Case 32 Primary Pulmonary Hypertension

Oligemic Lung Fields

This patient fits the typical clinical and radiological profile of a patient with primary pulmonary hypertension. The pulmonary arteries are markedly enlarged with the right atrial chamber also enlarged. The normal right pulmonary descending artery diameter is less than 16 mm in males and 15 mm in females. The lung fields are clear and the lung volumes normal making lung disease causing pulmonary hypertension unlikely. Other causes to be ruled out are congenital heart disease and chronic...

Case 34 Bronchiectasis Affecting Both Lower Lobes

Hamartoma Cxr

The CXR shows infiltrates especially in the right middle lobe and the left lower lobe. The ring shadows and tramlines indicate the presence of dilated and thickened airways. The CXR findings were noted a few years previously indicating its chronicity. The accepted modality for the diagnosis of bronchiectasis is a highresolution CT Thorax which demonstrates these dilated airways in the left lower lobe Fig. 34.2 using very thin 1-2 mm slices. Bronchography is now seldom used. Case 35. This...

Case 62 Lung Cancer With Lymphangitis Carcinomatosis

Chemical Inhalation

The CXR shows a left upper lobe mass and mid-zone infiltrates with a normal heart size. In addition, there are Kerley B lines Fig. 62.2 in the periphery of the left mid zone, suggestive of lymphatic distension. These features are consistent with the advanced lung cancer metastasizing to the lymphatics. The prognosis is extremely poor. Case 63. This 24-year-old female was asymptomatic. Six months ago, she presented with pneumonia-like symptoms of cough, fever, and purulent sputum. Describe her...

Case 88 Pleural Lipoma

Macleod Syndrome

It is usually possible to differentiate this from lung parenchymal masses abutting the pleura which tend to be relatively round with the angle between the mass and the chest wall being acute unlike here where the angle is obtuse - Fig. 88.2 . The CT Thorax Fig. 88.3 shows that the mass is of fat density confirming the presence of a pleural lipoma, which is benign. Case 89. This patient is asymptomatic. The CXR is shown Fig. 89.1 . CASE 89 SWYER-JAMES-MACLEOD'S...

Case 18 Hereditary Hemorrhagic Telangiectasia Or Osler Weber Rendu Disease

Pleural Effusion Copd

The CXR shows a mass in the right lower zone. The mass has a sharp margin and two vessels supplying artery and draining vein leading to the mass Fig. 18.2 . The CT Fig. 18.3 shows marked enhancement of the mass with contrast confirming the presence of pulmonary arteriovenous malformation pAVM . Of patients with pAVM, 60 have Osler's disease, and 10 of patients with Osler's disease have pAVM. This condition is autosomal dominant. Other sites of involvement include skin, nose epistaxis ,...

Case 45 Left Upper Lobe Collapse Due To Lung Cancer

Pleural Effusion Lung Collapse Image

The CXR shows evidence of left upper lobe collapse. There is a hazy, veil-like opacification in the left upper lobe, which does not have a sharp inferior margin unlike right upper lobe collapse see Case 30 . This is because there is usually no left transverse fissure and the lobe collapses anteriorly. There is also volume loss in the left hemithorax as evidenced by an elevated left hemidiaphragm and crowding of the left upper ribs. Sometimes the trachea may also be deviated to the same side and...