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Chest x-ray - evaluation of the lung fields
Diffuse white area (opacity)
A diffuse lesion is a lesion that is not limited to a specific
area of the lung, and can be found anywhere as opposed to focal
lesions which are limited to a specific area in the lung.
- Nodular ? discrete opacities
- Reticular ? mesh like appearance
- Alveolar ? ?fluffy? appearance
The diffuse patterns are not always easy to interpret and the
descriptive categories above are not very specific. Generally, the
following pathologies need to be considered.
?Upper lobe diversion
Kerly B lines ? horizontal, non-branching white lines best seen at
the periphery of the lung above the costophrenic angle.
The confluent shadowing of severe heart failure gives an alveolar
pattern spreading out from the hilum - ?bat?s wing?
Tends to be reticular or fine reticulo-nodular shadowing
Review old CXRs May be confused with oedema.
More likely to be fibrosis if the middle / upper lobes are involved
Small lung fields / reduced expansion
Mediastinal shift toward the shadowing
- Tends to be nodular (coarse)
- Tend towards the bases and the peripheries
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Can be difficult to separate from pulmonary oedema, sarcoidosis
or metastatic disease.
Looks much like pulmonary oedema, but exists in the settings of
extreme sepsis, trauma, poisoning.
Not sure if there is an abnormality or not?
- Look for air bronchogram
- Silhouette sign (heart and diaphragm)
- Site of suspected lesion:
- Nodularity in the outer 1/3 is abnormal.
- Nodularity in the middle 1/3 is tapering laterally and
nodules there are no bigger than size of expected vessels.
- Nodularity in the inner 1/3 takes the pattern of branching
vessels and nodules there are no bigger than size of expected