cases of chest from the text book of the teaching files chest , diagnosis chest radiology, differential diagnosis of chest cases

1. THE TEACHING
FILESCHEST
CASE 1 TO 10
Maw Maw Oo

2. A 30-year-old man with fever, undergoing radiography
• Differential Diagnosis
• Pneumonia
• Aspiration
• Hemorrhage
• Pulmonary edema
• Atelectasis
shows a focal area of
consolidation in the right lower
lung zone with obscuration of
the
right heart border (i.e., silhouette
sign) that is consistent with the
diagnosis of right middle lobe
pneumonia in a 30-year-old man
with fever.

3. Round pneumonia was diagnosed in a 40-year-old man with
fever and cough.
Posteroanterior chest radiograph shows a round, mass-like area
of consolidation in the right middle lobe

4. A 53-year-old man who is asymptomatic but has an incidental radiographic finding,
undergoing computed tomography (CT).
• Differential Diagnosis
• Obstructive pneumonitis distal to
bronchial obstruction
• Lipoid pneumonia
• Intralobar sequestration
• Lung cancer (mainly adenocarcinoma)
• Pulmonary lymphoma (primary or
secondary lipoid pneumonia. CT shows focal consolidation in the
right upper lobe surrounded by minimal ground-glass
opacity.
Characteristic Clinical Features
Patients are often asymptomatic or have nonspecific
symptoms of cough or fever.

5. CT using soft tissue windows shows foci of fat attenuation within the
consolidation that is consistent with lipoid pneumonia.

6. A 44-year-old man with acute onset of fever and cough,undergoing radiography.
• Differential Diagnosis
• Bronchopneumonia (bacterial, viral,
fungal)
• Pneumonia
• Aspiration
• Pulmonary hemorrhage
• Pulmonary edema
areas of consolidation
in the right lung and bilateral
hazy areas of increased
opacity. The
culture was positive for
Streptococcus pneumoniae.

7. Multifocal consolidation was diagnosed in a 40 year old
man with bronchopneumonia. The posteroanterior chest
radiograph shows patchy consolidation in the left upper
and lower
lobes. Notice the inhomogeneous increased opacity of the
left heart compared with the region of the right atrium,
which is consistent with consolidation in the retrocardiac
region of the left lower lobe.

8. Multifocal consolidation was diagnosed in a 35-year-old
man with Wegener granulomatosis who presented with
hemoptysis.
The posteroanterior chest radiograph shows consolidation
in the right upper lobe and bilateral hazy areas of
increased opacity (i.e., ground-glass opacities) that are
consistent with pulmonary
hemorrhage.

9. Aspiration pneumonia was diagnosed in a 32-year-old
woman. The chest radiograph shows multifocal
consolidation involving mainly the dependent lung
regions

10. A 41-year-old woman with a 7-week history of cough and recent laboratory tests showing
peripheral eosinophilia, undergoing radiography and computed tomography
• Differential Diagnosis
• Simple pulmonary eosinophilia
(Loeffler syndrome)
• Chronic eosinophilic pneumonia
• Bronchiolitis obliterans organizing
pneumonia
• Bronchioloalveolar cell carcinoma
• Lymphoma
41-year-old woman had a 7-week
history of cough and peripheral
eosinophilia. The posteroanterior
chest radiograph
shows bilateral, multifocal,
peripheral, dense consolidations. The
patient had chronic eosinophilic
pneumonia

11. In the same patient with chronic eosinophilic
pneumonia, coronal, reformatted CT shows bilateral,
multifocal, peripheral consolidations and adjacent ground-
glass opacities involving mainly the upper lung regions

12. Multifocal consolidation is seen in a 50-year-old woman
with idiopathic (cryptogenic) organizing pneumonia.
The posteroanterior chest radiograph shows patchy,
bilateral areas of consolidation
and hazy areas of increased opacity.

13. Multifocal consolidation is seen in an 18-year-old woman
with primary pulmonary lymphoma. CT image shows
bilateral, multiple, mass-like areas of consolidation
containing air bronchograms.

14. A 31-year-old woman with acute onset of dyspnea after six cycles of bleomycin for Hodgkin
lymphoma, undergoing radiography and computed tomography
• Differential Diagnosis
• Pulmonary edema
• Acute respiratory distress syndrome
(ARDS)
• Diffuse pulmonary hemorrhage
• Severe pneumonia
31-year-old woman has acute
onset of dyspnea after six
cycles of bleomycin for
Hodgkin lymphoma. shows
extensive bilateral areas of
consolidation that are
consistent with diffuse
alveolar damage resulting
from a drug reaction and
widening of the mediastinum

15. extensive, bilateral areas of ground-glass
opacities and consolidation,
with the latter mainly in the dependent lung
regions
In the same patient, CT using soft tissue windows shows
mediastinal lymph node enlargement (arrows) resulting
from Hodgkin lymphoma and extensive consolidation
involving mainly the dependent lung regions

16. A 46-year-old-man with chronic cough and progressive dyspnea, undergoing radiography
 Differential Diagnosis
 Pulmonary alveolar proteinosis
 Organizing pneumonia
(bronchiolitis obliterans
organizing pneumonia [BOOP])
 Eosinophilic pneumonia
 Lymphoma
 Bronchioloalveolar cell
carcinoma
Chest radiograph shows
extensive, bilateral
consolidation
and hazy areas of increased
opacity (i.e., ground-glass
opacities)
in a 46-year-old patient with
alveolar proteinosis

17. In a 59-year-old man with diffuse organizing pneumonia
reaction due to amiodarone toxicity, the chest
radiograph shows extensive consolidation. Other changes
are related to a previous
sternotomy.
CT shows extensive consolidation and ground-
glass opacities in a peribronchial distribution

18. A 58-year-old man with acute shortness of breath after coronary artery bypass graft surgery,
undergoing radiography
 Differential Diagnosis
 Hydrostatic pulmonary edema
 Diffuse pulmonary hemorrhage
 Pneumocystis pneumonia
 Organizing pneumonia
(bronchiolitis obliterans
organizing pneumonia [BOOP])
 Pulmonary alveolar proteinosis
acute hydrostatic pulmonary
edema
after coronary artery bypass
graft surgery. shows bilateral
areas of consolidation
involving mainly the perihilar
regions and medullary portions
of both lungs, creating a bat’s
wing or butterfly appearance;
the cortex of both lungs is
relatively unaffected.

19. Diffuse pulmonary hemorrhage was diagnosed in a
36-year-old man with microscopic polyangiitis. CT shows
extensive bilateral areas of consolidation in a
predominantly central and peribronchial distribution.

20. A 39-year-old woman with chronic cough and progressive dyspnea, undergoing computed
tomography
 Differential Diagnosis
 Chronic eosinophilic pneumonia
 Organizing pneumonia (bronchiolitis
obliterans organizing pneumonia
[BOOP])
 Sarcoidosis
 Bronchioloalveolar cell carcinoma
 Radiation pneumonitis and fibrosis
A 48-year-old woman has
a chronic cough and
peripheral eosinophilia.
The chest radiograph
shows bilateral
consolidations
involving mainly the
peripheral lung regions of
the upper lung
zones. The final diagnosis
was chronic eosinophilic
pneumonia

21. A 39-year-old woman has a chronic cough and progressive
dyspnea. CT shows bilateral consolidations involving mainly the
peripheral lung regions. Lung biopsy confirmed organizing pneumonia,
and the final diagnosis was cryptogenic organizing pneumonia.
Peripheral consolidation (reverse pulmonary edema
pattern).

22. A 40-year-old man with a mild, chronic cough
Chest radiograph shows hyperlucency and decreased vascularity of the
left lung. The mediastinum is shifted to the left, consistent with a
decreased left lung volume. The patient was a
40-year-old man with Swyer-James-McLeod syndrome

23. High-resolution CT shows decreased attenuation and vascularity of the left lung
with associated bronchiectasis and mild volume loss, leading to an ipsilateral
shift of the mediastinum and anterior junction line. The patient was a 61-year-old
woman with Swyer-James-McLeod syndrome

24.  Differential Diagnosis
 Swyer-James-McLeod syndrome
 Partial bronchial obstruction
 Compensatory hyperinflation in lobar atelectasis or lobectomy
 Congenital lobar emphysema
 Proximal interruption of the pulmonary artery
 Fibrosing mediastinitis with narrowing of pulmonary artery
 Pneumothorax
 Congenital absence of pectoralis muscle (e.g., Poland syndrome)
 Mastectomy
 Scoliosis

25. A 55-year-old man with acute shortness of breath, undergoing computed tomography
CT shows extensive, bilateral, smooth, interlobular
septal thickening (i.e., septal pattern) in a 55-year-
old man with interstitial
pulmonary edema. Small, bilateral pleural effusions
can be seen.

26.  Differential Diagnosis
 Pulmonary edema
 Lymphatic spread of tumor (e.g. lymphangitic
carcinomatosis,lymphoma, leukemia)
 Sarcoidosis
 Metabolic lung disease (e.g., alveolar proteinosis,
 amyloidosis, alveolar microlithiasis, Niemann-Pick
syndrome)
 Interstitial pulmonary fibrosis (e.g., idiopathic
pulmonary fibrosis, nonspecific interstitial pneumonia,
asbestosis, chronic hypersensitivity pneumonitis)
 Pulmonary veno-occlusive disease
 Churg-Strauss syndrome
 Pleural inflammation

27. Posteroanterior chest radiograph shows a septal pattern in
the lymphangitic carcinomatosis of a 36-year-old
woman with breast cancer. The radiograph shows
extensive, bilateral, linear opacities and right paratracheal
lymph node enlargement
(arrow).

28. Posteroanterior chest radiograph shows the septal pattern
in a 54-year-old man with interstitial pulmonary edema.
Extensive, bilateral linear opacities are 1 to 2 cm long
perpendicular
to the pleura (i.e., Kerley B lines). A central venous
line is in place.