Pneumonia, Atelectasis Pneumonia, Atelectasis & Effusions& Effusions

Normal ChestNormal Chest

Good InspirationGood Inspiration

Sharp Cardiac and Sharp Cardiac and Mediastinal BordersMediastinal Borders

Sharp Costophrenic Sharp Costophrenic AnglesAngles

Normal Pulmonary Normal Pulmonary VascularityVascularity

Early CHFEarly CHF

Cephalization of Cephalization of pulmonary pulmonary vasculature vasculature

Kerley lines Kerley lines

Haziness of Haziness of pulmonary vascular pulmonary vascular shadows shadows

Pleura effusions Pleura effusions

Severe CHFSevere CHF

Diffuse Alveolar Diffuse Alveolar EdemaEdema

Air BronchogramsAir Bronchograms

Pleural EffusionsPleural Effusions

Prominent Central Prominent Central Pulmonary Pulmonary VasculatureVasculature

Lobar PneumoniaLobar Pneumonia

Most common gram positive pneumonia Most common gram positive pneumonia

90% community acquired 90% community acquired

Organism: strep pneumoniae Organism: strep pneumoniae

Tends to affect elderly, immunocompromised, Tends to affect elderly, immunocompromised, alcoholics, sickle cell patientsalcoholics, sickle cell patients

Inflammatory edema in alveoli spread via pores Inflammatory edema in alveoli spread via pores of Kohn to more lateral alveoliof Kohn to more lateral alveoli

Right Upper Lobe ConsolidationRight Upper Lobe Consolidation

Right upper lung zone Right upper lung zone densitydensity

Air bronchogramsAir bronchograms

No mediastinal shift No mediastinal shift or hemidiaphragm or hemidiaphragm elevationelevation

Right Middle Lobe Right Middle Lobe ConsolidationConsolidation

Lingular ConsolidationLingular Consolidation

Hazy left lower lung zone Hazy left lower lung zone opacityopacity

Loss of the left heart Loss of the left heart borderborder

Left hemidiaphragm still Left hemidiaphragm still visiblevisible

No evidence of volume No evidence of volume lossloss

Lingular ConsolidationLingular Consolidation

Triangular density Triangular density projecting over the projecting over the heartheart

Small left pleural Small left pleural effusioneffusion

Left Lower Lobe ConsolidationLeft Lower Lobe Consolidation

Left lower lung zone Left lower lung zone opacityopacity

Loss of the left Loss of the left hemidiaphragmhemidiaphragm

No significant volume No significant volume loss or meniscusloss or meniscus

Left Lower Lobe ConsolidationLeft Lower Lobe Consolidation

Left lower lobe Left lower lobe opacityopacity

Major fissure not Major fissure not displaceddisplaced

Loss of left Loss of left hemidiaphragmhemidiaphragm

AtelectasisAtelectasis

Evidence of volume lossEvidence of volume loss

Elevation of hemidiaphragmElevation of hemidiaphragm

Displacement of fissuresDisplacement of fissures

Crowding of ribsCrowding of ribs

Compensatory emphysemaCompensatory emphysema

Affected lung more opaqueAffected lung more opaque

Crowding of bronchiCrowding of bronchi

Right Upper Lobe AtelectasisRight Upper Lobe Atelectasis

Elevation of the right Elevation of the right hemidiaphragmhemidiaphragm

Upward displacement Upward displacement of the minor fissureof the minor fissure

Increased triangular Increased triangular density abutting the density abutting the right superior right superior mediastinummediastinum

Right Upper Lobe AtelectasisRight Upper Lobe Atelectasis

Common causes Common causes includeinclude

Central obstructing Central obstructing massmass

Mucus pluggingMucus plugging

Right Middle Lobe AtelectasisRight Middle Lobe Atelectasis

Ill defined density Ill defined density abutting the right abutting the right heart borderheart border

Could be right middle Could be right middle lobe atelectasis or lobe atelectasis or pneumoniapneumonia

Obtain lateral for Obtain lateral for confirmationconfirmation

Right Middle Lobe AtelectasisRight Middle Lobe Atelectasis

Triangular density Triangular density projecting over the projecting over the heartheart

Downward Downward displacement of the displacement of the minor fissureminor fissure

Left Upper Lobe AtelectasisLeft Upper Lobe Atelectasis

Increased veil like Increased veil like opacity within the left opacity within the left hemithoraxhemithorax

Elevation of the left Elevation of the left hemidiaphragmhemidiaphragm

Left Upper Lobe AtelectasisLeft Upper Lobe Atelectasis

Crescentic increased Crescentic increased density abutting the density abutting the anterior chestanterior chest

Anterior displacement Anterior displacement of the major fissureof the major fissure

Left Lower Lobe AtelectasisLeft Lower Lobe Atelectasis

Triangular density Triangular density behind the heartbehind the heart

Loss of the medial Loss of the medial hemidiaphragmhemidiaphragm

Elevation of the left Elevation of the left hemidiaphragmhemidiaphragm

Left Lower Lobe AtelectasisLeft Lower Lobe Atelectasis

Increased density Increased density over the lower over the lower thoracic spinethoracic spine

Loss of the left Loss of the left hemidiaphragmhemidiaphragm

Posterior and inferior Posterior and inferior displacement of the displacement of the major fissuremajor fissure

Pleural EffusionsPleural Effusions

Blunting of the Blunting of the costophrenic anglescostophrenic angles

Mediastinal shift if Mediastinal shift if large enoughlarge enough

Lateral decubitus film Lateral decubitus film is very sensitive for is very sensitive for detection of pleural detection of pleural effusion 10cceffusion 10cc

Pleural EffusionsPleural Effusions

Obscuration of the Obscuration of the hemidiaphragmshemidiaphragms

175cc can be hidden 175cc can be hidden before being seen before being seen laterallylaterally

Left pleural effusion Left pleural effusion can sometimes be can sometimes be estimated with help of estimated with help of gastric bubblegastric bubble

Pleural EffusionsPleural Effusions

Blunting of the Blunting of the posterior costophrenic posterior costophrenic angleangle

Subpulmonic EffusionSubpulmonic Effusion

Lateralization of the Lateralization of the diaphragm apexdiaphragm apex

Elevation of the Elevation of the hemidiaphragmhemidiaphragm

Loculated EffusionsLoculated Effusions

Increased opacity Increased opacity over the right over the right hemithoraxhemithorax

No blunting of the No blunting of the costophrenic anglecostophrenic angle

Density does not Density does not correspond to lobar correspond to lobar anatomyanatomy

Diaphragm and heart Diaphragm and heart still visiblestill visible

Loculated EffusionLoculated Effusion

Homogeneous Homogeneous density abutting the density abutting the posterior chest wall posterior chest wall with obtuse marginswith obtuse margins

Sharp margin Sharp margin anteriorlyanteriorly

Suspicious for Suspicious for empyemaempyema

Loculated EffusionLoculated Effusion

Homogeneous Homogeneous density abutting the density abutting the right lateral chest wallright lateral chest wall

Has a sharp medial Has a sharp medial marginmargin

Does not have a Does not have a meniscusmeniscus

Self TestSelf Test

Subpulmonic EffusionSubpulmonic Effusion

Right Middle Lobe AtelectasisRight Middle Lobe Atelectasis

Normal ChestNormal Chest

Large Right Pleural EffusionLarge Right Pleural Effusion

Left Upper Lobe AtelectasisLeft Upper Lobe Atelectasis

Early CHFEarly CHF

Right Upper Lobe AtelectasisRight Upper Lobe Atelectasis

Left Lower Lobe PneumoniaLeft Lower Lobe Pneumonia

Loculated EffusionLoculated Effusion

Right Upper Lobe PneumoniaRight Upper Lobe Pneumonia