1. CHEST Radiology
อ.พญ.วิรณา อางทอง
ภาควิชารังสีวิทยา มหาวิทยาลัยศรีนครินทรวิโรฒ
1.Pneumothorax.
1.2 Simple pneumothorax.
Findings:
- There is thin white visceral pleural line at left side hemithorax.
- No lung marking distal to visceral line.
- Collapse of left lung field.
- No shifting of mediastinum.
Deep sulcus sign
Findings:
Supine CXR of neonate demonstrates
abnormal deepening and lucency of
the left lateral costophrenic
angle.
Pneumothorax ในทานอน airจะลอยขึ้นมาใน
สวนnondependent portionของpleural
cavity ซึ่งคือตําแหนงlateral costophrenic
angle ทําใหบริเวณดูดําลงและขยายลึกลงมาทางดาน
ทองมากขึ้น

2. 1.2 Tension pneumothorax:
Findings:
- There is thin white visceral
pleural line at left side
hemithorax.
- Marked collapse and distortion
of let lung.
- Shifting of mediastinum to the
right side which is compatible
with tension pneumothorax.
***Small pneumothorax is easier seen on an expiration film, due to reduce lung
volume which make pneumothorax look relatively larger.
2. Pneumomediastinum
Findings:
-There is linear radiolucency of air density outlining the left subclavian
artery and the left carotid artery (tubular arterysign). (จะเห็นairอยูรอบ ๆหลอดเลือดที่อยูใน
mediastinum)
-Lateral radiograph demonstrates the “ring around the artery” sign. (จะเห็นair density
โอบลอมรอบหลอดเลือดในmediastinumเปนรูปวงแหวน ภาพดานบนโอบรอบright pulmonary artery.

3. The continuous diaphragm
sign (เห็นเปนair density ทางดานลาง
ของmediastinum ซึ่งair นี้จะเซาะอยู
ทางดานหนาของpericardial cavity จึง
เห็นเหมือนเปนเงาของdiaphragmที่
ตอเนื่อง)
Findings:
-Air in the subcutaneous
tissues of the neck (subcutaneous
emphysematous)
-Thymic sail sign: thymus is out line
by air. (airในmediastinumเซาะตามขอบของ
thymus)
3. Pleural effusion.
Findings:
-Homogeneous density
-Concave at upper border
-Meniscus shape at edge of
right pleural effusion ( Higher
lateral than medial)
-If large amount of pleural
effusion will displace the
mediastinum towards the
contralateral side.

4. 4. Loculated pleural effusion
Findings:
- Haziness of right hemithorax (density not corresponding to lobar
anatomy ).
- Lateral film below shows loculated fluid overlying vertebral column
Findings:
- Unusual shape (lentiform) or unusual
position in the thorax cavity.
Large right pleural effusion
Findings:
-The right hemithorax is
opaque.
- There is shift of heart and
trachea away from the side of
opacification.

5. 5. Hydropneumothorax
-There is opacification at left lower thorax with air-fluid level.
6. CHF
6.1 Pulmonary interstitial edema
- Kerley B lines
- Kerley A lines
(Kerley – thicken connective
tissue septa )
- Peribronchial cuffing:
thicken bronchial wall and
peribronchial sheath.
- Thickening of the fissures
- Pleural effusion
- Perihilar haze: blurring of
hilar shadows.
- Blurring of pulmonary
vascular markings

6. Kerley B line:
-Faint multiple white lines
perpendicular to the pleural
surface and 1-2 cm long.
Kerley A line:
-Relatively long linear
shadows in upper lung, deep
within lung parenchyma.
Peribronchial cuffing:
-Bronchial wall thickening

7. Fluid in minor fissure
6.2 Pulmonary alveolar edema
Findings:
-Symmetrical bilateral opacification
spreading from the hilar regions into
the lungs with sparing of peripheral
lung fields is called butterfly or bat
wing configuration.
-Cardiomegaly.
Findings:
-Bilateral air space infiltration
(or alveolar infiltration) at
bilateral perihilar region
-Air bronchogram is seen.
-Cardiomegaly.

8. 7. Metastasis
Findings:
-Multiple well-defined pulmonary nodules scatter both lung
fields which are vary in size.
8. Bronchiectasis
Findings:
-There are multiple thin wall cystic areas at perihilar region of both lung
fields which some of them show air-fluid level.

9. 9. Emphysema
Findings:
-Over expanded lungs
-Flat diaphragms lying below the 6th rib anteriorly.
-Increase retrosternal airspace on lateral film
-Decreased vascular markings of lung fields
-Increase AP diameter of cheast and anterior bowing of sternum
-Narrow mediastinum
10. Mediatinal mass
10.1 Anterior mediastinal mass
-The anterior mediastinum is bounded anteriorly
by the sternum; posteriorly by the pericardium,
aorta, and brachiocephalic vessels; superiorly by
the thoracic inlet; and inferiorly by the diaphragm
-Its contents include the thymus, lymph
nodes, adipose tissue, and internal mammary vessels

10. Findings: lymphoma in anterior mediastinal mass
-There is a large lobulated mass causes obliteration of cardiac shadow which
could be anterior mediastinal mass.
-The descending aorta is clearly seen which indicating that this mass not within
posterior mediastinm.
10.2 Middle mediastinal mass

11. -The middle mediastinum is bounded anteriorly by the pericardium, posteriorly by the
pericardium and posterior tracheal wall, superiorly by
the thoracic inlet, and inferiorly by the diaphragm
-Its contents include the heart and pericardium; the ascending and transverse aorta; the
superior vena cava (SVC) and inferior vena cava (IVC); the brachiocephalic vessels;
the pulmonary vessels; the trachea and main bronchi; lymph nodes; and the phrenic,
vagus, and left recurrent laryngeal nerves.
Findings: lymph node in
middle mediastinum
-There is right paratracheal
soft tissue mass.
10.3 Posterior mediastinal mass
-The posterior mediastinum is bounded anteriorly by the posterior trachea and
pericardium, anteroinferiorly by the diaphragm, posteriorly by the vertebral column,
and superiorly by the thoracic inlet.
-The contents include the esophagus, descending aorta, azygos and hemiazygos
veins, thoracic duct, vagus and splanchnic nerves, lymph nodes, and fat.

12. Findings: Descending aortic aneurysm in posterior mediastinum.
-There is lateral displacement of lateral margin of descending thoracic aorta
due to aortic aneurysm.
11. Atelectasis
Pattern of pulmonary collapse or atelectasis
General signs of lobar collapse
- Decrease lung volume
- Displacement of fissure
- Local increase in density of lobar collapse due to non-aerated lung
- Elevation of hemidiaphragm
- Displacement of hilar vessel
- Displacement of mediastinum
- Compensatory overinflation of adjacent lobes.
Specific sign of lobar collapse
1. RUL-Collapse upwards and anteriorly
Minor fissure
Findings:
-Opacity in right upper lung due to reduce volume of non-areated lung
-Elevation of minor fissure
-Elevation of right hilum
-Tracheal deviation to the right

13. 2. RML
Minor f
Major f
Findings:
-Increase density in right middle lung zone with loss of definition of right cardiac border
-Lateral film: triangular shape opacity projected over the heart
(Triangular shapeเกิดจากการdisplacementของminorและmajor fissureเขาหาlobar collapse)
3. LUL-Collapses upwards and anteriorly
Major fissure
Findings:
PA film
-Decrease volume with increase density of LUL
-Loss of definition of left cardiac border and of left hilum
-Elevation of left hilum
-Tracheal deviation to the left
Lateral film
-Increase opacity anteriorly (due to collapse lobe), which has well-defined posterior
margin due to left major fissure

14. 4. LLL-Collapses downwards and posteriorly
12 Abnormal infiltration
12.1 Air space/ alveolar infiltration
Findings:
-Fluffy, ill-defined areas of opacification
(เห็นเปนปุยๆที่มีขอบเขตไมชัด)
-Area of consolidation tend to coalesce
-Air bronchograms: airที่อยูในbronchus ถูก
ลอมรอบดวยconsolidated lung การเห็นair
bronchogramsนั้นบงบอกวาdieseaseนั้นอยูใน
lung parenchyma ไมใช pleura หรือ
mediastinum.
แบงออกเปน
-Segmental/lobar alveolar pattern:
DDx
-Pneumonia
-Segmental/lobar collapse
-Pulmonary infarction
-Alveolar carcinoma
-Contusion (associated with
rib fracture, pneumothorax ect)

15. -Diffuse pattern:
DDx
-Cardiogenic pulmonary edema
-ARDS
-Fluid overload
-Pulmonary hemorrhage
-Pneumonia: PCP, Mycoplasma
12.2 Interstitial infiltration
- Linear pattern
Findings: fine lines running to the
lung
-Kerley A lines.
-Kerley B lines.
(ดูในเรื่องCHF)
-Nodular pattern
Findings:
-intersitial nodules are small
(1-5mm), well-defined border
-Not associated with air
bronchograms

16. -Honeycomb pattern
-Represent end-stage of disease
-Imply extensive pulmonary
destruction.
-There are multiple cysts that
range in size from tiny up to 2 cm.
-Very thin wall cysts
-Normal vasculature cannot be
seen.
13 Pulmonary TB
-Primary TB
-Usually asymptomatic
-Heal pulmonary lesion
Findings:
-Heal tiny calcific pulmonary nodule
(Calcific granuloma at LUL)
-Heal calcific hilar lymph node
-Post-primary pulmonary TB (reactivation TB)
Findings:
-Cavitation: Thick-walled,
irregular cavity with/or
without air-fluid level

17. Findings:
-Reticulonodular infiltration at apical and posterior segment of upper lobe and
superior segment of lower lobe.
-Volume loss at both upper lobes from fibrotic change
-Calcification may occur in fibrosis

18. NEURORADIOLOGY
1.Epidural hematoma
Finings:
-There is lens shape (or biconcex
shape) hyperdensity fluid
(HU=50-100) at left parietal
region.
-Displacement of left lateral
ventricle
-Usually not cross suture except
associated with diastatic fracture
.
2. Subdural hematoma
Findings:
-There is crescentric shape
hyperdensity fluid at left
fronto-parieto-temporal region.
- Can cross suture
- Not cross falx or dura
3. Subarachnoid hemorrhage
Findings:
-There is hyperdensity fluid in
sulci and cistern (eg suprasella
cistern, sylvain cistern)
-There is intraventricular
hemorrhage
-Communicating hydrocphalus

19. 4.Hypertensive hemorrhage
Findings:
-There is hyperdensity of acute hematoma at right basal ganglia and
thalamus and extends to ventricular system (intraventricular
hemorrhage).
-Displacement of right lateral ventricle
-Midline shifting to the left side
5.Acute cerebral infarction
Findings:
-Hyperdense artery sign on noncontrast CT scan represented of
intraluminal thrombus in middle cerebral artery

20. Insular ribbon sign
Findings:
-There is wedge shape hypodensity area involving both gray
and white matter at left frontoparietal region
-Loss of gray white differentiation
-Insular ribbon sign: loss of gray white differentiation at left
insular cortex.
Findings:
-There is wedge shape of hypodensity area of both gray and white
matter at left fronto-parietotemporal region which compatible with
left MCA territory
-Pressure effect to left lateral ventricle and midline shifting

21. 6.Subacute cerebral infarction
Findings:
-There is well-defined hypodensity area at left parietal region.
-Decrease degree of pressure effect-After contrast administration reveals
gyral enhancement (abnormal enhancementตามgyri จากการสูญเสียblood brain
barrier)
7. Chronic cerebral infarction
Findings:
-There is very low density area at
right basal ganglia which compatible
with old basal ganglia infarction.
-Sign of volume loss: Ipsilateral
dilatation of right ventricular system