Tension hydropneumothorax

2. Tension hydropneumothorax • Air fluid level at right costophrenic angle • Deeper right costophrenic angle as compared to the left • Contralateral shift of mediastinum

3. ARDS • Bilateral diffuse fluffy infiltrates • Normal cardiac size • Tracheostomy tube • Right subclavian central line going inside the right atrium • ECG wires

4. Right lung collapse - PA view • Ipsilateral shift of mediastinum and trachea • Bronchial cut-off sign suggestive of endobronchial obstruction • Rib crowding • Loss of volume • Obscured right mediastinal and cardiac outline • Obscured right hemidiaphragm (silhouette sign) • Compensatory hyperinflation of left lung • Prominent left pulmonary artery (cardiac output passing through single artery)

5. Right lung collapse – lateral view • Loss of gradually increasing transradiancy down the spine • Only one hemidiaphragm is visible (left) • Suspicion of mass in lower lobe with lymph node in mediastinum

6. Left lung collapse • Ipsilateral shift of trachea, carina and mediastinum • Bronchial cut-off sign (left mainstem bronchus) • Rib crowding • Loss of volume • Compensatory hyperinflation of right lung

7. Collapse with airbronchogram • Airbronchogram sign • Produced as a result of airspace opacification of the lung parenchyma • This results in visibility of the normally invisible black bronchi against a background of white opacification • Seen in consolidation and collapse with at least some patency of the bronchus

8. Left upper lobe collapse – PA view • Loss of volume on left side • Ipsilateral shift of trachea and mediastinum • Compensatory hyperinflation of left lung • Raised left hemidiaphragm (compare with right) with tenting • Haziness over the aortic knuckle (silhouette sign)

9. Left upper lobe collapse – Lateral view • Oblique fissure displaced anteriorly • Opacification anterior to the oblique fissure

10. Right upper lobe collapse - PA view • Loss of volume on right side • Opacification of right upper lobe • Transverse fissure raised • Right hilum is also raised

11. Right upper lobe collapse – lateral view • Oblique fissure displaced anteriorly • Transverse fissure pulled upwards • Opacification with loss of volume of right upper lobe

12. Left lower lobe collapse – PA view • Loss of volume on left side • Ipsilateral shift of the heart • Both hila are at the same level (left hilum has come down) • Double opacity behind the heart • Outline of left hemidiaphragm is obscured (silhouette sign) • Left hemidiaphragm is raised (watch the gastric bubble)

13. Left lower lobe collapse – Lateral view • Loss of gradually increasing transradiancy down the spine • One hemidiaphragm is clearly visible • Oblique fissure is displaced posteriorly

14. Miliary shadowing • Multiple small millet sized nodules throughout both lung fields

15. Mediastinal mass with left lower lobe collapse • Mediastinal widening in upper part mediastinum • Loss of volume on left side • Double opacity behind the heart • Left hemidiaphragm not visible • Heart shifted to the left side

16. Aspergilloma • Fungus ball with surrounding rim of air

17. Mesothelioma • Left sided pleural effusion • Associated lobulated pleural thickening • No shift of mediastinum due to encasement by mesothelioma

18. Pleural based mass • Cat under the rug appearance indicative of pleural based origin • Angle between chest wall and opacity is obtuse (>90o)

19. Sarcoidosis • Bilateral hilar lymphadenopathy • Right paratracheal strip enlargement • Bilateral infiltrates involving predominantly the mid zones

20. Pneumothorax • Left sided apical pneumothorax • Visceral pleural line is clearly visible • There should be no lung markings distal to the visceral pleural line

21. Effusion with collapse • Complete opacification of right hemithorax without significant contralateral shift of mediastinum • Absence of shift is indicative of concomitant collapse • Usually a sign of malignancy