General Discussion

The classical radiological signs of pneumonia include a nonhomogenous opacity that has air bronchograms and that may have segmental or lobar distribution. Various silhouette signs (i.e., loss of diaphragm margin for lower lobes and loss of heart border for anteriorly placed middle lobe or lingula) are used to determine which lobes are involved. The spine sign on a lateral film indicates lower lobe involvement and is especially useful in determining the involvement of the superior segment of the...

Solitary Pulmonary Nodule

Description of X-rays in This Chapter Figure 1. This chest x-ray shows a radiographically dense nodule in the left hilum. Cardiophrenic and costophrenic angles are clear. An 0.8 x 1-cm circular solitary pulmonary nodule with peripheral yet distinct calcification in the superior aspect is seen overlying the 5th posterior rib in the right upper lung zone. Figure 2. This chest x-ray shows a normal heart size. No pleural or medi-astinal disease is noted. Cardiophrenic and costophrenic angles are...

Specific Discussion

The answers are 151-c, 152-a. With a family history of tuberculosis in a close household contact, the likelihood of the patient's illness being active primary TB is very high. Thirty percent of persons with a close contact with active disease have a positive PPD, and this is increased in children under the age of 4 years. About 5 of persons with recent contact may develop active disease. Most children infected with Mycobacterium tuberculosis are asymptomatic and their chest x-rays may...

Description of Xrays in This Chapter

This x-ray shows bilateral cystic-appearing opacities involving the lower and middle zones. These cysts have distinct walls and air-fluid levels. This picture is consistent with bilateral lower lobe and lingular bronchiectasis. Note the large pulmonary arteries, which may suggest secondary pulmonary hypertension and cor pulmonale. Figure 22. This x-ray shows a bilateral lower zone hazy density with small cystic-appearing shadows. There is dextrocardia with situs inversus totalis,...

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Torax Perfil

A 50-year-old male smoker is evaluated for chronic shortness of breath. On physical examination his vital signs are pulse 110 bpm temperature normal respirations 30 min with use of accessory muscles and pursed-lip breathing blood pressure 110 78 mm Hg. Other pertinent findings are heart exam apex beat (impulse) is medial to the midclavicular line with generalized decreased breath sounds on lung exam ABGs (FiO2 0.21) pH 7.38 Pco2 47 mm Hg Po2 67 mm Hg. PFTs spirometry FVC 2.80 L (67 of...

Lung Masses

Description of X-rays in This Chapter Figure 9. A large, 7 x 11-cm mass is seen in the left parahilar area. This has a well-defined edge and silhouettes out the hilar structures. The diaphragms are flattened, and there is no pleural disease. There are mediastinal (sternal) wires from prior CABG. Figure 10. This chest x-ray shows a 3 x 2.5-cm rounded masslike shadow in the right middle zone with slightly irregular margins. There is an area of nonspecific infiltrate above this mass with air...

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A 44-year-old man with a history of chronic bronchitis is admitted with severe shortness of breath and left-sided chest pain. CXR is shown in Fig. 48. EKG shows left ventricular strain. 84. What is the most likely diagnosis to explain the symptoms 85. Physical findings will likely entail a. Decreased breath sounds on the left side with stony dullness on percussion b. Absent breath sounds with hyperresonance on the left side c. Decreased breath sounds with rhonchi bilaterally d. Bilateral...