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1. Dyspnoea

  • Cardiac causes: pulmonary oedema.
  • Pleural causes: pneumothorax.
  • Pulmonary parenchymal causes: tumour, infection, COPD, asthma, interstitial lung diseasse (ILD).
  • Vascular causes: PE.
  • Diaphragmatic pathology.

2. Pulmonary oedema

  • Signs: cardiomegaly, increased pulmonary vascular calibre, interstitial oedema (Kerley B lines), pleural effusion.

3. Pulmonary embolism

  • CTPA is the investigation of choice.
  • Signs: Westermark sign, Hampton’s hump.

4. Pneumomediastinum

  • Causes: ruptured alveoli (diving, asthma, ventilation), oesophageal rupture, perforated viscus into retroperitoneum, mediastinal infection, trauma to oesophagus & airways.

5. Thoracic aortic dissection

  • Stanford type A vs B.
  • Signs: widened mediastinum, abnormal aortic knuckle, left pleural effusion, pericardial effusion.

6. Pleural effusion

  • Causes: transudate, exudate, blood, lymph.

7. Pleural plaques/apical pleural thickening

  • Causes: previous infection, asbestosis.

8. Airspace opacity

  • Causes: pus = pneumonia; fluid = oedema; blood = contusion; cells = adenocarcinoma.

9. Pulmonary nodule

  • Solitary nodule, causes: artefact, infection (granuloma), neoplasm, haematoma, inflammatory (rheumatoid nodule), vascular (AVM/aneurysm), congenital (sequestration), chest wall deformity.
  • Multiple nodules, causes: infection, metastases, inflammatory (RA nodules, Wegners granulomatosis), vascular (AVM).

10. Distal erosion of clavicle

  • Causes: hyperparathyroidism, post-traumatic osteolysis, RA.

11. Rib fractures

  • Fracture of ribs 1-3 can be A/W brachial plexis injury, vascular injury, ruptured bronchus.
  • Fractures of the lower ribs can be A/W laceration of the liver, kidneys, spleen.
  • Flail segments: 2 fractures in > 2 adjacent ribs. The segments move paradoxically and can adversely affect gas exchange.

12. Diaphragmatic injury

  • Causes: sudden rise in intra-abdominal pressure.
  • Left more often than right, however few cases are bilateral.
  • Signs: gas-filled viscus in the thorax, abnormal contour of a dome, NG tube coiled up high on the left.
  • Herniation of abdominal viscera is often delayed.


1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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