1. Pneumonia, Atelectasis & Effusions

2. Normal Chest Good Inspiration Sharp Cardiac and Mediastinal Borders
Sharp Costophrenic Angles
Normal Pulmonary Vascularity

3. Early CHF Cephalization of pulmonary vasculature Kerley lines
Haziness of pulmonary vascular shadows
Pleura effusions

4. Severe CHF Diffuse Alveolar Edema Air Bronchograms Pleural Effusions
Prominent Central Pulmonary Vasculature

5. Lobar Pneumonia Most common gram positive pneumonia
90% community acquired
Organism: strep pneumoniae
Tends to affect elderly, immunocompromised, alcoholics, sickle cell patients
Inflammatory edema in alveoli spread via pores of Kohn to more lateral alveoli

6. Right Upper Lobe Consolidation
Right upper lung zone density
Air bronchograms
No mediastinal shift or hemidiaphragm elevation

7. Right Middle Lobe Consolidation

8. Lingular Consolidation
Hazy left lower lung zone opacity
Loss of the left heart border
Left hemidiaphragm still visible
No evidence of volume loss

9. Lingular Consolidation
Triangular density projecting over the heart
Small left pleural effusion

10. Left Lower Lobe Consolidation
Left lower lung zone opacity
Loss of the left hemidiaphragm
No significant volume loss or meniscus

11. Left Lower Lobe Consolidation
Left lower lobe opacity
Major fissure not displaced
Loss of left hemidiaphragm

12. Atelectasis Evidence of volume loss Elevation of hemidiaphragm
Displacement of fissures
Crowding of ribs
Compensatory emphysema
Affected lung more opaque
Crowding of bronchi

13. Right Upper Lobe Atelectasis
Elevation of the right hemidiaphragm
Upward displacement of the minor fissure
Increased triangular density abutting the right superior mediastinum

14. Right Upper Lobe Atelectasis
Common causes include
Central obstructing mass
Mucus plugging

15. Right Middle Lobe Atelectasis
Ill defined density abutting the right heart border
Could be right middle lobe atelectasis or pneumonia
Obtain lateral for confirmation

16. Right Middle Lobe Atelectasis
Triangular density projecting over the heart
Downward displacement of the minor fissure

17. Left Upper Lobe Atelectasis
Increased veil like opacity within the left hemithorax
Elevation of the left hemidiaphragm

18. Left Upper Lobe Atelectasis
Crescentic increased density abutting the anterior chest
Anterior displacement of the major fissure

19. Left Lower Lobe Atelectasis
Triangular density behind the heart
Loss of the medial hemidiaphragm
Elevation of the left hemidiaphragm

20. Left Lower Lobe Atelectasis
Increased density over the lower thoracic spine
Loss of the left hemidiaphragm
Posterior and inferior displacement of the major fissure

21. Pleural Effusions Blunting of the costophrenic angles
Mediastinal shift if large enough
Lateral decubitus film is very sensitive for detection of pleural effusion 10cc

22. Pleural Effusions Obscuration of the hemidiaphragms
175cc can be hidden before being seen laterally
Left pleural effusion can sometimes be estimated with help of gastric bubble

23. Pleural Effusions
Blunting of the posterior costophrenic angle

24. Subpulmonic Effusion Lateralization of the diaphragm apex
Elevation of the hemidiaphragm

25. Loculated Effusions Increased opacity over the right hemithorax
No blunting of the costophrenic angle
Density does not correspond to lobar anatomy
Diaphragm and heart still visible

26. Loculated Effusion
Homogeneous density abutting the posterior chest wall with obtuse margins
Sharp margin anteriorly
Suspicious for empyema

27. Loculated Effusion
Homogeneous density abutting the right lateral chest wall
Has a sharp medial margin
Does not have a meniscus

28. Self Test

29. Subpulmonic Effusion

30. Right Middle Lobe Atelectasis

31. Normal Chest

32. Large Right Pleural Effusion

33. Left Upper Lobe Atelectasis

34. Early CHF

35. Right Upper Lobe Atelectasis

36. Left Lower Lobe Pneumonia

37. Loculated Effusion

38. Right Upper Lobe Pneumonia