1. Chest Radiology in Intensive Care Medicine Dr. Andrew Ferguson MEd FRCA DIBICM FCCP Assistant Professor, Medicine (Critical Care) & Anesthesia Dalhousie University
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3. Radiographic anatomy Or LA NOTE In spite of what you May have heard… The right heart border Is formed by left atrium in up to 38% of patients AV TV MV
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6. Silhouette Sign Lobe Silhouetted structure Right middle lobe Right heart border Left lingula Left heart border Right lower lobe Right hemidiaphragm Left lower lobe Left hemidiaphragm Post apical segment left upper lobe Aortic knob Ant segment right upper lobe Ascending aorta
31. RLL collapse Fissure may be visible Sail-like line behind right heart plus indistinct diaphragm
32. LUL Collapse Lufsichel sign = Aerated superior segment of left lower lobe interposes between collapsed upper lobe and mediastinum producing lucency around aorta
33. LLL collapse Sail-like line behind heart – occasionally seen as extremely straight heart border
41. Naclerio’s V sign Lucent band of gas extending along descending aorta and intersecting band of gas that extends along medial left hemi- diaphragm, together forming “V’
42. Double bronchial wall sign Air on both sides of bronchial wall makes full wall visible
43. “ Ring around the artery” sign Air around pulmonary artery
52. Pitfalls – Mach band effect “ The Mach band effect is associated with convex surfaces, appearing as a region of lucency adjacent to structures with convex borders. The absence of an (associated) opaque line, which is typically seen in pneumomediastinum, can aid in differentiation ” Zylak C. Pneumomediastinum Revisited. Radiographics 2000; 20: 1043-1057.
62. Anteromedial pneumothorax Sharp outline of mediastinum and right heart border. Right hemithorax has concurrent consolidation and effusion Rankine, J. J et al. Postgrad Med J 2000;76:399-404