Esam Alhamad, MD,FCCP, FACPDivision of Pulmonary MedicineCollege of Medicine

Is this film centered?

Why do you have to know whether it is PA or AP film

?

Is this a PA or AP film?

Is the exposure appropriate?

Mediastinal Masses

Anterior mediastinal masses (4Ts)

ThymomaTeratomaThyroidTerrible lymphoma

Middle Mediastinal Masses

3 As

AdenopathyAneurysm/vascularAbnormalities of development

Bronchogenic cyst Pericardial cyst Esophageal cyst

Posterior Mediastinal MassesNeural tumorNeurobalstoma, ganglioneuroma ,

Ganglineuroblastoma

Nerve root tumorsSchwannoma, neurofibroma

Airbronchogram

Indicates that the opacity is parenchymal not mediastinal or pleural

DDx:Consolidation ,Hemorrhage, Edema, Bronchoalveolar Cell Carcinoma, Lymphoma, Sarcoidosis, Alveolar Proteinosis

Pulmonary Hemorrhage

Pulmonary-renal syndrome

Wegener’s granulomatosisSLEGoodpasture’s syndromPolyarteritis nodosaHenoch Shonlein purpura

Pulmonary Hemorrhage

Without renal diseaseAnticoagulationPulmonary infectionPulmonary embolismTraumaBone marrow transplantation

Pleural effusion

InfectionNeoplasmCHFCirrhosisPancreatitisUremiaSubdiaphragmatic abscessCTD ( SLE, RA)HypothyrodismPulmonary embolism

Pleural effusion

“ITCH” Large unilateral pleural effusion

InfectionTumorChylous ( ruptured thoracic duct lymphoma)Hemorrhage

Pneumothorax

SpontaneousPrimaryCOPDAsthmaCystic fibrosisCavitary pneumoniaSarcoidosisPleural metastases

Pericardial effusion

SerousCHF, Hypoalbuminemia, CTD, Hypothyroidism

BloodyAcute MI, Trauma, Neoplasm, CRF

PurulentBacterial, Viral ,Tuberculosis, Fungal