Soft-tissue calcifications lend themselves to a systematic approach that connects a diverse group of diseases. Although this chapter focuses primarily on abdominal calcifications, the same principles and approach apply to dystrophic calcification found anywhere in the body. Case Quiz 16 Question This is a supine abdominal radiograph of a 56-year-old female with chronic renal disease. The image demonstrates two of the four classic patterns of calcification…

Recognition of extraluminal air is an important finding that can have an immediate effect on the course of treatment. Air is normally not present in the peritoneal or extraperitoneal spaces, bowel wall, or biliary system. Air outside of the bowel lumen is called extraluminal air. The four most common locations of extraluminal air are: Intraperitoneal (pneumoperitoneum) (frequently called free air ) Retroperitoneal air Air in the…

In Chapter 12, Chapter 13 , we discussed how to recognize the normal intestinal gas pattern on conventional radiographs and computed tomography (CT). In this chapter, you will learn how to recognize and categorize the four most common abnormal bowel gas patterns and their causes. These abnormal patterns of bowel gas will appear the same whether imaged initially by conventional radiography or by CT scanning. CT…

Introduction To abdominal and Pelvic CT It is estimated that around 90 million CT scans of all kinds were performed in the United States in 2019. Almost 10% of all visits to the emergency department are for abdominal pain of a nontraumatic nature. Many of those patients undergo a CT scan of the abdomen and pelvis performed to detect or clarify their clinical findings. Since the advent…

While imaging of the abdomen is now largely performed utilizing CT, ultrasound, or MRI, many patients still have conventional radiographs (“plain films”) of the abdomen as a first step before other imaging studies are performed or as a method of following-up on findings demonstrated by other modalities. Many of the principles that guide the interpretation of conventional radiographs also apply to the modalities of CT, MRI,…

This chapter will discuss how to assess heart size, then describe the normal and abnormal contours of the heart on the frontal radiograph and, finally, illustrate some imaging findings in common cardiac diseases. Case Quiz 11 Question This 47-year-old female with a history of systemic lupus erythematosus presented with chest discomfort and muffled heart sounds. What is the most likely diagnosis based on the appearance of…

In this chapter, you will learn how to recognize mediastinal masses, benign and malignant pulmonary neoplasms, pulmonary thromboembolic disease, and selected airway diseases. Case Quiz 10 Question This is a view of the lung apices in a 73-year-old male with shoulder pain, a drooping eyelid, and constricted pupil on one side. You can deduce which side from the x-ray. What is the most likely diagnosis from…

Patients in the critical or intensive care units (ICU) are monitored on a frequent basis with portable chest radiography both to check on the position of their multiple assistive devices and to assess their cardiopulmonary status. Case Quiz 9 Question This patient just had a central venous catheter inserted on the left side in the subclavian vein (arrow) and you are asked to check this postinsertion…

General Considerations Pneumonia can be defined as consolidation of the lung produced by inflammatory exudate, usually as a result of an infectious agent. Most pneumonias produce airspace disease, either lobar or segmental. Other pneumonias demonstrate interstitial disease and some produce findings in both the airspaces and the interstitium. Case Quiz 8 Question This is a chest x-ray immediately following a diagnostic test the patient was undergoing.…

Normal Anatomy and Physiology of the Pleural Space Normal anatomy The parietal pleura lines the inside of the thoracic cage and the visceral pleura adheres to the surface of the lung parenchyma including its interface with the mediastinum and diaphragm. The enfolds of the visceral pleura form the interlobar fissures —the major ( oblique ) and minor ( horizontal ) on the right, only the major…

What is Atelectasis? Common to all forms of atelectasis is a loss of volume in some or all of the lung, frequently (but not always) leading to increased density of the lung involved. The lung normally appears “black” on a chest radiograph because it contains air. When the air in all or part of the lung is absent because of resorption or compression as in atelectasis,…

There are three major causes of an opacified hemithorax (plus one other that is less common). They are: Atelectasis of the entire lung A very large pleural effusion Pneumonia of an entire lung And a fourth cause Pneumonectomy— removal of an entire lung Case Quiz 5 Question This 61-year-old heavy smoker presents with cough and shortness of breath. Is the most likely cause of her opacified…

Recognizing the difference between normal anatomy and what is abnormal is critical to your ability to make a correct diagnosis. This chapter begins your exploration into the realm of the abnormal, starting with recognizing patterns of parenchymal lung disease. Case Quiz 4 Question A close-up view of the left upper lobe is shown. Is this most likely airspace disease or interstitial lung disease? Given a history…

Starting with conventional radiography, we’ll begin with an assessment of heart size, then describe the normal and abnormal contours of the heart on the frontal radiograph and, finally, discuss the normal anatomy of the heart as seen on computed tomography (CT) and magnetic resonance imaging (MRI). Case Quiz 3 Question The image is a frontal chest x-ray of a 52-year-old female with a history of episodes…

In this chapter, you’ll learn how to evaluate the normal anatomy ( Fig. 2.1 ) and the technical adequacy ( Fig. 2.2 ) of the lungs on conventional radiography as well as on computed tomography. To become more proficient interpreting images of the chest, you should first be able to recognize fundamental, normal anatomy in order to differentiate it from what is abnormal. Case Quiz 2 Question This…

This chapter will briefly introduce you to the major imaging modalities: conventional radiography, computed tomography, ultrasound, magnetic resonance imaging, and the use of fluoroscopy. Nuclear medicine has its own online chapter (see e-Appendix A ). In every chapter of this text, there will be a “Case Quiz” based on material in that chapter. The answer to each quiz question can be found in a special box…