malignancy mimicking edema. Those etiologies rarely present with as much uniformity as this case, which was due to prolonged decubitus positioning that rapidly resolved on subsequent radiographs.
Incidentally noted is the presence of a tracheostomy tube with an overlying tracheostomy mask supplying oxygen to the patient.
This radiograph demonstrates a left upper extremity peripherally inserted central catheter (PICC) with tip terminating in a persistent left SVC. The presence of a persistent left SVC was confirmed on review of prior cross sectional imaging. A PICC in the internal thoracic vein can have a similar appearance on AP/PA radiographs, however a lateral radiograph easily distinguishes the two as a persistent left SVC will course centrally and the internal thoracic vein will course anteriorly.
The radiograph is otherwise unremarkable.