Chest X-ray Abnormalities – Lung abnormalities

Chest X-ray Abnormalities – Lung abnormalities

Key points

• Compare the left and right upper, middle and lower lung zones
• Decide which side is abnormal
• Compare an area of abnormality with the rest of the lung on the same side
• The whiter side is not always the abnormal side
• Remember many lung diseases are bilateral and symmetrical

Lung zones

Assess the lungs by comparing the upper, middle and lower lung zones on the left and right. Asymmetry of lung density is represented as either abnormal whiteness (increased density), or abnormal blackness (decreased density). Once you have spotted asymmetry, the next step is to decide which side is abnormal. If there is an area that is different from the surrounding ipsilateral lung, then this is likely to be the abnormal area.

Consolidation

If the alveoli and small airways fill with dense material, the lung is said to be consolidated. It is important to be aware that consolidation does not always mean there is infection, and the small airways may fill with material other than pus (as in pneumonia), such as fluid (pulmonary oedema), blood (pulmonary haemorrhage), or cells (cancer). They all look similar and clinical information will often help you decide the diagnosis.

Air bronchogram

If an area of lung is consolidated it becomes dense and white. If the larger airways are spared, they are of relatively low density (blacker). This phenomenon is known as air bronchogram and it is a characteristic sign of consolidation.

Consolidation with air bronchogram

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Consolidation with air bronchogram

• The left middle zone is white
• Dark lines through the area of white are a good example of air bronchogram

Clinical information

• The patient had a high temperature and a productive cough

Diagnosis

• Pneumonia – consolidation with pus

Differential diagnosis of consolidation

• Pneumonia – airways full of pus
• Cancer – airways full of cells
• Pulmonary haemorrhage – airways full of blood
• Pulmonary oedema – airways full of fluid

Small lung zone abnormalities

Careful comparison of the lung zones can lead to noticing smaller abnormalities which may otherwise be ignored.

Unilateral middle zone abnormality

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Unilateral middle zone abnormality

• The middle zones are asymmetrical
• There is a small irregular opacity on the right
• This opacity contains a dark area – cavity
• Other areas of the lungs are normal

Clinical information

• This patient had a history of intravenous drug abuse and presented with a high fever

Diagnosis

• Septic embolus

Differential diagnosis of lung cavities

• Lung abscess – TB, Klebsiella or Staph aureus
• Lung cancer
• Septic embolus – infected thrombus
• Fungal infection – if immunocompromised
• Granulomatosis with polyangiitis

Bilateral lung abnormalities

Comparing sides does not always give the answer. The lungs may be abnormal on both sides and so awareness of the normal appearances of lung parenchyma becomes more important.

Bilaterally abnormal lung zones

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Bilaterally abnormal lung zones

• Multiple bilateral lung nodules
• Symmetrical distribution
• More nodules at the lung bases

Clinical information

• Shortness of breath, weight loss and clinically suspected underlying malignancy

Diagnosis

• Pulmonary metastases

Unilateral low density

If there is asymmetry of the lungs, sometimes it is the dark (less dense) area that is abnormal.

Unilateral black lower zone

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Unilateral black lower zone

• Asymmetrical lower zones
• Left darker than right
• Lung hyperexpansion

Clinical information

• Chronic smoker with increasing shortness of breath

Diagnosis

• Chronic obstructive pulmonary disease with a large left lower zone lung bulla

Page author:
Dr Graham Lloyd-Jones BA MBBS MRCP FRCR – Consultant Radiologist –
Salisbury NHS Foundation Trust UK
(Read bio)

Last reviewed:
July 2019

Lung Opacity: Understanding What This Means

Even though over 80 million people undergo computed tomography (CT) scans each year in the United States, some of the words and phrases related to this imaging test can be complicated and hard to understand.

For example, one term that healthcare professionals might use in reference to a lung CT scan is “opacity.” This is a radiological term that refers to the hazy gray areas on images made by CT scans or X-rays.

This article will provide information about lung opacity, whether it means you have lung cancer, and what the outlook may be for those with lung opacity.

Ground-glass opacity is a radiological term that refers to hazy gray areas on the images made by CT scans or X-rays. It indicates increased density in these areas.

Typically, the lungs appear black on a CT scan or X-ray. This shows that they are free of blockages. When gray areas are visible instead, it means that something is partially filling this area inside the lungs.

These gray areas are referred to as ground-glass opacity. Ground-glass opacity can be a sign of:

• fluid, pus, or cells filling the air space
• walls of the alveoli thickening
• space between the lungs thickening

Ground-glass opacity can result from a variety of causes, according to 2020 research.

Sometimes it is temporary and the result of a short-term illness. In other cases, it can signify a chronic or more serious condition. Ground-glass opacity can also indicate an infection or other inflammatory process, which is usually what a clinician will share with you or your loved one who has had a CT scan or X-ray.

Healthcare professionals see lung opacities on imaging scans. Your doctor may suggest a scan of your lungs if you are experiencing:

• shortness of breath
• persistent coughing
• coughing with yellow, green, or bloody mucus
• chest pains
• blue- or white-tinged fingertips or lips
• voice changes

Opacities are also likely to show up on a scan if you have a history of smoking or vaping.

It’s also good to know that chest CTs are used to screen for risk of lung cancer, and a physician may order a CT scan if you have a history of smoking.

Lung opacities can indicate many conditions besides cancer. Many times they are benign (noncancerous). They may be due to infections, hemorrhages, a history of smoking, and even COVID-19.

Lung opacities are common, 2021 research suggests. They can indicate a broad range of conditions, and your doctor may need to do further scans and tests to determine the exact cause of any lung opacities.

Lung opacity can show up on the imaging scan in a variety of ways, depending on the underlying condition. Some conditions will result in multiple types of opacities.

Opacities may be:

• Diffuse: This describes when opacities show up in multiple lobes or both lungs. This is usually the result of fluid, damaged tissue, or inflammation.
• Nodular: This can mean either a malignant or benign condition. Because this opacity can be caused by small scars from a recent infection, doctors may choose to watch it over several scans to see if it grows.
• Centrilobular: This type of opacity can appear within one or several lobules of the lung. The connective tissues between the lobules will be unaffected in this type of opacity.
• Mosaic: Opaque areas vary in intensity in this pattern. It is due to small arteries or airways within the lung being blocked.
• Crazy paving: This describes a linear pattern that develops when spaces between the lobules widen.
• Halo sign: This describes when opacity fills the area around the nodules.
• Reversed halo sign: The opacity will be surrounded by liquid-filled tissue.

Lung opacity can indicate different conditions that have their own treatment plans. Depending on the cause, your doctor may suggest:

• steroid medications to reduce inflammation
• immunosuppressants to prevent your immune system from further damaging your lungs
• antibiotics
• oxygen treatments
• surgery

If the lung opacity is due to cancer, treatment will vary depending on the severity and type. Treatment may include radiation, chemotherapy, and surgery.

Lung opacity can result from many different causes, with varying degrees of seriousness.

Some conditions that cause lung opacity, like viral infections, are typically short-lived with low long-term risk. Other conditions, like alveolar hemorrhage and lung cancer, require more serious treatments.

Ground-glass opacity nodules can be divided into two types: pure and partially solid. Pure nodules do not contain any solid mass, whereas partially solid nodules do have solid components.

A 2019 study found that in cases when lung opacity showed cancer, pure ground-glass opacity nodules were more likely to be seen in earlier stages of lung cancer. There was also less lymph node invasion compared with ground-glass opacity nodules that also include solid masses.

Additionally, pure ground-glass opacity nodules took longer to double in size than ground-glass opacity nodules with solid masses in these studies. This means that lung cancer outlook may be better when a person has pure ground-glass opacity, compared with scans that showed a solid part in the nodules.

After a CT scan or X-ray, a radiologist will look at the scan to determine if there are areas of concern. One thing that can show on a CT scan or X-ray is a degree of haziness referred to as opacity.

Opacity on a lung scan can indicate a concern, but the cause can vary. Your doctor may recommend additional testing to determine the exact cause of any potential lung issues.

The outlook and treatment options available will depend on the cause of the opacity.

X-ray (x-ray) of the chest organs – “A simple and free procedure helps to explain why pathology appeared on the fluorogram – a shadow in the lung” that I

• lost 2 kg of body weight in two days,
• self-diagnosed myself with lung cancer,
• picked up a “funeral dress” and a photo for a monument,
• , in a state of slight paralysis, went to the “copy of the OGK”.

Why am I writing this review? The procedure itself can be described in one paragraph. I will definitely do it. But if someone encounters the same problem as me, there is not so much information on the Internet about such errors in reading fluorograms. I will contribute to the section “fluorogram reading errors”.

Usually such blackouts in the pictures give hair, if they are not neatly pulled up – but I have short hair. Also, shadows from the nipples can be mistaken for shadows in the lungs if the laboratory assistant presses your chest too hard against the apparatus. Then the breasts (left, right, both at once) will shift to the sides, and the nipples will give a shadow in the picture, which the radiologist must notice and prescribe an additional examination to exclude pathology. But if in our polyclinics everything was done in a human way, and not through… if people were talked to…

My story – passed the annual fluorographic examination. There is no special faith in him, since my father did not do fluorography for seven years, and died of lung cancer, and a colleague underwent fluorography every year – nevertheless, he also received a diagnosis of lung cancer not according to the results of annual screening, but after visits to the doctor due to loss of voice, when the tumor was already inoperable.

Without thinking about the bad, I come to work and receive a call right in the morning – to urgently retake a fluorography. What, why, why – xs. They called from the factory health center. Then, even later, the district nurse will call. I come to the fluorography room – they take a picture in a lateral projection. “The doctor didn’t like something” – is very informative, isn’t it? Inspires optimism. Doctor, as it turned out later, one for three places – and for a fluorograph, and for a mammograph, and for an x-ray. He would be happy to explain and talk to the patient, but he does not have such an opportunity. And lab assistants don’t get paid to talk. At the end of the procedure: if something goes wrong – we will call .

I have read all sorts of things on the Internet, but hope still glimmered . The next day I rushed to find out the results *passive waiting is not for me* and received a referral for a “copy of the OGK”. To the question: “Can you still find out what’s wrong with my picture?” the answer was received: “Your lungs will watch. The doctor did not like something.” Well, after that I was unstoppable.

Maybe from the outside it seems ridiculous and stupid, that I am so easily demoralized, that I overdramatize everything, etc. But a loved one was dying from lung cancer in front of my eyes and hands, so burdened heredity and visualization of the picture of the future in I was complete. Plus, I lived for several months in a state of acute stress, which had already led to a neoplasm and surgery a year ago. Plus – I periodically have pains under my left breast, which I attribute to “heart”, although a familiar paramedic says that they are “muscular”. Plus – I already live this life on neuroleptics and antidepressants. A man with a sick psyche! In general, the clinic is complete. And I have a sick and dependent person in my care. I don’t want to live and I don’t want to die. Especially from lung cancer. I want to die in my sleep, unexpectedly. Like all normal people – to fall asleep and not wake up.

Chest scan is performed in the surgical building of the city hospital. X-rays and barium enema are also performed there. I gave the direction, sat down to wait for me to be called. I waited for an hour – the first to accept the “broken”. A woman was sitting next to me with the same piece of paper (direction) as mine. I recognized him by the specific handwriting and triangular seal of the doctor. She did not look happy, but she did not have “all the world’s sorrow” painted on her face, like mine. I sat, composed mantras and prayed.

Called . Undress to the waist, take off your shoes. The doctor shouted that she should not undress ahead of time, but first she went to him. The doctor is young *younger than me*, and it is clear that the cynicism that is the constant companion of medical workers has not yet settled into him. He showed me pictures from 2016 and 2017, where “everything is clean”. Showed a picture from 2018. The picture in the lateral projection of the pathology did not show *at least one *** told me this when I came to find out the results*.

The doctor explained that he suspected that my left breast was pressed hard, which caused the nipple to shift and form its projection in the form of a shadow on the picture. He showed why I have such a shadow does not mean central or peripheral lung cancer, how would the shadow look in this case. But he is obliged to check everything, so that “he was calmer, and I was calmer. ” A real-time copy of the OGK allows you to do this, you do not need to receive more intense radiation on a CT scan and pay for this expensive procedure. The doctor warned that he would tell me when to hold my breath, when to take a deep breath.

Comrades, there will be no photo in the review, because I was not at all up to photo . I only have a doctor’s note.

Evaluate the handwriting – they also say that all doctors are specifically taught to write illegibly.

After the conversation, I undressed to the waist, took off my shoes and stood on the stand. There was no one in the office, the doors were closed. The apparatus began to move – something drove up to me and rose, got closer. I was already standing – neither alive nor dead, only my heart was pounding. The doctor communicated with me through the speaker. In total, the procedure did not take much time, no more than 5 minutes, I held my breath and exhaled for three cycles.

After that, the doctor said that everything in my lungs is clear , he will make a note in the database, what caused the blackout. It turned out that the woman who was sitting with the same problem as me had a large mole on her back – the mole also gave a shadow. If there are large moles on the chest, there will be a similar result. The advantage of fluoroscopy is that the doctor has the opportunity to assess the state of the lungs in dynamics – on inhalation and exhalation. Also, on fluoroscopy, you stand freely, you are not pressed anywhere, so a “laying defect” is impossible.

Apparently, I had a very expressive face, so the doctor sat and talked to me for another 15 minutes *maybe he just liked me*. Stressed the importance of mammography. Complained that the doctor reading the pictures should be able to talk to the patient, so that it doesn’t turn out the way it happened with me. Recommended that all examinations be accompanied by the results of previous and related examinations. For example, I went for a mammogram – take an ultrasound of the mammary glands with you, if any. And for yourself, your loved one, it makes sense once a year to allocate funds and take tests for tumor markers. Because our bloodstream reacts to everything instantly, to any inflammatory process. Even MRI and CT will not show anything, but tumor markers will.

I won’t talk about the harm of exposure. Choose the lesser of two evils. Although my hands were shaking for a long time after the CT scan, at the moment I can rule out a serious pathology of the lungs. But it cannot be completely excluded either, because MRI or CT is more informative.

As far as I understood, when I was surfing the Internet , the purpose of fluorography is precisely screening – that is, the differentiation of norm and pathology. The next step is an x-ray. Those who wish to skip this stage can immediately do a CT or MRI, but this is not always necessary, as it turned out in my case.

If you think that lung cancer affects only long-term smokers , people working in hazardous industries and other “risk groups”, then you are very much mistaken. It is enough to read the stories of relatives of patients on the site “We will win Cancer”. So many wonderful, blooming, active and healthy men and women learn that they are sick when the tumor goes into an inoperable stage. And then the bill goes on for months.

Take care of yourself, take care of your own health and the health of your loved ones , especially men who hate hospitals.

Respiratory Distress Syndrome – How to Diagnose Pediatric Tips

How to Diagnose Neonatal Respiratory Distress Syndrome: Respiratory Distress Syndrome of the Newborn (RDS) occurs when the baby’s lungs are not fully developed and cannot supply enough oxygen, causing difficulty breathing. Primary diagnosis of respiratory distress syndrome of a newborn will require a consultation with a therapist. As an additional examination based on the results of the examination, the doctor may prescribe:

• x-ray
• CT scan of the chest.

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This disease usually develops in premature babies. It is also known as childhood respiratory distress syndrome, hyaline membrane disease, or surfactant deficiency lung disease. Despite the similar name, respiratory distress syndrome is not related to acute respiratory distress syndrome.

Causes of neonatal respiratory distress syndrome

Respiratory distress syndrome of the newborn usually occurs when the baby’s lungs do not produce enough surfactant, a protein and fat substance that helps maintain lung inflation and prevents them from collapsing. The fetal lungs usually start producing surfactant somewhere between 24 and 28 weeks of pregnancy. Most babies produce enough surfactant by 34 weeks to breathe on their own at birth at that time. If the baby is born earlier, then there is a high probability of insufficient production of surfactant. More often, respiratory distress syndrome affects premature babies, for example, when:

• mother has diabetes;
• the child is underweight;
• The child’s lungs are not developing properly.

Approximately half of all babies born between 28 and 32 weeks of gestation develop this pathology. In recent years, the number of premature babies born with respiratory distress syndrome has decreased due to steroid injections that can be given to mothers at risk of preterm birth.

Symptoms of respiratory distress syndrome

Symptoms of neonatal respiratory distress syndrome are often noticeable immediately after birth and worsen over the next few days. These may include:

• blue lips, fingers and toes of a newborn;
• rapid, shallow breathing;
• flaring nostrils;
• grunting sound when breathing.

Diagnosis of respiratory distress syndrome

A number of tests are used to diagnose neonatal respiratory distress syndrome and rule out other possible causes. These include:

• physical examination;
• blood tests to measure the amount of oxygen in the child’s blood and check for infection;
• pulse oximetry test to measure the amount of oxygen in a child’s blood using a sensor attached to a finger, toe, or ear;
• X-ray or CT scan of the chest to determine the characteristic cloudy appearance of the lungs in distress syndrome.

Treatment of respiratory distress syndrome

The main goal of treating respiratory distress syndrome is to help the child breathe.

Treatment before birth

If there is a high risk of preterm birth before 34 weeks of gestation, treatment for RDS may be started before delivery. For this, a single injection of steroids is performed, and then the second dose is administered 24 hours after the first. Steroids stimulate the development of the baby’s lungs and the production of surfactant. Treatment is estimated to help prevent respiratory distress syndrome in a third of preterm births. The patient may also be offered magnesium sulfate to reduce the risk of developmental problems associated with early birth. If the course of treatment with magnesium sulfate is more than 5-7 days or is carried out several times during pregnancy, then additional examinations may be offered to the newborn child. This is because long-term use of magnesium sulfate during pregnancy rarely leads to bone problems in newborns.

Postpartum care

A newborn with respiratory distress syndrome may be transferred to a specialized unit for premature babies (neonatal unit). If the symptoms are mild, he may only need supplemental oxygen. It is usually injected into the nose through an incubator or through a tube. If the symptoms are more severe, the child will be put on a breathing machine (ventilator) to either support or take over his breathing. These procedures are often started immediately in the delivery room before transfer to the neonatal unit. Also, a child with respiratory distress syndrome may be given a dose of artificial surfactant through a breathing tube. Evidence suggests that early treatment within 2 hours of delivery is more effective than if it is delayed. Distressed children will also be given fluids and food through a tube connected to a vein. Some will only need help with breathing for a few days, but some premature babies, usually born earlier, may need support for weeks or even months. The length of a baby’s stay in the neonatal unit will depend on how early he was born and what his condition is.

Complications of neonatal respiratory distress syndrome

Most infants with respiratory distress syndrome can be successfully treated, although they remain at an increased risk of developing other problems later in life.

Sometimes air can escape from the child’s lungs and accumulate in the child’s chest. This condition is called pneumothorax. The air pocket puts extra pressure on the lungs, causing them to collapse and leading to additional breathing problems. Air leaks can be repaired by inserting a tube into the chest to allow entrapped air to escape.

Distressed infants have a significantly increased risk of bleeding inside the lungs (pulmonary hemorrhage) and the brain (cerebral hemorrhage). Pulmonary bleeding is treated with air pressure from a ventilator to stop it and a blood transfusion. Cerebral hemorrhage is quite common in premature babies, but most bleeding is mild and does not cause long-term problems.

Occasionally, ventilation started within 24 hours of birth or a surfactant used to treat respiratory distress syndrome causes scarring of the baby’s lungs, which affects their development. This complication is called bronchopulmonary dysplasia. Symptoms of dysplasia include rapid shallow breathing and shortness of breath. Babies with a severe complication like this usually need supplemental oxygen through their nose to help them breathe. Supplemental oxygen support is usually needed for several months while the lungs heal. But some children with bronchopulmonary dysplasia may need regular medications, such as bronchodilators, to widen the airways and make breathing easier.

If a child’s brain is damaged as a result of the development of respiratory distress syndrome, either due to bleeding or lack of oxygen, all this can lead to long-term developmental disabilities, such as learning difficulties, movement problems, hearing impairment and vision. But these developmental problems are usually not serious. For example, a study found that 3 out of 4 children with developmental problems have only mild disabilities, which should not prevent them from leading a normal adult life.

Author: Belyakov Nikolai Grigorievich

Specialization: Pediatrician

Where does the reception: Clinic General Medical Center (GMC), St. Petersburg

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