ABNORMAL CHEST XRAY

• Lung Parenchyma
• Pleura
• Hilum
• Mediastinum
• Diaphragm
• Chest wall and bones
 Predominantly
Airspace
Increased
radiographic
density Predominantly
Parenchymal
diseases Interstitial tissue
Decreased
radiographic
density
ALVEOLAR DISEASE VS
INTERSTITIAL DISEASE
ALVEOLAR DISEASE
 CONSOLIDATION
• Alveolar space filled
with inflammatory
exudate
• Interstitium and
architecture remain
intact
• The airway is patent
• Radiologically:This
transcribes to ;
• A density corresponding
to a segment or lobe
• Airbronchogram
• No significant loss of
lung volume
 AIR BRONCHOGRAM SIGN
• Definition
Visualization of bronchi within parenchymal consolidation.
• Findings
Branching lucencies surrounded by consolidative opacity.

• Differential
non-obstructive atelectasis
pneumonia
pulmonary edema
hemorrhage
bronchoalveolar carcinoma
lymphoma
• Significance
Excludes a pleural or mediastinal lesion
AIR BRONCHOGRAM SIGN
 BULGING FISSURES SIGN
• The bulging fissure
sign refers to
LOBAR CONSOLIDATION
where the affected portion
of the lung is expanded.
• The most common infective
causative agents are
Klebsiella pneumoniae
Streptococcus pneumoniae
Pseudomonas aeruginosa
Staphylococcus aureus
 SILHOUETTE SIGN
• An intra-thoracic radio-
opacity, if in anatomic
contact with a border of
heart , aorta or
diaphragm , will obscure
that border.
• An intra-thoracic lesion
not anatomically
contiguous with a border
or a normal structure will
not obliterate that border.

Right middle lobe disease

SILHOUETTE SIGN
APPLICATION
ITS NOT JUST IN PNEUMONIA
 PITFALLS
• In a small percentage of normal individual, the right
heart border may not be seen
• A depressed sternum can produce loss of the right heart
border, an appearance which mimics middle lobe
pneumonia .This is because:
(a) the depressed sternum pushes the heart posteriorly
and to the left; and
(b) bunching of the soft tissues of the deformed chest wall
causes an increase in density.
 ITS NOT JUST THE PRESENCE
• The absence of a silhouette sign can tell you
where a shadow (consolidation or mass) is
NOT situated.
RT. MIDDLE LOBE PNEUMONIA

Indistinct borders, air bronchograms, and silhouetting of the right heart border.
COLLAPSE
In collapse air is absorbed
and not replaced in
contrast to consolidation.
 COLLAPSE

• The signs of lobar or pulmonary collapse can be divided

into
1) Direct

2) Indirect
 COLLAPSE
Direct signs are;
• Opacity of the affected lobe(s);
• Crowding of the vessels and bronchi within the collapsed area
• Displacement or bowing of the fissures .

Indirect signs are:

• Compensatory hyperinflation of the normal lung
• Displacement of the mediastinal structures toward the affected side
• Displacement of the ipsilateral hilum which changes shape
• Elevation of the ipsilateral hemidiaphragm
• Crowding of the ribs on the affected side
LEFT LUNG COLLAPSE
 COLLAPSE
Golden S Sign:
• Seen in case of
collapse due to
a hilar mass
• The mass gives
a convexity to
the concave
displaced
fissure
 DIFFERENCES

COLLAPSE CONSOLIDATION
 Volume loss.  Normal or increased

 Associated ipsilateral
volume
shift  No shift, or if present

 Linear, wedge
then contrlateral
shaped  Consolidation, air

 Apex at hilum
space process.
 Not centred at hilum
 Air bronchograms

are not seen  Air bronchograms

are seen
INTERSTITIAL DISEASE
 DIFFUSE LUNG DISEASE
• Non-homogenous
• Various patterns are :
Linear
Septal Lines
Milliary Shadow
Reticulonodular, Nodular
Honeycoomb Shadowing
Cystic
Peribronchial Cuffing
 RETICULAR/LINEAR SHADOWING

• Appears as a fine
irregular network of
linear opacities
surrounding air –filled
lung.
 RETICULAR/LINEAR SHADOWING

Fine reticular pattern Coarse reticular pattern

 RETICULONODULAR SHADOWING

• More common than

reticular or nodular
shadowing alone.
• The nodules are less
than 1cm in diameter.
• Ill defined and
irregular in outline.
 CAUSES OF DIFFUSE BILATERAL
RETICULONODULAR SHADOWING

•Infections – Fungal, viruses, mycoplasma

•Pneumoconiosis – Coal workers pneumoconiosis,
silicosis,asbestosis
•Collagen vascular diseases – SLE, Dermatomyositis,
Scleroderma, rheumatoid lung
•Cardiac – Pulmonary oedema, hemosiderosis ,
•Miscellaneous: Idopathic interstitial fibrosis, extrinsic
allergic alveolitis, drugs, sarcoidosis,
amyloidosis, alveolar proteinosis, lymphangitis
carcinomatosis
 HONEYCOMB SHADOWING
• Air–containing spaces
with thick walls that are
lined with bronchiolar
epithelium and fibrous
tissue.
• Due to destruction of
alveoli and loss of acinar
architecture
• Associated with
pulmonary fibrosis.
• Usually 5-10 mm in size
 LINEAR AND BAND SHADOWS
• Normal structures such
as the blood vessels
and fissures form linear
shadows within the
lung fields.
• However, there are
many disease processes
which may result in
linear shadows.
• Linear shadows are
less than 5 mm wide,
• Band shadows are
greater than 5 mm thick
.
 CAUSES
• Pulmonary infarct
• Sentinel Lines
• Thickened Fissures
• Pulmonary and pleural scars
• Curvilinear shadows(Bullae/Pneumatocoele)
• Plate atelectasis ( Fleischner Lines) etc
 SENTINEL LINES
• Mucus-filled bronchi
• Coarse lines lying
peripherally in contact
with the pleura and
curving upwards.
• Often left-sided and
associated with left lower
lobe collapse.
• They may develop due to
kinking of bronchi
adjacent to the collapse.
 KERLEY LINES
Kerley's A lines (arrows) :
• Linear opacities extending from the periphery to the hila
• Due to distention of anastomotic channels between
peripheral and central lymphatics.
Kerley's B lines (white arrowheads) :
• Short horizontal lines situated perpendicularly to the
pleural surface at the lung base
• Due to edema of the interlobular septa.
Kerley's C lines (black arrowheads): Reticular opacities at
the lung base representing superimposed Kerley's B lines.
 KERLEY LINES

C
 CAUSES OF KERLY LINES
• Pulmonary oedema
• Pneumoconiosis
• Infections (viral, mycoplasma)
• Lymphangiectasia
• Mitral valve disease
• Lymphangitis carcinomatosis
• Interstitial pulmonary fibrosis
• Lymphatic obstruction
• Congenital heart disease
• Sarcoidosis
• Alveolar cell carcinoma
• Lymphangiomyomatosis
• Pulmonary venous occlusive disease .
 MILIARY PATTERN
• Small discrete
opacities
• 2-4 mm in diameter
• MC in Tuberculosis
 OLD PLEURAL AND PULMONARY
SCARS
• Scars are unchanged in
appearance on serial film.
• Thin linear shadow often
with associated pleural
thickening and tenting of
the diaphragm.
• Apical scarring is a
common finding with
healed tuberculosis,
sarcoidosis and fungal
disease
THICKENED BRONCHIAL WALLS
• Parallel TRAMLINE
shadows
• Ring shadows on end-on
view
• They are common finding
in
Bronchiectasis,
Recurrent asthma,
Bronchopulmonary
aspergillosis ,
Pulmonary oedema
Lymphangitis carcinomatosis.
 SOLITARY PULMONARY NODULES
• Discrete, well-marginated, rounded opacity
• Less than or equal to 3 cm in diameter
• Completely surrounded by lung parenchyma, does not
touch the hilum or mediastinum,
• Not associated with adenopathy, atelectasis, or pleural
effusion.
• Lesions larger than 4 cms are treated as malignancies
until proven otherwise.
 SOLITARY PULMONARY NODULES

A right lower lobe solitary pulmonary

Right lower lobe nodule later confirmed to
nodule that was later identified as a
be primary pulmonary lymphoma
hamartoma.
 SOLITARY PULMONARY NODULES
• Intrapulmonary mass forms
an acute angle with the lung
edge.
• Extrapleural and
mediastinal masses form
obtuse angles .
• A nodule is assessed for its Extra
pleural
size, shape and outline and Mass
for the presence of
calcification or cavitation. .
 SOLITARY PULMONARY
NODULES
• Carcinomas often have irregular, spiculated or notched
margins.
• Calcification favours a benign lesion although a
carcinoma may arise coincidentally at the site of an old
calcified focus.
• Calcified metastases are rare, the primary tumour being
usually an osteogenic or chondrosarcoma.
• Granulomas frequently calcify and are usually well
defined and lobulated.
 SOLITARY PULMONARY NODULES
Calcified mets in
Hamartoma Chondrosarcoma
 MULTIPLE PULMONARY NODULES
• Multiple small nodules 2-4
mm are called miliary
shadows .
• Mostly metastases or
tuberculous granulomas.
• Calcified nodules are
generally benign except for
metastases from bone or
cartilaginous tumours.
Posteroanterior view of the chest showing multiplediffuse pulmonary nodules.
 PULMONARY INFARCTS
• These are variable in
appearance.

• Usually wedge shaped

with base towards the
periphery(HAMPTON’
S HUMP)

• Resolve slowly over

months decreasing in
size (MELTING SIGN)
 CAVITATING LESIONS AND CYSTS
• It’s a gas filled space surrounded by a complete wall which
is 3 mm or greater in thickness.

• Thinner walled cavities are called CYSTS or ring shadows.

• Requires a patent airway to communicate with necrotic area

• Common cavitating processes are tuberculosis,

staphylococcal infections and carcinoma
 CAVITATING LESIONS
Cavitating Staphylococcal
Bronchogenic Ca Pneumonia
 CAVITATING LESION
Common sites of the Lesion
• Tuberculous cavities : Upper zone and apical segments
of the lower lobes.
• Lung abscesses following aspiration : Rightsided and
lower zone(patient position dependant)
• Traumatic lung cysts : Subpleural
• Amoebic abscesses : Right base ,infection extending
from the liver.
• Pulmonary infarcts : Usually in lower lobes
 CAVITATING LESION
THICK WALLED THIN WALLED
• Acute abscesses • Bulles
• Most neoplasms (usually • Pneumatoceles,
squamous cell) • Cystic bronchiectasis
• Lymphoma • Hydatid cysts
• Most metastases • Traumatic lung cysts
• Wegener's granulomas • Chronic inactive
• Rheumatoid nodules tuberculous cavities
• Neoplasms
 CAVITATING LESION
Thick walled cavity
B/L Bullae
with air-fluid
 FLUID LEVELS
• Fluid levels are common
in primary tumors , and
irregular masses of blood
clot or necrotic tumor
may be present.
• Fluid levels are
uncommon in cavitating
metastases and
tuberculous cavities .
FLUID LEVELS ON A CHEST RADIOGRAPH

• Abscesses
• Hydropneumothorax-Trauma, surgery,
bronchopleural fistula
• Oesophageal – pharyngeal pouch, diverticula
Obstruction – tumours, achalasia
• Mediastinal – Infections, oesophageal perforation
• Pneumopericardium
 AIR CRESCENT SIGN
Crescent-shaped radiolucency
within a parenchymal
consolidation or nodular
opacity
Air fills the space between the
devitalized tissue and
surrounding parenchyma
Opaque rim of hemorrhagic
tissue peripheral to the
radiolucency
Common in Aspergilloma
 WATER LILY SIGN
Ruptured hydatid
cysts with daughter
cysts floating within
the cavity.
• Other intracavitory lesions include inspissated pus,blood
clot and cavernoliths.

• Blood clot may form within cavitating neoplasms,

tuberculosis and pulmonary infarcts
 CALCIFICATION
• Calcification is most easily recognized with low kVp
films.
• In the elderly , calcification of the tracheal and bronchial
cartilage is common.
• Tuberculosis is the commonest calcifying pulmonary
process usually upper zone.
• Chickenpox foci are smaller (1-3 mm), regular in size
and widely distributed.
 CALCIFICATION

Pulmonary TB Chicken pox pneumonia

 CALCIFICATION

Punctate - Silicosis Irregular - Pleural Plaques

 COMMON CAUSES OF APICAL SHADOWS

• Pleural caps
• Pleural fluid
• Bullae
• Pancoast tumour
• Pneumothorax
• Infections-tuberculosis
 APICAL SHADOWING

Apical pleural thickening/Pleural Cap

• It is crescent shaped density
• It may represent old pleural thickening
• Also seen in Pancoast tumor – assess the ribs for
notching
Lung apex
• Commom site for Tb , fungal infection like
histoplasmosis , coccidioidomycosis, aspergillosis etc
APICAL SHADOWING
 CAUSES OF AN OPAQUE HEMITHORAX
• Technical .
Rotation, scoliosis
• Pleural.
Hydrothorax, large effusion
Thickening, mesothelioma.
• Surgical.
Pneumonectomy,
thoracoplasty.
• Congenital.
Pulmonary agenesis.
• Mediastinal .
Cardiomegaly, Tumours.
• Pulmonary .
Collapse, consolidation,
fibrosis .
• Diaphragmatic hernias
 UNILATERAL
HYPERTRANSLUCENCY
• Comparision of lungs should reveal any focal or
generalized abnormality of transradiancy.
• Look for signs of obstructive or compensatory
emphysema such as
o splaying of the ribs
o separation of the vascular markings
o mediastinal displacement
o depression of the hemidiaphragm
 UNILATERAL
HYPERTRANSLUCENCY
• Most common causes : Patient rotation and scoliosis

• With rotation to the left, the left side becomes more

radiolucent.

• Mastectomy is another important cause. An abnormal

axillary fold is seen following a radical mastectomy.
 UNILATERAL
HYPERTRANSLUCENCY

Obstructive Emphysema Mastectomy

PLEURAL ABNORMALITIES
 PLEURAL ABNORMALITIES
• Pleural effusion.
• Pleural fibrosis/Thickening.
• Pleural plaques.
• Pleural calcification.
• Pleural tumors.
• Pneumothorax
• Fibrothorax
 PLEURAL EFFUSION
• Fluid in the pleural
cavity.
• Erect CXR- commonest
appearance is an opaque
meniscus at costophrenic
angle.
• If the effusion is very
large entire hemithorax
may be opaque and heart
may be pushed to the
normal side.
 PLEURAL EFFUSION

Features on CXR:
• Blunting of the costophrenic angle
• Blunting of the cardiophrenic angle
• Fluid within the horizontal or oblique fissures
• A meniscus will be seen, on frontal films seen laterally and
gently sloping medially
• With large volume effusions, mediastinal shift occurs away
from the effusion

Approximately 200 ml of fluid are needed to

detect an effusion in the frontal film vs.
approximately 75ml for the lateral
 ATYPICAL EFFUSION

• LAMELLAR EFFUSION: Shallow collections between

the lung surface and the visceral pleura sometimes
sparing the costophrenic angle.

• LOCULATED EFFUSION: Effusion within the fissures.

ATYPICAL EFFUSION
SUBPULMONIC EFFUSION
• Effusions accumulate between the diaphragm and
undersurface of a lung.
The following features are helpful :
• Right: peak of the hemidiaphragm is shifted laterally
• Left: increased distance between lower lobe air and
gastric air bubble
SUBPULMONIC EFFUSION
 PLEURAL PLAQUES
• Plaques are focal areas of
thickening of parietal pleura due
to previous exposure to asbestosis.
• Characteristically appear as
scattered islands of well
circumscribed pleural densities.
• Most commonly seen posteriorly
and laterally, predominantly
affecting the lower third of the
thorax.
• Do not involve the CP angles .
• May be calcified.
 PLEURAL CALCIFICATION

True calcification
• Calcified pleural plaques from
asbestos exposure : typically has
sparing of costophernic angles
• Haemothorax
• Infection involving the pleura -
e.g pyothorax / empyema
• Tuberculous pleuritis
• extra skeletal osteosarcomaof
pleura .
 PNEUMOTHORAX
• Refers to the presence of gas in the pleural space.
• Open Pneumothorax: If air can move in and out of
pleural space during respiration
• Closed Penumothorax: No movement of air occurs
• Valvular : Air enters pleural space on inspiration but
doesnot leave on expiration
• When this collection is constantly enlarging with
resulting compression of mediastinal structures it is
known as a tension pneumothorax.
 DEEP SULCUS SIGN

• This sign refers to a deep

collection of intrapleural
air (pneumothorax) in the
costophrenic sulcus as
seen on the supine chest
radiograph .
•
 CXR APPEARANCES
• Visible visceral pleural edge
see as a very thin, sharp white
line
• No lung markings are seen
peripheral to this line
• The peripheral space is
radiolucent compared to
adjacent lung
• The lung may completely
collapse
• No mediastinal shift unless
a tension pneumothorax is
present .
 HYDROPNEUMOTHORAX
• It is the concurrent
presence of a
pneumothorax as well as
a hydrothorax in the
pleural space.

• On an erect chest
radiograph, classically
seen as an air-fluid level.
 FIBROTHORAX
• Fibrosis within the pleural space
• Occurs secondary to the inflammatory response
• Seen in
TB
Asbestosis
Hemothorax etc
HILAR ABNORMALITIES
 HILAR ABNORMALITIES
• Superior margin of left hilum is normally higher than
the right.

• Whenever a left hilum appears lower than right – check

whether there is other evidence suggestive of collapse of
either left lower lobe or of right upper lobe ; or
enlargement of right hilum(eg; tumor or nodes)
 HILAR ENLARGEMENT
• Bilateral hilar enlargement -Enlarged lymph nodes, or
vascular enlargment.

• Unilateral enlargement : MC due to neoplasm or infections

such as tuberculosis and whooping cough.

• Nodes affected by lymphoma are often asymmetrically

involved.

• Bilateral involvement occurs with sarcoidosis, silicosis and

leukaemia
HILAR ABNORMALITY
 MEDIASTINAL
ABNORMALITIES
MEDIASTINAL ABNORMALITIES
 CERVICOTHORACIC SIGN
• Used to discern the anterior or posterior location of a lesion in
the superior mediastinum on frontal chest radiographs.

• The anterior mediastinum stops at the level of the superior

clavicle.

• Thus when a mass extends above the superior clavicle, it is

located either in the neck or in the posterior mediastinum.

• When lung tissue comes between the mass and the neck, the
mass is probably in the posterior mediastinum.
 CERVICOTHORACIC SIGN

A mass extending above the

level of the clavicle and
there is lung tissue in front
of it, so this must be a mass
in the posterior
mediastinum.
 ANTERIOR MEDIASTINAL MASS

T cell lymphoma

Anterior mediastinal masses consist of the 4 "T's" (Terrible lymphoma, Thymic tumors,
Teratoma, Thyroid mass) and aortic aneurysm, pericardial cyst, epicardial fat pad.
 RETROSTERNAL GOITRE
• Retrosternal goitre
The plain chest film
shows a large
superior mediastinal
mass narrowing the
trachea
 MIDDLE MEDIASTINAL MASS
MC:L
ymphadenopathy
due to metastases
or primary tumor.
 Other causes
include
hiatial hernia,
aortic aneurysm,
thyroid mass,
duplication cyst
bronchogenic cyst.

Esophageal duplication cyst

 POSTERIOR MEDIASTINAL
MASS
The differentials
• Neoplasm,
 Lymphadenopathy,
 Aortic aneurysm.
 Neurenteric cyst or
 Lateral meningocele
 Extramedullary
hematopoiesis.

Mass is detected by a pleural margin search along the superomedial part of right lung.
The interface is interrupted.
• Lymphadenopathy is
the next most frequent
cause of a mediastinal
swelling..
• Lymphadenopathy
may occur in any of the
three compartments
and it is often possible
to diagnose enlarged
lymph nodes from their
lobulated outlines Superior mediastinal lymph node
and the multiple enlargement. Note the bilateral
locations involved. lobular masses.
 HILUM OVERLAY SIGN

• This sign is used to distinguish between cardiac

enlargement and an anterior mediastinal mass, as
follows;

• Hilum lateral to the lateral border of the “mass”–

Cardiac enlargement.

• Hilum medial to the lateral border of mass”–

Mediastinal mass.
HILUM OVERLAY SIGN
 HILUM CONVERGENCE SIGN
• Used to distinguish between a prominent hilum and
an enlarged pulmonary artery.

• If the pulmonary arteries converge into the lateral

border of a hilar mass, the mass represents an
enlarged pulmonary artery.

• If the convergence appears behind the abnormality or

arises from the heart, a mediastinal mass is more
likely.
HILUM CONVERGENCE SIGN
 THORACOABDOMINAL SIGN
• To localize the LOWER MEDIASTINAL MASS on frontal CXR
 PNEUMOMEDIASTINUM
• It is the presence of extraluminal gas within
the mediastinum.
AETIOLOGY
• Blunt chest trauma
• Secondary to chest, neck, or retroperitoneal surgery
• Esophageal perforation :
– Boerhaave syndrome
– Endoscopic intervention
– Esophageal carcinoma
 PNEUMOMEDIASTINUM- CXR
APPEARANCES.
• Air around the pulmonary artery produces a black ring
appearance.

• Air around the arteries arising from the aortic arch

appears as a black rings and often referred to as the
“ring around the artery sign”.

• Angel wing sign – represents the normal thymus

surrounded by mediastinal air.
 CONTINUOUS DIAPHRAGM SIGN

 Continuous lucency outlining

the base of the heart,
representing
Pneumomediastinum .

• Air in the mediastinum

tracks extrapleurally,
between the heart and
diaphragm .

• Pneumopericardium can
have a similar appearance
but will show air
circumferentially outlining
the heart.
DIAPHRAGM
 DIAPHRAGM

CAUSES OF A UNILATERAL ELEVATED DIAPHRAGM

• Above diaphragm: phrenic nerve palsy; infiltration from
bronchial carcinoma or mediastinal tumour.
• Diaphragm: eventration, more common on the left and results
from deficiency or atrophy of muscle.
• Below diaphragm: right diaphragm elevation; liver or
subphrenic abscess, liver secondary deposits.
 DIAPHRAGM
CAUSES OF BILATERAL ELEVATED DIAPHRAGMS
• Obesity
• Hepatosplenomegaly
• Ascites
• Pregnancy
• Abdominal masses.
 DIAPHRAGMATIC HERNIA
• A congenital defect in the
diaphragm, more common
on the left, allows bowel
protrusion into the thoracic
cavity.

Eg: Hiatus Hernia

Bochdalek Hernia
Morgagni Hernia
EVENTRATION OF THE DIAPHRAGM
• This is a congenital
condition in which the
diaphragm lacks muscle
and becomes a thin
membranous sheet.

• The eventration may only

involve part of one
hemidiaphragm, resulting
in a smooth 'hump
Localized eventration of the diaphragm.
There is a smooth localized elevation of the
medial half of the right hemidiaphragm
(arrows
CHEST WALL ABNORMALITY
 CHEST WALL ABNORMALITIES
BONES

CLAVICLE
• Old healed fractures are frequent findings.
• Erosion of the outer ends of the clavicles is associated
with rheumatoid arthritis and hyperparathyroidism.
• Hypoplastic clavicles are seen with the Holt-Oram
syndrome and cleido cranial dysostosis
 CLAVICULAR ABNORMALITY

Holt Oram Syndrome Rheumatoid arthritis

 STERNAL ABNORMALITIES

• Sternal fractures are often due to a steering wheel

injury.

• Associated with congenital heart disease: Sternal

agenesis, premature obliteration of the ossification
centres and pigeon chest which are found
with ventricular septal defects.
 STERNAL ABNORMALITIES

• Depressed sternum(Pectus Excavatum) - Atrial septal

defects and Marfan's syndrome.

• Delayed epiphyseal fusion is a feature of cretinism

• Double ossification centres in the manubrium commonly

occur in Down's syndrome
 RIB NOTCHING
• It may affect the superior or
inferior surface and can be U/L or
B/L

• Superior notching : Rheumatoid

arthritis, SLE,hyperparathyroidism
Marfan's syndrome,
neurofibromatosis and in
paraplegics and polio victims.

• Inferior notching develops as a

result of hypertrophy of the
intercostal vessels or with
neurogenic tumours .
CAUSES OF INFERIOR RIB NOTCHING
 CERVICAL RIB
• A cervical rib in humans
is a supernumerary rib
which arises from the
seventh cervical vertebra.
• Congenital rib anomalies
such as hypoplasia,
bridging and bifid ribs
are common.
 RIB FRACTURE
• The sixth to ninth ribs line are the
common sites for cough fractures.

• Stress fractures usually affect the

first ribs.

• Pathological fractures may be due

to senile osteoporosis, myeloma,
Cushing's disease and other
endocrine disorders, steroid
therapy and diffuse metastases.

• Cushing's disease is associated

with abundant callus formation
 THORACIC SPINE
• Check for abnormal curvature or alignment , bone and disc
destruction, sclerosis, paravertebral soft-tissue masses and
congenital lesions such as butterfly vertebrae
• Anterior erosion of vertebral bodies sparing the disc spaces is
noted with aneurysm of descending aorta, vascular tumors
and neurofibromatosis.
• A single dense vertebra , the ivory vetebra, - classical
appearance of lymphoma, but also – pagets disease and
metastasis.
THORACIC SPINE
 THORACIC SPINE

• Destruction of pedicle is typical of METASTASIS .

• Destruction of the disc with adjacent bony

involvement is characteristic of an INFECTIVE
PROCESS.

• Disc calcification occurs in ochronosis and ankylosing

spondylitis.
 SOFT TISSUE ABNORMALITIES
Skin lesions
• Skin lesions including
naevi and lipomas may
simulate lung tumours.
• Multiple nodules occur
with neurofibromatosis .
• Mastectomy is one of the
commonest causes of a
translucent hemithorax
 SOFT TISSUE ABNORMALITIES

• Poland’s syndrome;
There is a congenital absence of pectoralis major
and minor, associated with syndactyly and rib
abnormalities .
Thank You