Tension hydropneumothorax

• Air fluid level at right costophrenic angle

• Deeper right costophrenic angle as compared to the left

• Contralateral shift of mediastinum

ARDS

• Bilateral diffuse fluffy infiltrates

• Normal cardiac size

• Tracheostomy tube

• Right subclavian central line going inside the right atrium

• ECG wires

• Ipsilateral shift of mediastinum and trachea

• Bronchial cut-off sign suggestive of endobronchial obstruction

• Rib crowding• Loss of volume• Obscured right mediastinal

and cardiac outline• Obscured right

hemidiaphragm (silhouette sign)

• Compensatory hyperinflation of left lung

• Prominent left pulmonary artery (cardiac output passing through single artery)

Right lung collapse - PA view

• Loss of gradually increasing transradiancy down the spine

• Only one hemidiaphragm is visible (left)

• Suspicion of mass in lower lobe with lymph node in mediastinum

Right lung collapse – lateral view

• Ipsilateral shift of trachea, carina and mediastinum

• Bronchial cut-off sign (left mainstem bronchus)

• Rib crowding• Loss of volume• Compensatory

hyperinflation of right lung

Left lung collapse

• Airbronchogram sign– Produced as a

result of airspace opacification of the lung parenchyma

– This results in visibility of the normally invisible black bronchi against a background of white opacification

• Seen in consolidation and collapse with at least some patency of the bronchus

Collapse with airbronchogram

• Loss of volume on left side

• Ipsilateral shift of trachea and mediastinum

• Compensatory hyperinflation of left lung

• Raised left hemidiaphragm (compare with right) with tenting

• Haziness over the aortic knuckle (silhouette sign)

Left upper lobe collapse – PA view

• Oblique fissure displaced anteriorly

• Opacification anterior to the oblique fissure

Left upper lobe collapse – Lateral view

• Loss of volume on right side

• Opacification of right upper lobe

• Transverse fissure raised

• Right hilum is also raised

Right upper lobe collapse - PA view

• Oblique fissure displaced anteriorly

• Transverse fissure pulled upwards

• Opacification with loss of volume of right upper lobe

Right upper lobe collapse – lateral view

• Loss of volume on left side• Ipsilateral shift of the heart• Both hila are at the same

level (left hilum has come down)

• Double opacity behind the heart

• Outline of left hemidiaphragm is obscured (silhouette sign)

• Left hemidiaphragm is raised (watch the gastric bubble)

Left lower lobe collapse – PA view

• Loss of gradually increasing transradiancy down the spine

• One hemidiaphragm is clearly visible

• Oblique fissure is displaced posteriorly

Left lower lobe collapse – Lateral view

• Multiple small millet sized nodules throughout both lung fields

Miliary shadowing

• Mediastinal widening in upper part mediastinum

• Loss of volume on left side

• Double opacity behind the heart

• Left hemidiaphragm not visible

• Heart shifted to the left side

Mediastinal mass with left lower lobe collapse

• Fungus ball with surrounding rim of air

Aspergilloma

• Left sided pleural effusion

• Associated lobulated pleural thickening

• No shift of mediastinum due to encasement by mesothelioma

Mesothelioma

• Cat under the rug appearance indicative of pleural based origin

• Angle between chest wall and opacity is obtuse (>90o)

Pleural based mass

• Bilateral hilar lymphadenopathy

• Right paratracheal strip enlargement

• Bilateral infiltrates involving predominantly the mid zones

Sarcoidosis

• Left sided apical pneumothorax

• Visceral pleural line is clearly visible– There should be

no lung markings distal to the visceral pleural line

Pneumothorax

• Complete opacification of right hemithorax without significant contralateral shift of mediastinum

• Absence of shift is indicative of concomitant collapse

• Usually a sign of malignancy

Effusion with collapse