EMQ practice - Chest Radiograph Pathology

Chest radiograph pathology

• Multiple bilateral nodules between 0.5 and 5cm in a former miner with rheumatoid arthritis
• Caplan's syndrome
• Pulmonary manifestation of rheumatoid arthritis (RA) characterised by the presence of pulmonary nodules
• Patients have RA and are exposed to coal dust, or other dusts like silicosis and asbestos
• Cough, shortness of breath, and haemoptysis
• RA can also cause fibrosing alveolitis, pleural effusions, and obliterative bronchiolitis
• RA can also affect the cricoarytenoid joints leading to upper respiratory tract infection
• Kerley B lines, bat-wing shadowing, prominent upper lobe vessels, cardiomegaly
• Left ventricular failure
• Typical
• Trachea deviated to the right, horizontal fissure and right hilum displaced upwards
• Right lower lobe collapse
• Left lower lobe there is no elevation of the horizontal fissure because there IS no horizontal fissure
• Instead there is a hazy white appearance over a large part of the left lung field
• Numerous calcified nodules sized less than 5mm located predominantly in the lower zones of the lungs
• Previous varicella pneumonitis
• Multiple small, calcified nodules may occur after varicella pneumonitis
• Other causes include TB, histoplasmosis, and chronic renal failure
• Double shadow right heart border, prominent left atrial appendage, left main bronchus elevation
• Mitral stenosis
• Calcification of mitral valve may also be seen, as may pulmonary oedema
• Left ventricular enlargement absent despite pulmonary oedema