Radiological Differential Diagnosis of Chest Diseases

Radiological Differential Radiological Differential Diagnosis of Chest Diagnosis of Chest

DiseasesDiseasesAn Incomplete ListAn Incomplete List

Devesh ChauhanDevesh Chauhan

Anterior Mediastinal Anterior Mediastinal MassesMasses

•ThymomaThymoma•TeratomaTeratoma•Sub-sternal thyroidSub-sternal thyroid•LymhomaLymhoma

Opacified HemithoraxOpacified Hemithorax

• AtelectasisAtelectasis

• PneumoniaPneumonia

• Pleural effusionPleural effusion

• Post-pneumonectomyPost-pneumonectomy

PneumomediastinumPneumomediastinum

• Ruptured esophagus.Ruptured esophagus.

• Ruptured trachea/bronchus.Ruptured trachea/bronchus.

• Iatrogenic.Iatrogenic.

• Asthma.Asthma.

• Pneumoperitoneum.Pneumoperitoneum.

Acute Alveolar Acute Alveolar InfiltrateInfiltrate

• Pulmonary edemaPulmonary edema• Pneumonia Pneumonia • AspirationAspiration• HemorrhageHemorrhage

Chronic Alveolar DiseaseChronic Alveolar Disease

–Alveolar cell carcinoma.Alveolar cell carcinoma.

–Alveolar sarcoid.Alveolar sarcoid.

–Lymphoma.Lymphoma.

–Alveolar Proteinosis.Alveolar Proteinosis.

Large Cavitary Lung LesionLarge Cavitary Lung Lesion

• AbscessAbscess

• Carcinoma.Carcinoma.

• Tuberculosis.Tuberculosis.

Bibasilar Interstitial DiseaseBibasilar Interstitial Disease

• Bronchiectasis.Bronchiectasis.

• AspirationAspiration

• Desquamative Interstitial Pneumonitis Desquamative Interstitial Pneumonitis (DIP).(DIP).

• Asbestosis.Asbestosis.

• Sickle Cell Disease.Sickle Cell Disease.

• Scleroderma.Scleroderma.

Upper Lobe DiseaseUpper Lobe Disease

• Post primary Tuberculosis.Post primary Tuberculosis.

• Silicosis.Silicosis.

• Eosinophilic Granuloma.Eosinophilic Granuloma.

• Ankylosing Spondylitis.Ankylosing Spondylitis.

Micro-nodular Lung DiseaseMicro-nodular Lung Disease

• Metastasis.Metastasis.

• Sarcoid.Sarcoid.

• Pneumoconiosis.Pneumoconiosis.

• Miliary Tuberculosis.Miliary Tuberculosis.

Chronic Interstitial DiseaseChronic Interstitial DiseasePulmonary Fibrosis

• Pneumoconiosis.Pneumoconiosis.

• Interstitial Pneumonia.Interstitial Pneumonia.

• Granulomatous Disease.Granulomatous Disease.

• Neoplastic disease.Neoplastic disease.

• Idiopathic fibrosis.Idiopathic fibrosis.

• Collagen vascular diseaseCollagen vascular disease

Small Cavitary Lung LesionsSmall Cavitary Lung Lesions

• Septic emboli.Septic emboli.

• Rheumatoid nodules.Rheumatoid nodules.

• Squamous or transitional cell Squamous or transitional cell metastasis.metastasis.

• Wegener’s Granulomatosis.Wegener’s Granulomatosis.

Lymphangitic Spread to the LungsLymphangitic Spread to the Lungs

• Lung Carcinoma.Lung Carcinoma.

• Breast Carcinoma.Breast Carcinoma.

• Stomach Carcinoma.Stomach Carcinoma.

• Pancreas carcinoma.Pancreas carcinoma.

• Laryngeal Carcinoma.Laryngeal Carcinoma.

• Cervical Carcinoma.Cervical Carcinoma.

Multiple Lung NodulesMultiple Lung Nodules

• Metastasis.Metastasis.

• Wegener’s granulomatosis.Wegener’s granulomatosis.

• Rheumatoid nodules.Rheumatoid nodules.

• Arterio-venous malformations.Arterio-venous malformations.

• Septic emboliSeptic emboli.

Pulmonary Interstitial EdemaPulmonary Interstitial Edema

• Congestive heart failure.Congestive heart failure.

• Lymphangitic spread.Lymphangitic spread.

• Allergic reaction.Allergic reaction.

Shifting InfiltratesShifting Infiltrates

• Loeffler’s Syndrome.Loeffler’s Syndrome.

• Allergic broncho-pulmonary Allergic broncho-pulmonary Aspergilosis.Aspergilosis.

• Asthma.Asthma.

• Polyarteritis.Polyarteritis.

• Viral Pneumonia.Viral Pneumonia.

Unilateral Hyperlucent Lung.Unilateral Hyperlucent Lung.

• Swyer-James syndrome.Swyer-James syndrome.

• Pulmonary embolism.Pulmonary embolism.

• Pneumothorax.Pneumothorax.

• Obstructive Emphysema.Obstructive Emphysema.

Rapidly Clearing Alveolar InfiltrateRapidly Clearing Alveolar Infiltrate

• Hemorrhage.Hemorrhage.

• Pulmonary edema.Pulmonary edema.

• Aspiration.Aspiration.

• Pneumococcal pneumonia.Pneumococcal pneumonia.

Cavitating PneumoniaCavitating Pneumonia

• Staphylococcus.Staphylococcus.

• Streptococcus.Streptococcus.

• Mycobacterium Tuberculosis.Mycobacterium Tuberculosis.

• Gram negative (Klebsiella).Gram negative (Klebsiella).

Middle Mediastinal MassesMiddle Mediastinal Masses

• Lymphadenopathy.Lymphadenopathy.

• Aneurysm.Aneurysm.

• Esophageal Duplication.Esophageal Duplication.

• Bronchogenic cysts.Bronchogenic cysts.

Masses with Air BronchogramMasses with Air Bronchogram

• Lymphoma.Lymphoma.

• Alveolar cell carcinoma.Alveolar cell carcinoma.

• Pseudolymphoma (MALToma – Mucosa Pseudolymphoma (MALToma – Mucosa associated pseudolymphoma)associated pseudolymphoma)

Hilar LymphadenopathyHilar Lymphadenopathy

• Sarcoidosis.Sarcoidosis.

• Tuberculosis.Tuberculosis.

• Lymphoma.Lymphoma.

• Bronchogenic Carcinoma.Bronchogenic Carcinoma.

• MetastasisMetastasis.

Cavities Containing MassesCavities Containing Masses

• Aspergillosis.Aspergillosis.

• Cavitating bronchogenic carcinoma.Cavitating bronchogenic carcinoma.

• Tuberculosis.Tuberculosis.

• Hydatid Cyst.Hydatid Cyst.

Infiltrates with EffusionInfiltrates with Effusion

• Staph Pneumonia.Staph Pneumonia.

• Strep Pneumonia.Strep Pneumonia.

• TB.TB.

• Pulmonary Infarct.Pulmonary Infarct.

Mass + ipsilateral Mass + ipsilateral LymphadenopathyLymphadenopathy

• Bronchogenic Carcinoma.Bronchogenic Carcinoma.

• Lymphoma.Lymphoma.

• TB.TB.

Solitary Pulmonary NoduleSolitary Pulmonary Nodule

• Bronchogenic Carcinoma.Bronchogenic Carcinoma.• Hamartoma.Hamartoma.• Histoplasmoma.Histoplasmoma.• TB Granuloma.TB Granuloma.• Bronchial Adenoma.Bronchial Adenoma.• Solitary Metastasis.Solitary Metastasis.• Round Pneumonia.Round Pneumonia.• Rounded atelectasis.Rounded atelectasis.

Pleural EffusionPleural Effusion

• CHF.CHF.• Metastasis.Metastasis.• Pancreatitis.Pancreatitis.• Pulmonary embolism.Pulmonary embolism.• Trauma.Trauma.• Empyema.Empyema.• Collagen Vascular Disease.Collagen Vascular Disease.• Ovarian Tumor (Meig’s Syndrome).Ovarian Tumor (Meig’s Syndrome).• Chylothorax.Chylothorax.

LT sided Pleural EffusionLT sided Pleural Effusion

• Boerhaave’s Syndrome.Boerhaave’s Syndrome.

• Dissecting Aortic aneurysm.Dissecting Aortic aneurysm.

• Pancreatitis.Pancreatitis.

• Distal thoracic duct rupture.Distal thoracic duct rupture.

Multiple Small CalcificationsMultiple Small Calcifications

• Histoplasmosis.Histoplasmosis.

• Silicosis.Silicosis.

• Chicken pox pneumonia.Chicken pox pneumonia.

• Metastatic calcification.Metastatic calcification.

• Secondary Amyloidosis.Secondary Amyloidosis.

• Alveolar Microlithiasis.Alveolar Microlithiasis.

Posterior Mediastinal MassesPosterior Mediastinal Masses

• Neurogenic Tumors.Neurogenic Tumors.

• Lymphadenopathy.Lymphadenopathy.

• Extra-medullary hematopoesis.Extra-medullary hematopoesis.

Mediastinal AdenopathyMediastinal Adenopathy

• Bronchogenic Carcinoma.Bronchogenic Carcinoma.

• Lymphoma.Lymphoma.

• TBTB

• Metastasis.Metastasis.

• Sarcoid.Sarcoid.

Lung disease & Rib DestructionLung disease & Rib Destruction

• Bronchogenic CA – Pancoast tumor.Bronchogenic CA – Pancoast tumor.

• Actinomycosis.Actinomycosis.

• Blastomycosis.Blastomycosis.

• Multiple myeloma.Multiple myeloma.

Pleural CalcificationPleural Calcification

• Old TB empyema.Old TB empyema.

• Asbestos exposure.Asbestos exposure.

• Hemothorax.Hemothorax.

Masses in Cardio-phrenic AngleMasses in Cardio-phrenic Angle

• Sequestration.Sequestration.

• Diaphragmatic hernia.Diaphragmatic hernia.

• Pericardial cyst.Pericardial cyst.

Unilateral Pulmonary EdemaUnilateral Pulmonary Edema

• Aspiration.Aspiration.

• Disease in other lung e.g. COPD.Disease in other lung e.g. COPD.

• Postural.Postural.

• Rapid expansion of pneumothorax.Rapid expansion of pneumothorax.

Reverse Pulmonary EdemaReverse Pulmonary Edema

• Eosinophilic lung disease, e.g. Eosinophilic lung disease, e.g. Loeffler’s .Loeffler’s .

• Sarcoidosis.Sarcoidosis.

• Pulmonary Contusions.Pulmonary Contusions.