Wegeners Granulomatosis
Patchy alveolar infiltrates, widely distributed multiple irregular masses plus or minus pleural effusion and plus or minus thick-walled canvities. [courtesy of Dr. M. Hutcheon]
Pulmonary Contusion
In this patient, note the irregular, soft, fluffy opacification at the right heart border suggestive of a medial right lower lobe pulmonary contusion.
Bronchogenic Carcinoma
Ill-defined infiltrating lesion in left hilar region.
Active Tuberculosis
Cavitation in apical regions and posterior segments of upper lobe plus or minus calcification. [courtesy of Dr. M. Hutcheon]
Tension Pneumothorax
In addition to the features of an uncomplicated pneumothorax, note the marked mediastinal shift to the left in this young patient with a right tension pneumothorax.
Pneumothorax – Pleural Disease
The patient’s left pneumothorax is more difficulty to diagnose on this supine film. This study demonstrates the “deep sulcus” sign, with the left costophrenic sulcus descending below the edge of the film. Other clues include a hyperlucent left hemithorax and slight sharpening of the left mediastinal border. This patient also has a tracheostomy, evidence of a prior sternotomy (not the multiple circular sternal wires), and a central venous catheter with its tip in the right ventricular outflow tract. The circular structures projecting over the chest, some with wires extending from them are ECG leads.
Pleural Effusion – RLD
This patient has a moderate-sized right pleural effusion. The lateral decubitus film places the effusion in the dependent position and will show layering unless the effusion is loculated. This is noted in the same patient’s left lateral decubitus film.
PA Film
Normal PA film of a male. Note the right and left clavicles (cl), posterior (p1-4) and anterior (a1-2) ribs, right and left costophrenic angles(cpa), right cardiophrenic angles (cdpa), right and left hemidiaphragms (hd), gastric air bubble (gab), trachea (tr), right and left mainstem bronchi (br), mediastinal shadow (med), carina (ca), and right and left hila (hi). The normal position of the minor fissure (mi) is also indicated.
PA Film
Normal PA film of a male. Note the right and left clavicles (cl), posterior (p1-4) and anterior (a1-2) ribs, right and left costophrenic angles(cpa), right cardiophrenic angles (cdpa), right and left hemidiaphragms (hd), gastric air bubble (gab), trachea (tr), right and left mainstem bronchi (br), mediastinal shadow (med), carina (ca), and right and left hila (hi). The normal position of the minor fissure (mi) is also indicated.
Normal – AP
Because the AP projection positions the heart and mediastinum further from the x-ray film than the PA projection, these structures appear magnified with the AP view. Other clues that you are looking at an AP projection include clavicles that project above the lung apices and scapulae that project over the lung fields.
