The American Association for the Surgery of Trauma (AAST) injury scoring scales are the most widely accepted and used system of classifying and categorising traumatic injuries. Injury grade reflects severity, guides management, and aids in prognosis. At the time of writing (mid 2016), 32 differe...
Aberrant left pulmonary artery, also known as pulmonary sling, represents an anatomical variant characterised by the left pulmonary artery arising from the right pulmonary artery and passing above the right main bronchus and in between the trachea and oesophagus to reach the left lung. It may le...
Aberrant right subclavian arteries (ARSA), also known as arteria lusoria, are the commonest of the aortic arch anomalies 2.
The estimated incidence is 0.5-2%.
They are often asymptomatic, but around 10% of people may complain of tracheo-oesophageal symptom...
Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core consisting of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessel...
Accessory fissures of the lung usually occur at the borders of bronchopulmonary segments. They are common normal variants but are less commonly seen on imaging.
Some of the more common accessory fissure include 1:
azygos fissure: most commonly seen accessory fissure
inferior accessory fissur...
The accessory (or superior) hemiazygos vein forms part of the azygos system and along with the hemiazygos vein, it is partially analogous to the right-sided azygos vein. It drains the left superior hemithorax.
Origin and course
The accessory hemiazygos vein is formed by the con...
The accessory phrenic nerve is an anatomical variant seen in a little over one third of patients (36%). It most commonly arises from the ansa cervicalis, or slightly less commonly, the subclavian nerve. It is unknown as to how much the accessory phrenic nerve contributes to diaphragmatic functio...
Achalasia (primary achalasia) is a failure of organised oesophageal peristalsis causing impaired relaxation of the lower oesophageal sphincter, and resulting in food stasis and often marked dilatation of the oesophagus.
Obstruction of the distal oesophagus from other non-functional aetiologies...
Acinar predominant adenocarcinoma of lung is a pathological subtype of adenocarcinoma of the lung.
Acinar patterns are thought to have an intermediate prognosis but better than those associated with micropapillary, mucinous/colloid, and solid patterns and worse than those with lepidi...
Acinic cell carcinoma of the lung (also known as a Fechner tumour) is a type of lung carcinoma of the salivary gland type. It is extremely rare, especially when it presents in the form of primary acinic cell carcinoma.
Histologically, they are comprised of clear cells with abundant g...
Acute airspace opacification with lymphadenopathy is a subset of the differential diagnosis for generalised airspace opacification and includes:
post-obstructive causes (usually chronic, but 'new' changes can occur)
primary lung cancer
Acute aspiration pneumonitis refers to a form aspiration pneumonia where the time of onset is rapid.
Plain radiograph / CT
Features can be variable and can range from a pulmonary oedema pattern to areas of consolidation. These changes may have a gravity dependent distrib...
Acute bilateral airspace opacification is a subset of the larger differential diagnosis for airspace opacification. An exhaustive list of all possible causes of acute bilateral airspace opacities is long, but a useful way to consider the huge list is via the material within the airways:
Acute coronary syndrome (ACS) is a group of cardiac diagnoses along a spectrum of severity due to the interruption of coronary blood flow to the myocardium, which in decreasing severity are:
ST elevation myocardial infarction (STEMI)
non-ST elevation myocardial infarction (non-STEMI)
Acute eosinophilic pneumonia (AEP) is a type of eosinophilic lung disease. It is diagnosed when the following combination clinical and radiographic findings occur 5,7:
febrile illness of less than five days' duration
diffuse alveolar or mixed alveolar-interstitial opacities on ches...
Acute hypersensitivity pneumonitis (AHP) refers to the acute form of hypersensitivity pneumonitis although this classification system has recently been challenged 4. For a general discussion of the condition, refer to the parent article.
Fever, chills, myalgia, headaches,...
Acute interstitial pneumonitis (AIP), also known as Hamman-Rich syndrome is a rapidly progressive non-infectious interstitial lung disease of unknown aetiology. It is considered the only acute process among the idiopathic interstitial pneumonias.
Truly idiopathic AIP tends to occu...
Acute lung transplant rejection is one of the early post lung transplant complications.
It can occur as several episodes and the first episode may occur early as 5 days after transplantation. The incidence is thought to peak at approximately 2 months post-transplantation (with sev...
Acute respiratory distress syndrome (ARDS) is a form of acute lung injury (ALI) and occurs as a result of a severe pulmonary injury that causes alveolar damage heterogeneously throughout the lung. It can either result from a direct pulmonary source or as a response to systemic injury.
Acute right heart syndrome (ARHS) is defined as a sudden deterioration in right ventricular (RV) function and failure of the RV to deliver adequate blood flow to the pulmonary circulation. This can result in systemic hypoperfusion.
ARHS can occur in several settings 1
in the setting...
Acute unilateral airspace opacification is a subset of the differential diagnosis for airspace opacification.
The exhaustive list of all possible causes would be huge, but a useful framework includes:
pus, i.e. infection
Adenocarcinoma in situ, minimally invasive adenocarcinoma and invasive adenocarcinoma of the lung are relatively new classification entities which replace the now-defunct term bronchoalveolar carcinoma (BAC).
In 2011 the International Association for the Study of Lung Cancer (IASLC) and several...
Adenocarcinoma in situ (AIS) of the lung refers to a relatively new entity for a pre-invasive lesion in the lung. This entity partly replaces the noninvasive end of the previous term bronchoalveolar carcinoma. Adenocarcinoma in situ is defined as a localised adenocarcinoma of <3 cm that exhibits...
Adenocarcinoma of the lung is one of the non-small cell carcinomas of the lung and is a malignant tumour with glandular differentiation or mucin production. This tumour exhibits various patterns and degrees of differentiation, including lepidic, acinar, papillary, micropapillary, and solid with ...
Adenoid cystic carcinomas are a rare histological subtype of adenocarcinoma.
Adenoid cystic carcinomas are generally considered low grade 4. The tumours have a notable tendency for perineural spread.
They have a wide distribution and mainly occur in relation to the airways...
Adenoid cystic carcinoma (ACC) of the lung is a type of non-small cell lung cancer. They are classified under lung carcinomas of the salivary gland type. Primary occurrence in the lung parenchyma is rare, while in the thorax they occur more commonly as adenoid cystic carcinoma of the tracheobron...
Adenoid cystic carcinomas of the tracheobronchial tree are a type of low-grade tracheal tumour. They are considered to be the second most common primary tumour of the trachea.
They are usually first recognised in patients in their 4th and 5th decades. There is no recognised gender...
Adenosquamous carcinoma (ASC) of the lung is a rare type of non-small cell lung cancer.
It is thought to constituting 0.4-4% of cases non-small cell lung cancer.
The definition of adenosquamous carcinoma indicates a carcinoma showing components of adenocarcinoma and sq...
Adult chest radiograph common exam pathology is essential to consider in the build up to radiology exams. The list of potential diagnoses is apparently endless, but there are some favourites that seem to appear with more frequency.
When dealing with the adult chest radiograph in the exam settin...
A chest radiograph in the exam setting may contain a vast variety of pathology. However, consider the history and correlate the likely diagnoses that may be demonstrated on film. Furthermore, check your review areas to ensure that the abnormality isn't at the corner of the film.
The adult chest radiograph pathology checklist is just a pathology checklist of things not to miss when reviewing a chest radiograph, especially in the exam setting.
standard review areas
below the diaphragm
right descending pulmonary artery (like a l...
There are a number of adult chest radiograph set-pieces. These are based on common patterns of disease that are seen on chest radiographs. Make sure that you have relevant differentials for these appearances and a quick aural set-piece for them when they come up.
Aflatoxins are naturally occuring mycotoxins that are produced by Aspergillus species, especially Aspergillus flavus. They are acutely toxic and carcinogenic.
High-level aflatoxin exposure can result in acute aflatoxicosis with acute hepatic necrosis, leading to cirrhosis, and p...
Agenesis of the diaphragm is a congenital diaphragmatic developmental anomaly where all or part of diaphragm fails to form. It can sometimes be thought of as an extreme form congenital diaphragmatic herniation 1.
The agenesis can either be unilateral or bilateral. Herniation of abdom...
AIDS-defining illnesses are conditions that in the setting of a HIV infection confirm the diagnosis of AIDS, and do not commonly occur in immunocompetent individuals 2. According to the CDC surveillance case definition 1, they are:
bacterial infections: multiple or recurrent
AIDS-related pulmonary lymphoma (ARPL) is classified as a distinct form of pulmonary lymphoma. Pulmonary involvement is a common extranodal site in AIDS-related NHL.
ARPL is typically a high-grade B-cell non-Hodgkin's lymphoma and the majority of patients have advanced HIV infection,...
Air bronchogram refers to the phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli. Air bronchograms will not ...
This is a basic article for medical students and other non-radiologists
Air-bronchograms are gas-filled bronchi surrounded by alveoli filled with fluid, pus or other material. It is a very useful sign because it is highly sensitive and specific for the presence of lung consolidation rather than...
An air crescent sign describes the crescent of air that can be seen in invasive aspergillosis, semi-invasive aspergillosis or other processes that cause pulmonary necrosis. It usually heralds recovery and is the result of increased granulocyte activity.
In angioinvasive fungal infection, the no...
Air space disease, or alveolar lung disease, is a process in which there is a filling of the lung's alveoli / acini.
lobar or segmental distribution
tendency to coalesce
bat's wing (butterfly) distribution...
An air space nodule is a small (few millimeters to 1 cm), ill-defined, nodular opacity that is often centrilobular in location and is non-specific, seen in many conditions. Commonly it represents a focal area of consolidation or peribronchiolar inflammation, and can indicate endobronchial spread...
Airspace nodules are irregularly marginated nodular opacities with air bronchograms that tend to measure 8 mm in diameter. They are quite separate from pulmonary nodules that range in size, are homogeneous and well-defined (being surrounded by normal lung).
Air space opacification is a descriptive term that refers to filling of the pulmonary tree with material that attenuates x-rays more than the surrounding lung parenchyma. It is one of the many patterns of lung opacification and is equivalent to the pathological diagnosis of pulmonary consolidati...
This is a basic article for medical students and other non-radiologists
Air-space opacification is a descriptive term that refers to filling of the lung parenchyma with material that attenuates x-rays more than the unaffected surrounding lung tissue. It is the radiological correlate of the path...
The differential for air space opacities is extensive, and needs to be interpreted in context of chronicity (previous imaging) and clinical context. It is therefore useful to divide airspace opacities as follows:
acute airspace opacities with lymph node enlargement
acute airspace opacities: un...
Air trapping in chest imaging refers to retention of excess gas (“air”) in all or part of the lung, especially during expiration, either as a result of complete or partial airway obstruction or as a result of local abnormalities in pulmonary compliance. It may also sometimes be observed in norma...
Airway foreign bodies in children are potentially fatal, which is why immediate recognition is important. Unfortunately, delayed diagnosis is common.
Children under the age of four years are at increased risk of foreign body (FB) aspiration, with a slight male predominance 1.
Airway invasive aspergillosis refers to a form of invasive aspergillosis that affects the airways as the major or only feature.
It usually occurs in immunocompromised neutropenic patients, particularly AIDS patients. Aspergillosis affecting the airways as the major or only feature...
Airway pressure release ventilation (APRV) is an alternative mode for mechanical ventilation. It can be adopted as a method of alternative method for difficult-to-oxygenate patients with acute lung injury / acute respiratory distress syndrome (ALI/ARDS).
Its is usually not recommended in patien...
Allergic bronchopulmonary aspergillosis (ABPA) is at the mild end of the spectrum of disease caused by pulmonary aspergillosis and can be classified as an eosinophilic lung disease 2-4.
This entity is most commonly encountered in patients with longstanding asthma, and only occasio...
All-trans retinoic acid (ATRA) syndrome (more recently known as differentiation syndrome (DS)8) is a condition that can occur with patients with acute promyelocytic leukaemia who are on therapeutic all-trans-retinoic acid (ATRA).
All-trans-retinoic acid (ATRA) is a normal constituent of plasma....
Alpha-1-antitrypsin (A1AT) deficiency is a hereditary metabolic disorder and is the most common genetic cause of emphysema and metabolic liver disease in children. It results in the unopposed action of neutrophil elastase and subsequent severe basal pan lobular emphysema and respiratory symptoms...
Alveolar sarcoidosis is an atypical pulmonary manifestation of sarcoidosis.
This appearance may be apparent in approximately 4% of those with pulmonary sarcoidosis on plain film 1 and up to 15% on CT 2.
This appearance is thought to result from the aggregation of a va...
The alveoli are tiny hollow air sacs that comprise the basic unit of respiration.
Alveoli are found within the lung parenchyma and are found at the terminal ends of the respiratory tree, clustered around alveolar sacs and alveolar ducts. Each alveolus is approximately 0.2 mm in ...
Amiodarone lung is an interstitial lung disease seen in patients being administered amiodarone and can manifest in a number of histopathologic patterns.
The reported prevalence of pulmonary toxicity in the patients receiving amiodarone is ~10% (range 2-18%) 8.
Patients are usuall...
Amniotic fluid embolism is a special type of pulmonary embolism where the embolus is comprised of amniotic fluid. It can be a highly fatal complication of pregnancy, with an 80% maternal mortality rate.
It is thought to complicate 1/8000-80,000 pregnancies.
The anatomy curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core anatomy knowledge for radiologists and imaging specialists.
Head and neck anatomy
Abdominal and pelvic anatomy
Angioinvasive aspergillosis is the most severe and aggressive form of invasive aspergillosis. It is a life-threatening condition that requires prompt treatment. Fortunately, it is not seen in the general population and only occurs in profoundly immunocompromised patients.
Angiosarcoma involving the lung includes:
metastatic angiosarcoma to lung 1
usual primary sites include the heart and breast 2
primary pulmonary angiosarcoma: very rare
Thoracic manifestations of ankylosing spondylitis can be varied. For a general discussion of the condition refer to the parent article on ankylosing spondylitis.
It can affect the tracheobronchial tree and the lung parenchyma, and the disease spectrum includes:
upper lobe fibrocystic changes -...
Anomalous systemic arterial supply to normal lung is an anatomical variant where a portion of the lung (usually a basal segment) gets supplied by a systemic vessel without a distinct pulmonary sequestration.
It was traditionally (perhaps inappropriately since not a true sequestrati...
Anorexia nervosa is a psychiatric disorder characterised by distorted self-perception of body weight leading to starvation, obsession with remaining underweight, and an excessive fear of gaining weight. One in five patients with anorexia dies, due to complications of the disease.
The anterior bronchus sign refers to the appearance of the anterior segmental bronchus of the upper lobes as seen on a frontal chest radiograph.
The anterior segment bronchus of the upper lobes courses anteriorly and laterally. When the orientation is predominantly anteriorly th...
The anterior junction (junctional) line is a feature of frontal chest x-rays and chest CTs. It is a result of the parietal and visceral pleura meeting anteromedially. It normally contains a small amount of fat but can form a stripe of variable thickness if there is a lot of fat present or by the...
Germ cell tumours are one of the causes of anterior mediastinal mass, and any of the germ cell histologies may be identified. They can therefore be divided histologically into:
non-seminomatous germ cell tumours (NSGCT)
embryonal cell carcinoma
yolk sac tumour
Getting a film with an anterior mediastinal mass in the exam is one of the many exam set-pieces that can be prepared for.
The film goes up and after a couple of seconds pause, you need to start talking:
There is a left sided mediastinal mass that makes obtuse angles with the mediastinal c...
The anterior mediastinum is the portion of the mediastinum anterior to the pericardium and below the thoracic plane.
It forms the anterior part of the inferior mediastinum, and contains the thymus, lymph nodes, and may contain the portions of a retrosternal thyroid.
The common causes of an anterosuperior mediastinal mass can be remembered by using the mnemonic:
T: thoracic aorta
T: terrible lymphoma
T: teratoma and germ cell tumours - see mediastinal germ cell tumours
Testicular cancer metastasis can represent a si...
Anti-neutrophil cytoplasmic antibody-associated vasculitides refer to a group of heterogeneous autoimmune diseases characterized by necrotising vasculitides and positive anti-neutrophil antibody titres. They are reactive to either proteinase-3 (PR3-ANCA) - cANCA or myeloperoxidase (MPO-ANCA) - p...
Antiphospholipid syndrome is a systemic autoimmune disorder. It is usually defined as the clinical complex of vascular occlusion and ischaemic events occurring in patients who have circulating antiphospholipid antibodies.
Patients have circulating antiphospholipid antibodies cross-re...
Pulmonary involvement in antiphospholipid syndrome is one of the most frequent arterial complications of antiphospholipid syndrome.
It is essentially related to pulmonary arterial microthrombosis and may cause a wide spectrum of conditions, which include 3-5:
Anti-synthetase syndrome (ASS) is a systemic, inflammatory, autoimmune disease that is characterised by inflammatory myositis, polyarthritis associated with interstitial lung disease (ILD) and anti-synthetase autoantibodies.
ASS can result from autoantibodies to eight of the aminoacy...
The aortic arch represents the direct continuation of the ascending aorta and represents a key area for a review of normal variant anatomy and a wide range of pathological processes that range from congenital anomalies to traumatic injury.
origin: continuation of the ascending aorta at...
Aortic dissection is the most common form of the acute aortic syndromes and a type of arterial dissection. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within th...
The aortic dissection detection risk score (ADD-RS) is a clinical decision tool that aids in grading the pretest probability of an acute aortic dissection. Scores range from 0-3, where 0 is classed as low risk, 1 is moderate risk and 2-3 is high risk 1.
The three domains in which pati...
The use of the aortic dissection detection risk score plus d-dimer is a proposed standardised strategy of safely ruling out the diagnosis of an acute aortic syndrome. Similar to how the pulmonary embolism rule-out criteria (PERC) negates the need for further workup of a pulmonary embolism.
The aortic hiatus is one the three major apertures through the diaphragm and lies at the level of T12. Strictly speaking, it is not a real aperture in the diaphragm, but an osseoaponeurotic opening between it and the vertebral column.
The hiatus is situated slightly to the left of the midline ...
Aortic intramural haematoma (IMH) is an atypical form of aortic dissection due to haemorrhage into the wall from the vasa vasorum without an intimal tear. It is part of the acute aortic syndrome spectrum.
Typically aortic intramural haematomas are seen in older hypertensive patien...
The aortic knob or knuckle refers to the frontal chest x-ray appearance of the distal aortic arch as it curves posterolaterally to continue as the descending thoracic aorta. It appears as a laterally-projecting bulge, as the medial aspect of the aorta cannot be seen separate from the mediastinum...
An aortic nipple is seen in about 10% of PA chest x-rays on the lateral surface of the aortic arch/aortic knob. It represents the left superior intercostal vein.
When prominent, superior vena cava obstruction should be considered as the left superior intercostal vein serves as a collateral path...
The aortic-pulmonary stripe is an uncommon feature of frontal chest x-rays and was first described by Keats in 1972 1.
It is formed by the interface of the pleural surface of the anterior segment of the left upper lobe contacting the mediastinal fat that is anterolateral to the pulmonary trunk ...
An aortic transection (also known as a traumatic aortic rupture) is a type of traumatic aortic injury. It is considered the second most common cause of death associated with motor vehicle accidents.
It occurs from a near-complete tear through "all the layers" of the aorta due to tra...
Aortopulmonary septal defect (APSD), also known as aortopulmonary window (APW), is a congenital anomaly where there is an abnormal communication between the proximal aorta and the pulmonary trunk in the presence of separate aortic and pulmonary valves.
APSD should not be confused w...
The aortopulmonary (aortic-pulmonary or AP) window is a radiological mediastinal space seen on frontal chest x-rays.
The term "aortopulmonary window" can also refer to a rare form of congenital heart disease, where there is an opening between the aorta and the pulmonary trunk 4. It...
A handy mnemonic to remember common apical lung diseases is:
SET CARP or CARPETS
E: eosinophilic pneumonia
C: cystic fibrosis
A: ankylosing spondylitis
R: radiation pneumonitis
Apical pleural cap refers to a curved density at the lung apex seen on chest radiograph.
The frequency of apical pleural thickening increases with age 3.
It arises from a number of causes:
idiopathic: chronic ischaemic aetiology is favoure...
The apical zone is one of the four chest radiograph zones and an important location for missed diagnoses when reporting a frontal chest radiograph and makes up one of the "check areas". It is sometimes thought of as a subdivision of the upper zone.
Asbestos is a set of six naturally occurring silicate minerals from mixture of calcium magnesium, iron, and sodium exploited commercially for their desirable physical properties, particularly their resistance to heat and burning. They all form thin elongated fibrous crystals, and can be manufact...
An asbestos body is a histological finding in interstitial lung disease that is suggestive of significant occupational asbestos exposure. They are usually identified following a parenchymal lung biopsy 3.
Macrophage ingestion of the asbestos fibres triggers a fibrogenic response via the release...
Asbestosis refers to later development of diffuse interstitial fibrosis secondary to asbestos fibre inhalation and should not be confused with other asbestos related diseases.
Asbestosis typically occurs 10-15 years following the commencement of exposure to asbestos and is dose re...
Asbestos related benign pleural disease forms a large part of asbestos related lung changes.
The spectrum comprises of:
pleural effusions: benign-asbestos induced pleural effusions
can be associated with functional impairment
usually occur within 10 years of exposure but can also develop muc...
Asbestos related disease, in particular affecting the lung, comprise of a broad spectrum of entities related to the inhalational exposure to asbestos fibres. They can be divided into benign and malignant changes 1-3.
Benign pleural and parenchymal lung disease
asbestos related benign pleural d...
Ascariasis is due to infection with the Ascaris lumbricoides adult worm and typically presents with gastrointestinal or pulmonary symptoms, depending on the stage of development.
Ascaris lumbricoides is widely distributed in tropical and subtropical regions and in other humid ar...