Diaphragm
1. Evaluate for Diaphragm
On the lateral film the costophrenic (CP) angle of each hemidiaphragm (HD) should be sharp.
Right Image: Close up of CP angle of each HD. (RD = right HD and LD = left HD)
Costophrenic Sulcus
Identify: Costophrenic Sulcus
Mediastinal Mass – Superior
– no image available –
Mediastinal Mass – Posterior
Look for:
- Neurogenic tumour (e.g. neurofibroma, schwannoma)
- Multiple myeloma
- Pheochromocytoma
- Extramedullary hematopoiesis
- Neurenteric cyst, thoracic duct cyst
- Lateral meningocele
- Bochdalek hernia
Mediastinal Mass – Middle
Everything from the heart and great vessels to a line 1 cm posterior to the anterior border of the thoracic vertebral bodies.
Look for:
- Esophageal carcinoma, esophageal duplication cyst
- Metastatic disease
- Lymphadenopathy (all causes)
- Hiatus hernia
- Bronchogenic cyst
Mediastinal Mass – Anterior
Anterior to heart and great vessels.
Look for:
- Teratoma, thyroid, parathyroid or thymic neoplasm
- Thymic or pericardial cyst, epicardial fat pad
- Foramen of Morgagni hernia
Pulmonary Nodules
This image shows a pulmonary nodule in the right upper lung. Differential diagnosis of pulmonary nodules includes:
- Malignancy (primary or metastatic)
- Benign neoplasm: hamartoma, bronchial adenoma
- Granuloma
- Simulated: nipple, bone lesion, skin lesion, foreign body, artefact
Less common causes include:
- Abscess
- Infarct
- Loculated pleural effusion
- Organized pneumonia
- Sarcoidosis
- Cystis disease
- Vascular lesions
Pulmonary Edema – Reticulonodular Pattern
Pulmonary Edema – Reticulonodular Pattern
Reticulonodular Patterns: A combination of reticular and nodular patterns.
No image available
Pulmonary Edema – Peribronchial Cuffing
Pulmonary Edema: Pulmonary edema is a redistribution of vascular fluid into the interstitium first, and then possibly the alveoli. The causes can be cardiogenic, renal failure, or due to respiratory conditions like ARDS.
Peribronchial Cuffing: Normal bronchi do not have the circumferential thickening depicted in the image below.
Pulmonary Edema – Kerly B Lines
Kerly lines result fomr thickened connective tissue planes occurring as a result of pulmonary edema or carcinomatosis.
Kerly A Lines: Radiate towards hila in mid- and upper-lung zones, 3-4 cm long, smaller than vascular markings (not useful)
Kerly B Lines: Horizontal, <2 cm long an d1 mm thick, at periphery of lung, reach lung edge (very useful)
Kerly C Lines: Thickened interlobular septa
