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Pooja Sikka MD Ashley Davidoff MD

Problem Posed

Solution 

CXR – Hyperinflation and LLL infiltrate and Tubular Structures in the Upper Lobes
77 year old female with history of asthma,  allergic bronchopulmonary aspergillosis (ABPA) and COPD
CXR shows hyperinflation, and  consolidation in the left lower lobe silhouetting the left hemidiaphragm, with prominent bronchovascular bundles in the upper lung fields seen both on the PA and the lateral Diagnosis: Asthma  Allergic Bronchopulmonary Aspergillosis (ABPA) COPD
Ashley Davidoff TheCommonVein.net
CT with Lingula Infiltrate
46 year old immunocompromised male  presents with a fever.  Axial  CT shows a subsegmental lingula infiltrate, abutting and silhouetting the left heart border 
Ashley Davidoff TheCommonVein.net
CT with Cavitation  in the Left Lung Apex and Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  Scout for the CT scan  shows a cavitating nodule in the left apex and a lingula infiltrate partially silhouetting the left heart border.
Ashley Davidoff TheCommonVein.net
CXR with Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  Lateral CXR shows a lingula infiltrate,  partially silhouetting the left heart border better seen in the magnified view.
Ashley Davidoff TheCommonVein.net
CXR with Cavitation  in the Left Lung Apex and Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  CXR shows a cavitating nodule in the left apex and a lingula infiltrate partially silhouetting the left heart border.
Ashley Davidoff TheCommonVein.net
Allergic Bronchopulmonary Aspergillosis (ABPA) and Atelectasis
77 year old male presents chest discomfort
CT scan without contrast shows atelectasis of the right lower lobe )asterisk c and r) and also seen axial projection (a) magnified in (b) and in (c) magnified in {d) Red arrowheads in b and d show airways filled with material. Aspergillus was isolated at bronchoscopy. Coronal imaging (e magnified in f) show silhouetting of the right hemidiaphragm by the atelectatic lung (white arrowheads
Ashley Davidoff TheCommonVein.net 117786cL
Abnormal mediastinal silhouette
The first image represents the normal and the second a mediastinal silhouette that is very abnormal.   There are multiple ?mogul? enlargements, including the region of the aortic knob, the pulmonary segment and the SVC.  The following CT explains the appearance. 
Ashley Davidoff MD TheCommonVein.net 2056c02
56-year-old male presents with history of Central Non Small Lung Cancer with Lingula Atelectasis
Axial CT images show a central mass with lingula atelectasis. The scout film shows silhouetting of the left heart border. The CXR shows similar finding following stent placement in the lingula
Ashley Davidoff MD TheCommonVein.net
Left Lower Lobe Atelectasis
57-year old male presents with a cough. CXR shows silhouetting of the left hemidiaphragm and leftward mediastinal shift. CT scan shows an airless consolidation with leftward shift consistent with atelectasis.
Ashley Davidoff MD TheCommonVein.net
82-year-old female presenting 24 hours post repositioning of a misplaced ETT. The endotracheal tube has been removed indicating improved pulmonary status. There is mild to moderate CHF and bilateral silhouetting of the hemidiaphragms relating to basilar infiltrates or effusions. The left upper lobe remains well aerated
Ashley Davidoff MD TheCommonVein.net
NORMAL AND SILHOUETTING OF THE LEFT DIAPHGRAGM
Ashley Davidoff MD TheCommonVein.net 130896c
Silhouette sign, left lower lobe collapse. Frontal (A) and lateral (B) radiographs demonstrate features consistent with left lower lobe collapse secondary to an infrahilar mass on the left. The left hemidiaphragm is obscured on the frontal view with retrocardiac opacity. The left heart border is preserved, suggesting lower lobe involvement with sparing of the lingula. The lateral view confirms the signs of left lower collapse with upward retraction of the diaphragm and obscuration of the left hemidiaphragm posteriorly due to an underlying pleural effusion. Findings were due to recurrent non-small cell lung carcinoma.
Source
Signs in Thoracic Imaging
Journal of Thoracic Imaging 21(1):76-90, March 2006.
Silhouette sign, right middle lobe pneumonia. Initial frontal (A) and lateral (B) radiographs in a patient with clinical suspicion of pneumonia demonstrate obliteration of the right heart border. Follow-up radiographs the next day (C, D) illustrate dense opacification on the lateral view and persisting loss of the right heart border, confirming the presence of a right middle lobe pneumococcal pneumonia.
Source
Signs in Thoracic Imaging
Journal of Thoracic Imaging 21(1):76-90, March 2006.

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