Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions

Radiology corner

Breathe 2017 13: 143-146; DOI: 10.1183/20734735.132117
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Case 1

A 43-year-old female presents with fever, productive cough and shortness of breath.

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

1. What is the main abnormality given the clinical history?

  • a) Bronchogenic malignancy

  • b) Pleural effusion

  • c) Left lower lobe consolidation

  • d) Lingular consolidation

  • e) Left lower lobe collapse

Case 2

A 29-year-old male presents with fever and night sweats.

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

1. What is the main abnormality?

  • a) Mediastinal abnormality

  • b) Hilar abnormality

  • c) Normal appearance

  • d) Lung parenchymal abnormality

  • e) Pleural abnormality

Answers

Case 1

1. c) Left lower lobe consolidation. There is left lower zone opacification with an air bronchogram visible, which confirms that the opacification is based in the lungs. The left hemidiaphragm is partly obscured while the left heart border is visible. This is due to the silhouette sign where, when consolidation or a mass abut an adjacent structure that the X-ray beam crosses at 90°, the margin between that structure and the lung is obscured. However, if a mass or consolidation is behind or in front of that structure, then the border of that structure is still visible. So, in this case, the fact that the heart border is visible tells us that the consolidation is not beside the heart border, so not in the lingula; however, it is beside the diaphragm, which is obscured, so it must be in the lower lobe. As there is no loss of volume, this is consolidation not collapse. Combined with the clinical history, this is likely to be due to an infective process. The asymmetrical appearance with increased opacification in the left lower zone is accentuated by the overlying breast tissue (note the right sided mastectomy).

Case 2

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

1. a) Mediastinal abnormality. There is right paratracheal widening which was due to adenopathy (red arrow). The right side of the trachea lies beside the lung and the right paratracheal stipe is usually <3 mm thick, except at the very lower end where the azygous vein is present and where it can measure up to 1 cm in thickness. Right paratracheal widening is usually due to mediastinal masses most commonly lymphadenopathy. This patient was diagnosed with tuberculosis.

The main differential diagnoses for these appearances would include:

  • Tuberculosis

  • Lymphoma

  • Metastatic disease

  • Sarcoidosis (less likely)

Case 3

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

1. A 24-year-old male was admitted following a fall.

Which of the following is not a diagnostic possibility for this appearance?

  • a) Sarcoidosis

  • b) Vasculitis

  • c) Infective multifocal consolidation

  • d) Metastatic disease

  • e) Radiation pneumonitis

Case 4

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

1. A 43-year-old male was recently discharged from hospital but presents with ongoing shortness of breath.

What is the main abnormality?

  • a) Pulmonary consolidation

  • b) Soft tissue mass

  • c) Lobar collapse

  • d) Pleural effusion

  • e) Mediastinal abnormality

Answers

Case 3

1. e) Radiation pneumonitis. In this case, there are multiple nodular opacities in both the middle and upper zones; some of these have air bronchograms evident. In addition, the left hilum has an abnormal contour as well as the aortopulmonary window. This was due to lymphadenopathy, which was confirmed on cross-sectional imaging. This patient was diagnosed with sarcoidosis following tissue biopsy. The histopathological basis for the alveolar pattern in sarcoidosis is loss of alveolar air because of compression of the alveoli by coalescent granulomas. In addition, the alveoli may be filled with macrophages and/or granulomas. With radiation pneumonitis, air space opacification is usually geographical, corresponding to the radiation field rather than presenting with multiple nodular opacities.

The differential diagnosis for these appearances would include:

NeoplasiaMetastases (e.g. testicular, sarcoma, melanoma, breast, thyroid or renal primaries)
Lymphoma
InfectionMultifocal abscesses (e.g. Staphylococcus aureus)
Fungal (e.g. histoplasmosis or coccidiomycosis)
Immune mediatedGranulomatosis with polyangiitis
Rheumatoid arthritis

Case 4

1. d) Pleural effusion. There is a right-sided subpulmonic effusion. Note the abnormal contour of the right hemidiaphragm and compare it with the normal left side. Subpulmonic effusions generally peak more laterally than is seen with a normal diaphragmatic contour. This patient was treated for community-acquired pneumonia and had developed a parapneumonic effusion as a complication.

  • ©ERS 2017

Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

PreviousNext
Back to top
Vol 13 Issue 2 Table of Contents
Breathe: 13 (2)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Radiology corner
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Radiology corner
Breathe Jun 2017, 13 (2) 143-146; DOI: 10.1183/20734735.132117

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Radiology corner
Breathe Jun 2017, 13 (2) 143-146; DOI: 10.1183/20734735.132117
Reddit logo Technorati logo Twitter logo Connotea logo Facebook logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Answers
    • Answers
  • Figures & Data
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Expert opinion

  • Lung cancer screening by volume CT
  • In pursuit of the primary
  • A rare complication in a case of nonsmall cell lung carcinoma
Show more Expert opinion

Radiology corner

  • Radiology corner
  • Radiology corner
  • Radiology corner
Show more Radiology corner

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About Breathe

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Intructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN: 1810-6838
Online ISSN: 2073-4735

Copyright © 2023 by the European Respiratory Society