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The Soft Tissues of the Thorax


THE CHEST WALL

FIGURE 9-1, Hair braids simulating gas in the soft tissues of the neck.

FIGURE 9-2, Plastic hair braid beads producing unusual appearance of the soft tissues of the neck and shoulders.

FIGURE 9-3, Simulated parenchymal lesions caused by hair braids (←). Note similar shadow laterally on right ( ).

FIGURE 9-4, The dense juvenile breast may cast shadows simulating parenchymal density (←). Note also shadows cast by hair braids ( ).

FIGURE 9-5, Juvenile breast simulating parenchymal abnormality

FIGURE 9-6, Intersecting shadows of the breast (←) and pectoral folds ( ).

FIGURE 9-7, Skin folds producing curvilinear densities in the lower thorax and upper abdomen in a 3-week-old infant.

FIGURE 9-8, Simulated pneumothorax caused by a skin fold in a 3½-year-old child.

FIGURE 9-9, Simulated pneumothorax in a neonate produced by a skin fold. A, Simulated pneumothorax. B, Normal appearance 5 hours later.

FIGURE 9-10, Two examples of simulated pneumothoraces produced by skin folds in neonates.

FIGURE 9-11, Folds of lax skin in the elderly may also simulate a pneumothorax.

FIGURE 9-12, A through D, Four examples of skin folds simulating pneumothoraces. The patient illustrated in D was intubated. Note the fading margin of the skin fold in contrast to the sharp pleural line seen with a true pneumothorax.

FIGURE 9-13, Examples of axillary folds simulating pneumothorax in lateral projection.

FIGURE 9-14, Redundant soft tissues of the axilla producing rounded densities overlying the mediastinum.

FIGURE 9-15, Nonsignificant asymmetry of the companion shadows of the clavicles resulting from faulty positioning. No shadow is seen on the left side.

FIGURE 9-16, Calcification in the costoclavicular fascia, not to be mistaken for parenchymal lesions. A, Plain film. B, Tomogram.

FIGURE 9-17, Calcified costal cartilage may simulate a parenchymal lesion. A, Plain film. B, Tomogram.

FIGURE 9-18, Exuberant calcified costal cartilage at the end of the first rib may produce a mass effect behind the sternum in the anterior mediastinum. A, Plain film. B, Tomography in the lateral projection shows that the mass consists of the calcified cartilage (←). Note the position of trachea for orientation ( ).

FIGURE 9-19, Ring shadow of calcified costal cartilage of first rib simulating a cavity in the lung.

FIGURE 9-20, Simulated nodule produced by underdevelopment of the anterior end of the first rib, with isolated development of the costal cartilage. Left, Plain film. Right, Tomogram.

FIGURE 9-21, The floor of the supraclavicular fossa may be very well defined and may simulate an air-fluid level in the lung.

FIGURE 9-22, The confluence of the shadows of the sternocleidomastoid muscle, the first rib, and the clavicle may simulate a bulla or cavity in the apex of the lung.

FIGURE 9-23, Two examples of the shadows of the subcostal muscles that produce an appearance simulating pleural thickening or a small pneumothorax.

FIGURE 9-24, Companion shadows of the ribs.

FIGURE 9-25, Triangular companion shadow of the first rib.

FIGURE 9-26, A, PA film shows bilateral soft tissue shadows resulting from large pectoral muscles. B, AP film does not show pectoral shadows.

FIGURE 9-27, Large pectoral shadows in a weightlifter producing hazy densities in midlung, more marked on the right.

FIGURE 9-28, Congenital absence of the left pectoralis major muscle producing increased radiolucency of the left hemithorax.

FIGURE 9-29, Shadow of the pectoralis major muscle simulating a lung lesion (←). Note also the pseudopneumothorax on the patient's right side, produced by a skin fold ( ).

FIGURE 9-30, Extrapleural fat in a very obese man simulating pleural thickening. The absence of blunting of the costophrenic angles in this entity is a useful differential clue.

FIGURE 9-31, Additional example of extrapleural fat deposits in a very obese patient simulating pleural thickening. The shadow of the extrapleural fat does not reach the costophrenic angles. Occasionally these extrapleural fat deposits may be slightly asymmetric.

FIGURE 9-32, Extrapleural fat seen in an off-lateral projection. Note that the fat loses its prominence at the bases.

FIGURE 9-33, The serratus anterior muscle produces a shadow that may be confused with pleural thickening or extrapleural fat. In frontal views, it produces a “bowling pin” configuration.

FIGURE 9-34, Two additional cases showing the varying appearance of the serratus anterior muscle shadows.

FIGURE 9-35, A demonstration of the muscle slips of the serratus anterior muscle that constitute the “bowling pin” sign in Figures 9-33 and 9-34 .

FIGURE 9-36, A, Simulated parenchymal density produced by soft tissues over the scapula, caused by improper positioning of the arms. B, Shadow not seen with proper positioning.

FIGURE 9-37, In an improperly positioned chest film, the spine of the scapula may overlap the lungs and produce a shadow that may be mistaken for a pneumothorax.

FIGURE 9-38, Simulated pneumothorax produced by the transverse process of T2.

FIGURE 9-39, Confluence of the first and second ribs simulating a pneumothorax.

FIGURE 9-40, Lucency of the medullary cavity of the second rib simulating a pneumothorax.

FIGURE 9-41, Two examples of the mammary anterior mediastinal pseudotumor. The lateral aspects of the dense, small breasts in young women may project into the anterior mediastinum in the lateral projection and simulate mediastinal masses.

FIGURE 9-42, The axillary tail of the breast may simulate an anterior mediastinal mass.

FIGURE 9-43, The compressed breast in the prone position may simulate a pneumothorax.

FIGURE 9-44, The axillary fold simulating a pneumothorax.

FIGURE 9-45, Pectoral skin fold simulating pneumothorax

FIGURE 9-46, Three examples of the sternal insertion of the pectoralis major muscle that might be mistaken for carcinoma on mammography. Top, Triangular area of increased density is seen in the medial aspect of the breast on craniocaudal view ( ), continuous with underlying pectoral muscle (←). Center, Rounded area of increased density is seen in the medial aspect of the breast on craniocaudal view. Bottom, Craniocaudal view of left breast in a female weightlifter reveals continuity between pectoral muscle (←) and density ( ).

FIGURE 9-47, Nipple shadow. Such shadows characteristically have a fading medial margin.

FIGURE 9-48, Simulated herniation of the lung produced by an inflatable brassiere.

FIGURE 9-49, Prosthetic breast implants. Note the resulting pseudotumor on the lateral projection.

FIGURE 9-50, Simulated air in soft tissues produced by rotation.

FIGURE 9-51, Air under the breast producing a striking radiolucency beneath the heart shadow in the lateral projection.

FIGURE 9-52, Breast shadow simulating pulmonary infiltrate.

FIGURE 9-53, Simulated consolidation of the lung produced by superimposed breast shadows.

FIGURE 9-54, Manubrium simulating a soft tissue mass in a 2½-year-old boy.

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