Radiological Differential Diagnosis Of Chest Diseases
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Radiological Differential Diagnosis of Chest Diseases An Incomplete List Devesh Chauhan
Anterior Mediastinal Masses
• Thymoma • Teratoma • Sub-sternal thyroid • Lymhoma
Opacified Hemithorax •
• • •
Atelectasis Pneumonia Pleural effusion Post-pneumonectomy
Pneumomediastinum • Ruptured esophagus. • Ruptured trachea/bronchus. • Iatrogenic. • Asthma. • Pneumoperitoneum.
Acute Alveolar Infiltrate • • • •
Pulmonary edema Pneumonia Aspiration Hemorrhage
Chronic Alveolar Disease – Alveolar cell carcinoma. – Alveolar sarcoid. – Lymphoma. – Alveolar Proteinosis.
Large Cavitary Lung Lesion • Abscess • Carcinoma. • Tuberculosis.
Bibasilar Interstitial Disease • Bronchiectasis. • Aspiration • Desquamative Interstitial Pneumonitis (DIP). • Asbestosis. • Sickle Cell Disease. • Scleroderma.
Upper Lobe Disease • • • •
Post primary Tuberculosis. Silicosis. Eosinophilic Granuloma. Ankylosing Spondylitis.
Micro-nodular Lung Disease • • • •
Metastasis. Sarcoid. Pneumoconiosis. Miliary Tuberculosis.
Chronic Interstitial Disease Pulmonary Fibrosis
• • • • • •
Pneumoconiosis. Interstitial Pneumonia. Granulomatous Disease. Neoplastic disease. Idiopathic fibrosis. Collagen vascular disease
Small Cavitary Lung Lesions • Septic emboli. • Rheumatoid nodules. • Squamous or transitional cell metastasis. • Wegener’s Granulomatosis.
Lymphangitic Spread to the Lungs • • • • • •
Lung Carcinoma. Breast Carcinoma. Stomach Carcinoma. Pancreas carcinoma. Laryngeal Carcinoma. Cervical Carcinoma.
Multiple Lung Nodules • • • • •
Metastasis. Wegener’s granulomatosis. Rheumatoid nodules. Arterio-venous malformations. Septic emboli. emboli
Pulmonary Interstitial Edema • Congestive heart failure. • Lymphangitic spread. • Allergic reaction.
Shifting Infiltrates • Loeffler’s Syndrome. • Allergic broncho-pulmonary Aspergilosis. • Asthma. • Polyarteritis. • Viral Pneumonia.
Unilateral Hyperlucent Lung. • • • •
Swyer-James syndrome. Pulmonary embolism. Pneumothorax. Obstructive Emphysema.
Rapidly Clearing Alveolar Infiltrate • • • •
Hemorrhage. Pulmonary edema. Aspiration. Pneumococcal pneumonia.
Cavitating Pneumonia • • • •
Staphylococcus. Streptococcus. Mycobacterium Tuberculosis. Gram negative (Klebsiella).
Middle Mediastinal Masses • • • •
Lymphadenopathy. Aneurysm. Esophageal Duplication. Bronchogenic cysts.
Masses with Air Bronchogram • Lymphoma. • Alveolar cell carcinoma. • Pseudolymphoma (MALToma – Mucosa associated pseudolymphoma)
Hilar Lymphadenopathy • • • • •
Sarcoidosis. Tuberculosis. Lymphoma. Bronchogenic Carcinoma. Metastasis. Metastasis
Cavities Containing Masses • • • •
Aspergillosis. Cavitating bronchogenic carcinoma. Tuberculosis. Hydatid Cyst.
Infiltrates with Effusion • • • •
Staph Pneumonia. Strep Pneumonia. TB. Pulmonary Infarct.
Mass + ipsilateral Lymphadenopathy • Bronchogenic Carcinoma. • Lymphoma. • TB.
Solitary Pulmonary Nodule • • • • • • • •
Bronchogenic Carcinoma. Hamartoma. Histoplasmoma. TB Granuloma. Bronchial Adenoma. Solitary Metastasis. Round Pneumonia. Rounded atelectasis.
Pleural Effusion • • • • • • • • •
CHF. Metastasis. Pancreatitis. Pulmonary embolism. Trauma. Empyema. Collagen Vascular Disease. Ovarian Tumor (Meig’s Syndrome). Chylothorax.
LT sided Pleural Effusion • • • •
Boerhaave’s Syndrome. Dissecting Aortic aneurysm. Pancreatitis. Distal thoracic duct rupture.
Multiple Small Calcifications • • • • • •
Histoplasmosis. Silicosis. Chicken pox pneumonia. Metastatic calcification. Secondary Amyloidosis. Alveolar Microlithiasis.
Posterior Mediastinal Masses • Neurogenic Tumors. • Lymphadenopathy. • Extra-medullary hematopoesis.
Mediastinal Adenopathy • • • • •
Bronchogenic Carcinoma. Lymphoma. TB Metastasis. Sarcoid.
Lung disease & Rib Destruction • • • •
Bronchogenic CA – Pancoast tumor. Actinomycosis. Blastomycosis. Multiple myeloma.
Pleural Calcification • Old TB empyema. • Asbestos exposure. • Hemothorax.
Masses in Cardio-phrenic Angle • Sequestration. • Diaphragmatic hernia. • Pericardial cyst.
Unilateral Pulmonary Edema • • • •
Aspiration. Disease in other lung e.g. COPD. Postural. Rapid expansion of pneumothorax.
Reverse Pulmonary Edema • Eosinophilic lung disease, e.g. Loeffler’s . • Sarcoidosis. • Pulmonary Contusions.
Anterior Mediastinal Masses
• Thymoma • Teratoma • Sub-sternal thyroid • Lymhoma
Opacified Hemithorax •
• • •
Atelectasis Pneumonia Pleural effusion Post-pneumonectomy
Pneumomediastinum • Ruptured esophagus. • Ruptured trachea/bronchus. • Iatrogenic. • Asthma. • Pneumoperitoneum.
Acute Alveolar Infiltrate • • • •
Pulmonary edema Pneumonia Aspiration Hemorrhage
Chronic Alveolar Disease – Alveolar cell carcinoma. – Alveolar sarcoid. – Lymphoma. – Alveolar Proteinosis.
Large Cavitary Lung Lesion • Abscess • Carcinoma. • Tuberculosis.
Bibasilar Interstitial Disease • Bronchiectasis. • Aspiration • Desquamative Interstitial Pneumonitis (DIP). • Asbestosis. • Sickle Cell Disease. • Scleroderma.
Upper Lobe Disease • • • •
Post primary Tuberculosis. Silicosis. Eosinophilic Granuloma. Ankylosing Spondylitis.
Micro-nodular Lung Disease • • • •
Metastasis. Sarcoid. Pneumoconiosis. Miliary Tuberculosis.
Chronic Interstitial Disease Pulmonary Fibrosis
• • • • • •
Pneumoconiosis. Interstitial Pneumonia. Granulomatous Disease. Neoplastic disease. Idiopathic fibrosis. Collagen vascular disease
Small Cavitary Lung Lesions • Septic emboli. • Rheumatoid nodules. • Squamous or transitional cell metastasis. • Wegener’s Granulomatosis.
Lymphangitic Spread to the Lungs • • • • • •
Lung Carcinoma. Breast Carcinoma. Stomach Carcinoma. Pancreas carcinoma. Laryngeal Carcinoma. Cervical Carcinoma.
Multiple Lung Nodules • • • • •
Metastasis. Wegener’s granulomatosis. Rheumatoid nodules. Arterio-venous malformations. Septic emboli. emboli
Pulmonary Interstitial Edema • Congestive heart failure. • Lymphangitic spread. • Allergic reaction.
Shifting Infiltrates • Loeffler’s Syndrome. • Allergic broncho-pulmonary Aspergilosis. • Asthma. • Polyarteritis. • Viral Pneumonia.
Unilateral Hyperlucent Lung. • • • •
Swyer-James syndrome. Pulmonary embolism. Pneumothorax. Obstructive Emphysema.
Rapidly Clearing Alveolar Infiltrate • • • •
Hemorrhage. Pulmonary edema. Aspiration. Pneumococcal pneumonia.
Cavitating Pneumonia • • • •
Staphylococcus. Streptococcus. Mycobacterium Tuberculosis. Gram negative (Klebsiella).
Middle Mediastinal Masses • • • •
Lymphadenopathy. Aneurysm. Esophageal Duplication. Bronchogenic cysts.
Masses with Air Bronchogram • Lymphoma. • Alveolar cell carcinoma. • Pseudolymphoma (MALToma – Mucosa associated pseudolymphoma)
Hilar Lymphadenopathy • • • • •
Sarcoidosis. Tuberculosis. Lymphoma. Bronchogenic Carcinoma. Metastasis. Metastasis
Cavities Containing Masses • • • •
Aspergillosis. Cavitating bronchogenic carcinoma. Tuberculosis. Hydatid Cyst.
Infiltrates with Effusion • • • •
Staph Pneumonia. Strep Pneumonia. TB. Pulmonary Infarct.
Mass + ipsilateral Lymphadenopathy • Bronchogenic Carcinoma. • Lymphoma. • TB.
Solitary Pulmonary Nodule • • • • • • • •
Bronchogenic Carcinoma. Hamartoma. Histoplasmoma. TB Granuloma. Bronchial Adenoma. Solitary Metastasis. Round Pneumonia. Rounded atelectasis.
Pleural Effusion • • • • • • • • •
CHF. Metastasis. Pancreatitis. Pulmonary embolism. Trauma. Empyema. Collagen Vascular Disease. Ovarian Tumor (Meig’s Syndrome). Chylothorax.
LT sided Pleural Effusion • • • •
Boerhaave’s Syndrome. Dissecting Aortic aneurysm. Pancreatitis. Distal thoracic duct rupture.
Multiple Small Calcifications • • • • • •
Histoplasmosis. Silicosis. Chicken pox pneumonia. Metastatic calcification. Secondary Amyloidosis. Alveolar Microlithiasis.
Posterior Mediastinal Masses • Neurogenic Tumors. • Lymphadenopathy. • Extra-medullary hematopoesis.
Mediastinal Adenopathy • • • • •
Bronchogenic Carcinoma. Lymphoma. TB Metastasis. Sarcoid.
Lung disease & Rib Destruction • • • •
Bronchogenic CA – Pancoast tumor. Actinomycosis. Blastomycosis. Multiple myeloma.
Pleural Calcification • Old TB empyema. • Asbestos exposure. • Hemothorax.
Masses in Cardio-phrenic Angle • Sequestration. • Diaphragmatic hernia. • Pericardial cyst.
Unilateral Pulmonary Edema • • • •
Aspiration. Disease in other lung e.g. COPD. Postural. Rapid expansion of pneumothorax.
Reverse Pulmonary Edema • Eosinophilic lung disease, e.g. Loeffler’s . • Sarcoidosis. • Pulmonary Contusions.
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