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eFigure 9–19. Normal lung perfusion. A routine examination may include as many as eight views– anterior, posterior, right and left anterior and posterior obliques, and both right and left laterals (A to H). Some physicians prefer to omit the anterior obliques; others do not include the laterals. There is general agreement that the posterior obliques are the most valuable views. When the patient is injected in the supine position, the radioactive particles are evenly distributed throughout the lungs, with a gently increasing gradient of activity from the upper anterior to the lower posterior lung fields. The cardiac and mediastinal spaces between the lungs have a configuration in the combined anterior and posterior views similar to that of the respective area in the posteroanterior CXR. Cardiomegaly and mediastinal masses will cause distortions that are common to both examinations. An enlarged cardiac space may be caused by cardiomegaly and by effusions or other conditions of the pericardial sac and adjacent pleural cavity. If the patient is rotated, the lung images may override and cause a false defect, which will disappear when the patient is repositioned accurately. However, a true lesion is unlikely if seen in only one view of a complete study. (Reproduced, with permission, from Baum S et al. Atlas of Nuclear Medicine Imaging, 2nd ed. Originally published by Appleton & Lange. Copyright © 1992 by The McGraw-Hill Companies, Inc.) A normal lung perfusion scan shows normal perfusion in six different views of the lungs.

Current Medical Diagnosis & Treatment 2024 > Pulmonary Venous Thromboembolism

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eFigure 9–24. Radiation-induced pulmonary fibrosis. CXR of a patient who underwent mediastinal irradiation for Hodgkin lymphoma. Notice the classic geographic distribution of fibrosis centered around the mediastinal radiation port. Radiation-induced pulmonary fibrosis is sometimes, but not always, preceded by radiation pneumonitis. A chest radiograph shows leads on a patient's chest and fibrosis centered around this region.

Current Medical Diagnosis & Treatment 2024 > Radiation Lung Injury

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eFigure 9–27. Early tension pneumothorax. The right lung is collapsed, and no vessels can be seen traversing the right hemithorax. The mediastinum is shifted slightly to the left. These are features of a large pneumothorax, with some tension component causing a shift of the mediastinum. An image shows that the right lung is collapsed and the mediastinum is shifted to the left.

Current Medical Diagnosis & Treatment 2024 > Pneumothorax

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eFigure 10–23. A: The ascending aorta (yellow dotted line) leading into the arch is dilated, whereas the distal arch and descending aorta (red dotted line) are normal in size. The left heart border (blue dotted line) can be traced upwards along the mediastinum to blend with the aortic arch, explaining why the medial (left) border of the ascending aorta is not visible on radiographs. B: CTA of the thorax confirms enlargement of the ascending aorta with a normal caliber descending aorta. Source: https://radiopaedia.org/cases/aortic-valve-stenosis-1. Case used with permission from Dr. Frank Gaillard, Radiopaedia.org, rID: 15391. Copyright 2020 Dr. Frank Gaillard. Used under license. A chest x ray reveals an enlarged ascending aorta, while the descending aorta appears normal. A chest x ray in the lateral view, reveals an enlarged ascending aorta, and a normal sized descending aorta.

Current Medical Diagnosis & Treatment 2024 > Valvular Heart Disease

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eFigure 10–23. A: The ascending aorta (yellow dotted line) leading into the arch is dilated, whereas the distal arch and descending aorta (red dotted line) are normal in size. The left heart border (blue dotted line) can be traced upwards along the mediastinum to blend with the aortic arch, explaining why the medial (left) border of the ascending aorta is not visible on radiographs. B: CTA of the thorax confirms enlargement of the ascending aorta with a normal caliber descending aorta. Source: https://radiopaedia.org/cases/aortic-valve-stenosis-1. Case used with permission from Dr. Frank Gaillard, Radiopaedia.org, rID: 15391. Copyright 2020 Dr. Frank Gaillard. Used under license. A chest x ray reveals an enlarged ascending aorta, while the descending aorta appears normal. A chest x ray in the lateral view, reveals an enlarged ascending aorta, and a normal sized descending aorta.

Current Medical Diagnosis & Treatment 2024 > Valvular Heart Disease

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