實戰課題Medical Internship Topic 7: CXR案例判讀

* All pictures from https://radiopaedia.org, just for learning purpose

1. Atelectesia
- Displacement of fissure
- Bronchovascular crowding 
- Increase opacity
https://openi.nlm.nih.gov/detailedresult.php?img=PMC2823759_1752-1947-4-17-1&req=4

* Juxtaphrenic peak sign(peaked or tented appearance of a hemidiaphragm which can occur in the setting of lobar collapse): mostly upper lobe atelectasia


* Reverse S sign=Golden S sign: upper lobe atelectasia


* Luftsichel sign: LUL lung collapse

 
* Flat waist sign: LLL lung collapse
http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=28734&ti=86331&searchkey= 

* Paraesophageal line deviation, azygoesophagus recess
 
2. Hilar obstruction: DDx
- Sputum
- Tumor
- TB
- LN
 
 3 Lung lobules
http://slideplayer.com/slide/9428451/29/images/2/Lung+Unit+Acinus+:+That+
part+of+the+lung+supplied+by+a+terminal+bronchiolus.+This+includes+
respiratory+bronchioli,+alveolar+ducts,+and..jpg
 
4. Descriping lung lesions:
- Fluffy margin
- Early coalescence
- Alveologram
- Rapid timing(?)
 
5. Cryptococcus pneumonia
- Lower lungs, nodules, air bronchogram


 
6. Slow in progress nodules
- BAC( a kind of adenocarcinoma)
- Lymphoma
- Autoimmune related, inflammation
 
7. Describing lung nodules
- 2S: size, shape
- 3C: calcification, cavitation, contrast
- DOA: doubling time, density, other, area, age
- scalloped(lobulated), corona radiata, rabbit ears, rat tail sign, pleural tag sign, eccentric cavitation, thick wall(>16mm? ex: SCC with cavitation)
 
8. DDx of lung nodules/masses
- H: hema(spread by blood)
- I: infection
- I: inhalation
- N: neoplasm
 
9. Fungus ball: aspergiilus

 
10. Bronchogenic cyst: homogenous, smooth

 
11. Calcifications:
good signs- popcron(harmatoma), diffuse, laminated, central nidus
bad signs- eccentric, strippled
Ring- teratoma, thymogenic cyst
 
12. Congenital pulmonary airway malformations (multicystic, bronchial proliferation)

13. Lung sequestration
- Often triangular


14. Varicella pneumonia
- Fast
- Skin rashes, vesicles
- Calcification(+)
DDx: miliary TB


15. GGO
- Viral
- Clamydia
- Legionella
- Cryptococcus
- PJP

16. Proteinosis, PJP in AIDS
- Long term
- Crazy paving
- Reticular
DDx: PAS(+), milky BAL  in proteinosis

17. LAM(lymphangioleiomyomatosis)
- Penumothorax
- Chylothorax
- Young people

18. Thymoma
- Anterior mediastinum
- Calcification(-)

19. EMH (extramedullary hematopoiesis)
- Bilateral
- Paraspinal rib widening


20. Hilum overlay


21. Asbestosis (associated with mesothelioma)


22. Diaphragm hernia
Morgagni hernia: right, anterior
Bochdalek hernia: left, posterior