Introduction To Abnormal Chest X-ray Findings

Introduction to Abnormal findings in chest radiographs

Learning objective

Students should be able to describe abnormal findings in chest radiographs under the following categories:

• Congenital disorders
• Acquired disorders
• Traumatic disorders

Degenerative disorders

Congenital Disorders

These are abnormalities present at birth due to genetic or developmental causes and can cause structural or functional defects.

Abnormal Findings ;

Congenital diaphragmatic hernia: Herniation of abdominal contents into the thoracic cavity which can be presented with Air-filled bowel loops in the thoracic cavity and mediastinal shift.

Congenital heart disease (e.g., Tetralogy of Fallot): presents with boot-shaped heart and can cause increased or decreased pulmonary vascular markings.

Congenital diaphragmatic hernia Tetralogy of Fallot(heart disease)

Introduction To Abnormal Chest X-ray Findings

Bronchopulmonary Sequestration: Non-functioning lung tissue with abnormal blood supply in chest x-ray present with Mass-like opacity with systemic arterial supply (may not be obvious on plain X-ray).

Bronchogenic cysts: Well-defined, round mediastinal or intrapulmonary mass.

Eventration of diaphragm: Smooth, elevated hemidiaphragm without signs of trauma or infection.

Pulmonary Agenesis: Complete absence of lung tissue, leading to mediastinal shift.

Bronchogenic cysts Eventration of diaphragm

Pulmonary Agenesis

Acquired Disorders

These develop later in life (after birth) due to various factors such as infections, tumors, or systemic diseases.

Abnormal Findings:

• Pneumonia: Infection leading to Localized consolidation, opacities and air bronchograms.

Tuberculosis: Upper lobe opacities, cavitations, calcified granulomas, fibrosis.

Pleural effusion: Accumulation of fluid in the pleural spaces in chest x-ray will present with Blunting of costophrenic angles, meniscus sign, homogeneous opacity.

• Cavitation:
• Calcified granulomas:

Fibrosis:

Pneumonia Tuberculosis

Pleural effusion

Introduction To Abnormal Chest X-ray Findings

Pulmonary edema (e.g., in CHF): Fluid accumulation in the lung causing Bilateral perihilar infiltrates ("bat-wing" appearance), Kerley B lines, cardiomegaly.

• Interstitial lung disease: Presents with Reticulonodular patterns, and honeycombing.

Sarcoidosis: Bilateral hilar lymphadenopathy, interstitial infiltrates.

Lung cancer: Mass lesion with irregular borders and possible hilar enlargement, and possible collapse or consolidation

Pulmonary edema

Interstitial lung disease Sarcoidosis

Traumatic Disorders

• Result from direct physical injury to the chest wall or internal thoracic structures.

Abnormal Findings:

• Rib fractures: Discontinuity in rib cortex, soft tissue swelling.

Note rib fracture can potentially leading to pneumothorax.

Pneumothorax: Abnormal air in the pleural space causing lung collapse presents with Visible pleural line with absent lung markings peripheral to it.

Rib fractures

Pneumothorax

Introduction To Abnormal Chest X-ray Findings

Hemothorax: Blood accumulation in the pleural cavity in chest x-ray will present with Fluid level or opaque hemithorax (depending on volume).

Pulmonary contusion: Also known as lung contusion Patchy opacities, often localized to site of trauma.

Flail chest: Paradoxical chest wall motion (clinical), multiple adjacent rib fractures on X-ray.

Diaphragmatic rupture: Elevated hemidiaphragm, bowel loops in thorax.

Hemothorax Diaphragmatic rupture

Degenerative Disorders

These are chronic conditions, usually progressing with age or chronic stress on the lungs.

Abnormal Findings:

Chronic Obstructive Pulmonary Disease (COPD): Emphysema and chronic bronchitis leading to Hyperinflated lungs, flattened diaphragms, increased retrosternal airspace.

Pulmonary fibrosis: Scarring of lung tissue causing Reticular or reticulonodular pattern, volume loss, honeycombing.

Aortic aneurysm (thoracic): Widened mediastinal silhouette, abnormal aortic contour(enlargement of aortic knob).

Degenerative spinal changes (visible on chest X-ray): Osteophytes, vertebral body sclerosis, kyphosis affecting lung expansion.

Silicosis: Interstitial lung disease due to inhalation of silica dust