Chest x-ray made easy by Jonathan Corne; Kate Pointon

By Jonathan Corne; Kate Pointon

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14 Fibrosis . . . . . . 15 Chickenpox pneumonia . 16 Miliary shadowing . . . 1 Collapse Collapse of a lung is an important cause of a white lung on X-ray. When confronted with a white lung it is important to be thorough in looking for the features suggestive of collapse since the presence of collapse indicates possible serious pathology. Collapse of the lung leads to a loss of volume of that part of the lung and so the normal radiological landmarks will be distorted. To diagnose collapse look at each of these markings carefully and decide whether they are in the correct position.

On the right the major fissure separates the lower lobe from the rest of the lung and the minor fissure separates the upper and middle lobes. The minor fissure can be difficult to spot. 4. Now look at the edge of the lungs. You should not be able to see normal pleura, as it is so thin; if there is density here, it must be abnormal. 5. Being able to identify the bronchi is important as it confirms which lobe any pathology lies within, but also remember to look inside the bronchi themselves, as there may be a tumour or an aspirated foreign body.

2. Look at the borders of the lesion. If the lesion is next to a dense (white) structure then the border between the lesion and that structure will be lost – this is called the silhouette sign. Therefore if the lesion is in the right lung and obscures part of the heart border it must be in the right middle lobe. If it obscures the border of the diaphragm it is in the right lower lobe. If the lesion is not going to be localized by CT, then a lateral film will be needed. Using the lateral, if the lesion is in the right lung: 1.

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