xray comments

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1-Plain X-ray Chest & heart Postero-anterior view(PA) showing:

Multiple osteolytic lesions on ribs & humerous & clavicle & fracture on rt . humerous due to hyperparathyroidism (hypercalcemia).

2-Fracture posterior end of right 6th-7th ribs

Plain X-ray Chest &heart Postero-anterior view(PA) showing:

Fracture of the posterior parts of 6th and 7th rib on the right side.

D: fracture ribs.

3-Bilateral cervical ribs (biforked ribs )

Plain X-ray Chest Postero-anterior view(PA) showing:

The first rib is bilaterally attached to transverse process of 7th cervical vertebrae which are directed downwards.

D:bilateral cervical rib.

اليمين على األسفل فى الغوايش

4-Bilateral gas under diaphragm

Plain X-ray Chest & heart Postero-anterior view(PA) showing:

Bilateral elevation of both copula of the diaphragm.

D: gas under diaphragm for D.D perforated viscus-pneumoperitoneium- gas forming organism

5-Bilateral gas (air) under diaphragm

Plain X-ray Chest & heart Postero-anterior view(PA) showing: Bilateral gas (air) under diaphragm, With normal position of the diaphragm at 10th rib posteriorly, ( Without elevation of both copula of the diaphragm ) due to perforated viscus.

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6-Elevated Left copula of the diaphragm


Unilateral elevation of the left copula of the diaphragm for D.D

-Diaph. Paralysis

-subphrenic abscess

-huge splenic mass

-huge gastric mass

7-Elevated Right copula of the diaphragm


Unilateral elevation of the right copula of the diaphragm for D.D

-unilateral diaphragmatic paralysis

-subphrenic abcess

-huge hepatic mass

8-Massive left-sided pleural effusion


Massive unilateral homogenous opacity in the left side (lung) & obliterating costophrenic angle with shift of mediastinum (trachea)to opposite (rt.)side

9-Right-sided hydropneumothorax with collapsed lung


Localized homogenous opacity at the lower zone of rt. Lung , obliterating rt. Costophrenic angle with fluid level & collapsed lung tissue at the hilum below & jet black hypertranslucency above

D: Rt. sided hydropneumothorax

10-Left encysted (localized) pleural effusion


Localized homogenous wedge shaped opacity at lateral aspect of the lt. Lung obliterating lt. Costophrenic angle & rising to axilla.

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11-Right middle lobe (localized) pneumonia (consolidation)


Localized homogenous wedge shaped opacity at medial aspect of lower zone the rt. Lung & with central mediastinum

D.D it from localized ( collapse or effusion or infarction).

12-Pulomnary embolism on rt lungPlain X-ray Chest Postero-anterior view(PA) showing:

Localized homogenous wedge (triangular) shaped opacity at lateral aspect of middle zone of the rt. Lung with peripheral base & central apex

13-Plain X-ray Chest Postero-anterior view(PA) showing :

Localized homogenous coin shaped opacity at the medial aspectof the lower zones of the right lung.

D.D localized pneumonia, carcinoma, adenoma, abscess, F.B,cyst.

14-Resolving pneumonia or bronchopneumonia in left middle lobe(correct comment for slide no. 14 in powerpoint )Plain X-ray Chest & heartPostero-anterior view(PA) showing:

massive heterogenous opacity taking middle & lower zones (most)(periphery) of the lt. Lung with central trachea

15-Cannon ball metastasesPlain X-ray Chest Postero-anterior view(PA) showing:

Homogenous large coin shaped opacities on medial aspect of the lower zone of rt lungis about 5cm & 2 at lt lung the 1st at the upper zone is about 10 cm & the 2nd at middle , lower zones is about 5-7 cm

16-Plain X-ray Chest Postero-anterior view(PA) showing: Multiple homogenous small rounded pinpoint opacities on both lung fields.

D.D.

Miliary T.B.

Sarcoidosis, pneumoconiosis

17-Apical fibrocavitary lesion


Multiple nonhomogeneous opacities of fibrocavitary lesion of different sizes giving picture of fluffy-cotton appearance on both apices of the lungs

Diagnosis: TB pulmonary fibrosis.

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18-Bilateral Emphysema and Emphsematous bullae


-bilateral and diffuse Jet Black hypertranslucency of lung shadows.

_with horizontal ribs and wide intercostal spaces.

-and bilateral depression of both copula of diaphragm

-with 2 large emphysematous bullae on the right side

D:Bilateral emphysema with bullae, differentiate from deep respiration


Jet black hyper translucency in Rt. Side e` collapsed lung in the hilum & trachea is shifted to the rt. side

Diagnosis-:

Rt. Side pneumothorax with lung collapse

20-Chronic lung abcessPlain X-ray Chest Postero-anterior view(PA) showing:

Localized translucency on medial aspect of lower zone of rt. Lung with very thick wall & fluid level

21-Chronic lung abcess


Localized translucency on lateral aspect of lower zone of rt. Lung with thick wall & fluid level

22-Multiple chronic lung (cavities) abcesses


Localized translucency on lateral aspect of lower zone of rt. Lung with thick wall.

Diagnosis: TB cavity

23-Honey-comb appearance of Bronchiectasis

Plain X-ray Chest & heart Postero-anterior view(PA)showing:

multiple small rounded translucency (cavities) equal on both sides at basal zones of both lungs giving picture of Honey-comb appearance

24-Aortic aneurysm and bilateral emphysema

Plain X-ray Chest & heart Postero-anterior view(PA)showing:

Fusiform swelling of superior mediastinum ( aortic aneurysm) & ribbon shaped heart and bilateral emphysema

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25-Trifestoned(TB) hilar lymphadenopathy


Multiple rounded small (tripple fused) trifestone opacities at hilum (medial aspect) of rt. Lung (called trifestones)

26-Artificial Pacemaker in right ventricle


Metallic F.B. attached by wire to the right side of the heart


Simple dextrocardia heart is on the right side

1-free costophrenic angles on both sides 3-Cardiophrenic angle on rt & lt side is acute 4-normal C/T ratio.

Abnormal site of the heart

1-the heart lies mainly to the rt side

2-the cardiac apex is on the rt side

3-lt border formed by rt atrium ,Rt. BORDER by pulm.artery, la ,lv

4-stomach is in normal site (gastric air bubbles on lt side)


Situs inversus totalis

Heart is shifted to Rt. Side equal in both side&

Trachea is central&

Gastric air bubble in the rightDiagnosis-:

Situsinversus totalis(fundus air on right side) اليمين الناحية على بالمعدة الموجود الهواء على ركز

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�(Same comment as above) Plain X-ray Chest & heart Postero-anterior view(PA) showing:

�1-free costophrenic angles on both sides 3-Cardiophrenic angle on rt & lt side is acute 4-normal C/T ratio

�Abnormal site of the heart

�1-the heart lies mainly to the rt side but equal in both side

�2-the cardiac apex is on the rt side

�3-lt border formed by rt atrium , rt by pa, la ,lv

�4-stomach is in abnormal site (gastric air bubbles on rt side)while liver shadow is on lt side

�29-Plain X-ray Chest & heart Postero-anterior view(PA) showing:

�Pericardialeffusion 1-Flask shape.

�2-Increase C/T ratio equally on both sides with broad cardiac base. 3-Well defined border of shadow(stenciled) with symmetrical bulge on both borders but cardiac borders are ill-defined & same density of the contour. 4-No double contour.

�5-free costophrenic angles on both sides

�6)Cardiophrenic angle on lt & rtside is acute

�7-normal pulmonary vascular markings .#Diagnosis :-Massive pericardial effusion To be D.D.Multivulular lesion &Dilated

cardiomyopathy.

اليمين على األعلى فى خطين عالمة�

� 30-Left ventricular enlargement

�Plain X-ray Chest & heart Postero-anterior view(PA) showing:1 -Huge Increase C/T ratio at both Rt. & Lt. side e` no double contour.

2-Obtuse Lt. cardio -phrenic angle.( Lt. V ++). 3-broad shaped heart

3-Prominent aortic Knuckle

Diagnosis-:

Cardiomegally due to Lt. ventricular & Rt. atrial enlargement.

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31-Plain X-ray Chest & heart Postero-anterior view(PA) showing:1-free costophrenic angles on both sides 3-Cardiophrenic angle on lt side is acute

4-increased C/T ratio . 4-bulge of lt & rt borders of the heart & double contour ,not prominent PAdiagnosis: Cardiomegaly due to LAD, rt.VH

32 -Plain X-ray Chest & heart Postero-anterior view(PA) showing :1-Increase C\T ratio 2-obtuse c\ph angle 3-double contour

diagnosis: Cardiomegaly Lt. A &Lt. V enlargementاألعلى في اليمين في 2 عالمة في

33-Plain X-ray Chest & heart Postero-anterior view(PA) showing:1-increase cardiothoracic ratio,2- acute lt. cardiophrenic angle,3- double contour.

Diagnosis:

cardiomegally due to lt. ventricluar enlargement & LAD.

34-Plain X-ray Chest & heart Postero-anterior view(PA) showing :1-Increase cardiothorathic ratio

2-Cardiophrenic angle is acute3-No double contour

Diagnosis :- Rt. At. & Rt. Vt. ++.Pulmonary artery dilatation.

اليمين أعلى في 8 عالمة


Homogenous opacity at lt. 2nd Space & normal sized heart diagnosis : ( Pulmonary artery dilatation due to p.hpn)

To be differentiated from Mass in posterior mediastinum, Pericardial cyst.

القلب في يمر أسود خط فيها


Aneurismal dilatation of pulmonary artery on both sides take (Dumpbell) shape.

Most probably due to Bilharzial core pulmonal .


Dumpell-shape Pulmonary artery dilatationAneurismal dilatation of pulmonary artery on both sides take (Dumpbell) shape, due to p.hpn.

Most probably Bilharzial core pulmonal.

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38-Multiple radio-opaque shadows in right hypochondrium

Plain X ray abdomen show-:

Multiple small opacities (radio-opaque stones) in Rt. Hypochondrium.

Kidney stone \ gall bladder stone ( need lateral view to differentiate gall stone anterior to vertebral column while renal stones on it. )

39-Intestinal obstruction

Plain x ray abdomen erect position show-:

Multiple air fluid level (more than >3) due to(intestinal obstruction )

40-Intestinal obstruction & perforated viscous

Plain x ray abdomen erect position show-:

Multiple air fluid level (more than >3) due to(intestinal obstruction )Bilateral gas under diaphragm due to ( perforated viscous )

41-Oral cholesystogram show-:

Multiple, small, rounded filling defect in gall bladder .

Diagnosis-: Calcular cholecystitis with radio translucent gall stones.

D.D: cancer gall bladder & acalcular cholecystitis artifact

فيها معدى خط في

42-T-tube cholangiogram with missed stone in common bile duct

T- tube cholangiogram show-:

Multiple radio translucent opacities (filling defects) stones in C.B.D & C.H.D.

with dilatation of biliary tree.

Diagnosis-:

Missed stone

43-Achalasia of lower esophageal sphincter

Barium Swallow Show-:

Short small smooth narrowing of lower part of the esophagus with smooth small dilatation Above ( funnel shaped).

Diagnosis-:

Acahlasia of the Cardia

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44-Barium swallow show-:

Short smooth narrowing with irregular filling defect with shouldering of the lower 1/3 of oesophagus, with rat tail appearance & mild abnormal irregular dilatation above.

Diagnosis-:

Cancer lower 1/3 esophagus

45-Barium swallow show -:

Large abnormal irregular filling defect in middle & lower oesophagus .

Diagnosis-:

Cancer mid & lower 2 thirds of oesophagus.

46-Esophageal varices

Barium swallow show-:

Multiple small rounded irregular filling defect in middle & lower Oesophagus giving picture of grape like.

47-Barium meal show-:

Gastric rougae pass through esophageal hiatus (diaphragm) into the chest. herniation of part of the stomach to or through the oesophogus.

Diagnosis -: Sliding hiatus hernia


Huge dilatation of stomach giving picture of soap dish appearance & retograde passage of barium into oesophogus when patient is in tredlenberg’s position.

Diagnosis-:

Chronic pyloric (out let) stenosis (obstruction) & GERD.

49-Hour-glass stomach(cancer stomach) with persistent duodenal ulcer niche

Barium meal show-:

Hour glass constriction of stomach & multiple irregular filling defect s in the lower 1\2 of stomach & deformed duodenal cap .

Diagnosis-:

Infiltrating gastric carcinoma&

Persistent ulcer niche on 2nd part (D.U.) ( chronic cicatrizing duodenal ulcer) .


leather bottle appearance due to cancer stomach taking all lumen leaving just narrow area above.

diagnosis : huge cancer stomach

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51-Barium meal show -:

normal C shape duodenal cap & out pouches in 3rd part of duodenum giving picture of ( mashroum shaped) doudenal diverticulum.

Diagnosis -:

duodenal diverticulum.

52-Barium meal show -:

Wide C shape deformity of duodenal cap & out pouches in 3rd part of duodenum ( flame-like doudenal diverticulum ).

Diagnosis -:

Cancer head of pancreas with duodenal diverticulum.

53-Trifolate duodenal cap

Barium meal show-: persistent Trifoliate deformity in duodenal cap

Diagnosis-:

Chronic ( cicatricial ) duodenal ulcer.

54-Ulcerative colitis complicated by cancer transverse colon

Barium enema show-:

Diffuse narrowing of the colon & Loss of haustration giving ribbon shaped appearance & smooth filling defect in rt. side of the transverse colon

Diagnosis-:

Ulcerative colitis complicated by cancer of transverse colon.

55-Colonic diverticulosis

Barium enema show-:

Multiple small out pouches in sigmoid colongiving saw tooth appearance.

Diagnosis-: Chronic diverticulosis coli.

56-Congenital megacolon

Barium enema show-:

Huge dilatation of the colon sparing rectum .

Diagnosis-:

Congenital mega colon (hirschsprung).

57-Barium enema show-:

Arrested barium enema in the middle of transverse colon stones, calcification.gas under diphragm, multiple fluid level

D.D. intusseption ,Cancer , obstruction, hard fecal mass.

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58-Acromegalic hand

Plain X ray on hand showing-:

Increase soft tissue shadow

Tufting of terminal phalanges, mushroom shaped.

59-Acromegalic skull

Plain X ray on skull showing-:1-Ballooning ( widening ) of sella turcica 2- erosion of dorsum sell .

3-Prognathism 4- pneumatization of air sinuses 5-thickened cortex, prominent occiput & mastoid.

Diagnosis: Acromegalic skull with (intrasellar) pituitary tumor .

60-Multiple osteolytic lesions in skull(Multiplte Myeloma)

Plain x ray on skull lateral view show-:

Multiple eqaul sized (small rounded filling defects) radiolucent osteolytic bone metastasis in the vault of skull mostly multiple myeloma

مغلق الفم

61-Osteosclerotic metastasis in occipital skull bone

Plain X ray on skull lateral view showing -:

Radio- opaque large shadow in occipital region (osteosclerotic bone metastasis )

D.D. cancer prostate &breast.

( تحت مكتوب 3رقم)

62-Cod-fish spine

Plain X ray abdomen (spine) lateral view Showing-: -Diffuse rarefaction of lumbar spine & code fish appearance ( biconcave vertebrae).

Diagnosis :- osteomalacia or Osteopenia for D.D. ( osteoporosis / osteomalacia )

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63-Cervical spondylosis.

Plain X ray, cervical spin Lateral view Show-:

Narrowing of disc (joint) space between C4 & C5. with osteophyte & sclerosis of adjacent vertebraeDiagnosis:- Spondylosis

D.D. T.B &Disc prolapsed



Narrowing of disc (joint) space between C4 & C5. with osteophyte & sclerosis of adjacent vertebraeDiagnosis:- Spondylosis




Narrowing of disc (joint) space between C4 & C5 , C5 & C6 with osteophyte & sclerosis of adjacent vertebraeDiagnosis:- Spondylosis




Narrowing of disc (joint) space between C6 & C7. with osteophyte & sclerosis of adjacent vertebraeDiagnosis:- Spondylosis D.D. T.B &Disc prolapsed

67-Diffuse osteosclerosis of spine (Hypoparathyrodism)

Plain X ray abdomen (spine) show-:

Diffuse sclerosis of lumbar vertebraeD.D.

Hypoparathyroidism & Paget disease .

68-Plain x ray on Rt. Femur show: multiple cysts & healed pathological fracture

D.D. Ostietisfibrosacystica

Hyperparathyroidism

69-Hour-glass myelogram

Myelogram Show-:

Hour glass constriction in lumber region giving picture of saddle shaped blockDiagnosis

Extradural extramedullary compression of spinal cord.

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