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Glossary of DDX Chest

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Unilateral pulmonar edema
Prolonged lateral decubitus position
Unilateral aspiration
Pulmonary Contusion

Congenital absence or hypoplasia of the pulmonary artery
McLeods Syndrome
Thromboembolism
Pulmonary edema
Heart failure
Non cardiogenic Pulmonary edema
Renal, Cerebral disease
Near drowning
Aspiration (Mendelson's Syndrome)
Radiotherapy
Rapid expansion of the lungs following thorancentesis
Drugs
Poisins
Mediastinal tumore (obstructing veins lymphatics)
Shock lung ARDS
High Altitude
Wide Spread Air Space Disease
Edema

Pneumonia infectious

Godpasture
Idiopathic pulmonary hemosiderosis
Hematogenous Mets

Fat emboli

Lymphoma

Sarcodosis

Loffler (reverse bat wings)
Localized Air Space Disease
Pneumonia
Infarction
Contusion
Edema
Radiation
Lymphoma
Honeycomb lung
Collagen Disorders
RA, Scleroderma (lower)
Extrinsic Allergic Alveolitis
(upper zone)
Pneumoconiosis
Asbestos
Cystic Bronchiectasis
Cystic Fibrosis
LCH (mid and upper)
LAM
TS
IPF (basal posterior progreses)
Neurofibromatosis (ribbon ribs)
Pneomoconioses
Inorganic Dust
Ferric Oxide (Siderosis)

Silica
Coal Dust
Asbestos

Berrylium
Hydrocarbon

Radioactive (uranium)
Asbestos
Pnemoconiosis
Oranic Dust
Mouldy Hay farmers lung
Sugar cane Bagassosis
Cotton Linnen Dust
Mushroom workers
Pidgeon and Bird Fanciers
Multiple Pin point Opacities
post lymphangiography
silicosis
alveolar microlithisasis
Multiple Opacities (0.5-2mm)
Miliary TB
Fungal Disease
CWP (mid zones spare upper, lower)
Sarcoidosis Mid zone, ill defined
Acute Allergic Extrinsic Alveolitis (micronodulation all zone predominately basal)
Multiple Opacities (0.5-2mm)
Greater than soft tissue density
Hemosiderosis
Silicosis
Siderosis
Multiple Opacities (2-5mm)
Carcinomatosis
Lymphoma
Sarcoidosis

Multifocal pneumonia
Pulmonary Edema
Extrinsic allergic allveolitis (basal)
Multiple Opacities (>5mm)
Mets
Abscesses Hydatid Fungal
Wegeners RA
PMF
AVM
Lung Cavity
Carcinoma (SCC) Cystic Bronchiectasis

Autoimmune Wegeners

Vascular Infarction (emboli)

Infection (abcess fungal TB echinococcus

Trauma pneumatoceles

Young Cystic bronchiectasis
Sequestered segment
Opacity with an air bronchogram
Pnemonia
Radiation pneumonitis
PMF
Non thrombotic Pulmonary Emboli
Septic emboli
Fat
Venous air
amniotic fluid Tumor
Talc
Pulmonary Calcification or Ossification

Localized calcification
TB
Histoplasmosis
Coccidioidomycosis
Pulmonary Calcification or Ossification

Calcification within in a solitary lesion
Usually benign

Exceptions
Carcinoma arising in pre-existing granuloma
Osteosarcoma
Primary peripheral squamous cell or papillary carcinoma
Pulmonary Calcification or Ossification

Diffuse or multiple calcifications
Infections TB Histo
Silicosis
Mets (mucinous cystadenocarcinoma of colon breat or papillary thyroid)

Alveolar Microlithiasis
Pulmonary Calcification or Ossification

Interstitial calcification
IPF
Chronic Venous Hypertension
Unilateral Hilar Enlargement
Lymph nodes
Ca bronchus, lymphoma, infective(TB, Histo, Cocc)

Sarcoidosis (unilateral in 1-5%)
Bilateral Hilar Enlargement
Sarcoidosis
Lymphoma
Lymphangitis carcinamatosis
Infective TB etc
Pulmonary hypertension
Immunological mushroom workers
Inhilation Silicosis
'Egg shell' Calcification
Silicosis
CWP (only 1%0
Sarcoid (only 5%)
Lymphoma following radiotherapy
Upper Zone Fibrosis
Cystic Fibrosis
Ankylosisng Spondylosis
Silicosis
Sarcoid
EG
TB
Pneumocystis carinii
Basal Interstitial Opacity
Bronchiectasis
Aspiration
Drugs DIP
Asbestosis
Scleroderma
Pleural Effusion
Transudate (< 30 g/l)
Cardiac
Hepatic
Nephrotic
Meigs

Exudate >30g/l
Infection
malignancy
Pulmonary Infarct
Collagen Vacular Dx
Subphrenic Abcess
Pancreatitis

Hemorrhage
Ca Bronchus
Trauma
Pulmonary Infarction
Bleeding Disorders

Chylous
Obstructed thoracic duct
Pleural Effusion due to Extrathoracic Disease
Pancreatitis
Subphrenic Abcess
Meig's Syndrome
Nephrotic Syndrome
Cirrhosis
Pleural Effusion with an otherwise normal Chest X-Ray
Primary TB (40% adults 10 % Children)
Viruses Mycoplasma (20%)

Mets
Mseothelioma

SLE 10%
RA 3%

see previous card

PE
Asbestosis
Pneumothorax
Spontaneos M>F 8:1
Iotrogenic
Traumatic
Secondary to Lung Dx
Emphysema, CF, Neoplasm
Pneumoperitoneum
Pneumomediastinum
Lung Tear
Perforation Esophagus Trachea bronchus
Perforation of hollow abdominal viscus
Right Sided Diaphragmatic Humps
Any Site
Subphrenic abcess, hepatic abcess, hydatid, Hepatic Met

Medially
pericardial fat pad, aortic aneurysm, spring water cyst (pleuropericardial) Sequestrated segment

Anteriorly
Morgagni

Posteriorly
Bochdalek
Unilateral Elevated Diaphragm
Causes Above
phrenic N palsey, pulmonary collapse infarct

Below
Gaseous distenion of stomac or splenic flexture

DDx subpulmonary effusion
Ruptured diaphragm
Bilaterally elevated diaphragm
Above
fibrotic lung disease, bibasal collapse

Below
ascites,pneumoperitoneum

Bilateral subpulmonic effusions
Pleural Calcification
TB
Asbestos
Fluid (empyema, hematoma)
Talc
Loculated Pleural Mass
Loculated pleural effusion
Mets
Mesotheliaoma
Fibroma

Plombage insertion of foreign material into extra pleural space tx for TB
Rib Lesions with an Adjacent Soft Tissue Mass
NEOPLASTIC
Bronchogenic Ca, Mets Myeloma, Mesothelioma neurofibroma

INFECTIVE
TB, actinomycosis

INFLAMMATORY
Radiation

METABOLIC
Renal Osteodystrophy
Neonatal Respiratory Distress
Pulmonary Causes
NO MEDISTINAL SHIFT
HMD
TTN
Meconium Aspiration Syndrome
Pneumonia
Pulmonary hemorrhage
Mikity Wilson (pulmonary dysmaturity)

MEDIASTINAL SHIFT AWAY FROM THE ABNORMAL SIDE
Diaphragmatic hernia, congenital lobar emphysema,
cystic adenoid malformation, pneumothorax, pleural effusion

MEDIASTINAL SHIFT TOWARDS THE ABNORMAL SIDE
atelectesis, agenesis
Ring Shadows in a Child
NEONATE
diaphragmatic hernia, interstitial emphysema, CCAM

OLDER CHILD
Cystic bronchiectasis, CF, pneumatoceles, neurofibromatosis, LCH
Drug Induced Lung Disease
Diffuse alveolar opacities
PULMONARY EDEMA
cocaine, herion , tricyclics, salicates

PULMONARY HEMORRHAGE
anticoagulants
Drug Induced Lung Disease
Focal alveolar opacities
Phospholipidosis
amiodorone

Pulmonary Eosinophilia
nitrofuratoin,sulphonamides

Vasculitis
ampicillin, penicillin
Drug Induced Lung Disease
Diffuse interstitial opacities
Acute interstitial reactions
trans retinoic acids, methotrexate

Brochospasm
B blockers, aspirin

Hilar enlargement
phenytoin, steroids
HIGH RESOLUTION CT NODULES
Centrilobular
TB, Endobronchial Tumor, Hypersensitivity Pneoumonitis,
Bronchiolitis
HIGH RESOLUTION CT NODULES
Perilymphatic
Sarcoid, Lymphangitis Carcinamatosis, Lymphoma, LIP, Amyloidosis, KS
HIGH RESOLUTION CT NODULES
Random
Miliary TB, Hematogenous Mets, Fungi, Silicosis, CWP LCH
HIGH RESOLUTION CT - LINES
Interlobular Septal Thickening
Sarcoid, Lymphangitis Carcinamatosis, pulmonary edema, alveolar proteinosis (smooth with associted ground glass appearance)
HIGH RESOLUTION CT - LINES
Intralobular Septal Thickening
Sarcoid, Lymphangitis Carcinamatosis, pulmonary edema, alveolar proteinosis
HIGH RESOLUTION CT - LINES
Parenchymal bands
Any cause of pulmonary fibrosis
HIGH RESOLUTION CT - GROUND GLASS OPACITY
Interstitial Pnemonitis, Pneumonia (PCP, viral eosinophilic hypersensitivty extrinsic allergic alveolitis)
Pulmonary Edema, hemorrhage, Sarcoid BOOP, Alveolar Proteinosis
HIGH RESOLUTION CT - CONSOLIDATION
PERIPHERAL
pneumonia, neoplasia (brochoalveolar carcinoma), pulmonary infarction

PERIBRONCHIOLAR
infection (invasisve aspergillosis)
Neoplasia (lymphoma, Kaposi Sarcoma)
BOOP
HIGH RESOLUTION CT - MOSAIC ATTENUATION
IF AIR TRAPPING THE DIAGNOSIS IS ALWAYS AIRWAYS DISEASE
BOOP, brochiectasis, CF, large bronchial obstruction

IF THERE IS NO AIR TRAPPING THE DIAGNOSIS IS VASCULAR DISEASE
Pulmonary Emboli
HIGH RESOLUTION CT - PATTERNS OF PARENCHYMAL DISEASE PROCESS

PERIPHERAL
IPF
EARLY: ground glass
subpleural reticulation at lung base
LATER: reticulation extends centrally
CHRONIC: small cyst formation at subpleural site

Asbestos
HIGH RESOLUTION CT - PATTERNS OF PARENCHYMAL DISEASE PROCESSES
Central/Upper and Mid Zones
Sarcoid
HIGH RESOLUTION CT - PATTERNS OF PARENCHYMAL DISEASE PROCESSES
Peripheral and Central Zones
Lymphangitis
HIGH RESOLUTION CT - PATTERNS OF PARENCHYMAL DISEASE PROCESSES
Widespread
Lymphangioleiomyomatosis
Anterior Mediastinal Masses in Children
CONGENITAL
Normal thymas, cystic hygroma, mogagni hernia

NEOPLASTIC
HD NHL leukemia
Germ cell tumors
thymoma

INFLAMMATORY
lymphadenopathy
Middle Mediastinal Masses in Children
NEOPLASTIC
NEOPLASTIC
HD NHL leukemia
Germ cell tumors
thymoma

INFLAMMATORY
lymphadenopathy

CONGENITAL
FOREGUT DUPLICATION CYSTS
bronchogenic, esopgageal duplication, neurentreic cyst
(contains neural tissue and maintains a connection to the spinal canal
CYSTIC HYGROMA, HIATIS HERNIA, ACHALASIA, CARDIOMEGALY OR VENA CAVAL ENLARGEMENT
Posterior Mediastinal Masses in Children
NEOPLASTIC
Ganglion cell tumors (neuroblastoma, ganglioneuroblastoma, gangioneuroma)

CONGENITAL
Bochdalek hernia
Anterior Mediastinal Masses in Adults
REGION I
Retrosternal goitre, tortuous innominate artery, lymph nodes, thymic tumors, aneurysm if the ascending aorta

REGION II
Germinal cell neoplasms SECT, Thymic Tumors, Sternal tumors (chondrosarcoma, myeloma, lymphoma)

REGION III
Pericardiac fat pad, diaphragmatic hump, morgagni hernia, pericardial cyst
Middle Mediastinal Masses in Adults
Lymph nodes, Ca bronchus, aneurysm of aorta, bronchogenic cyst
Posterior Mediastinal Masses in Adults
REGION I (paravertebral)
lymphoma, myeloma, metastases, extramedullary hematopoiesis, abcess, ganglioneuroma

REGION II
dilated esophagus, aorta

REGION III
Hiatus hernia
CT Mediastinal Mass Containing Fat
Diaphragmatic Hernia (omentum), lipoma, liposarcoma, teratodermoid
CT Mediastinal Cysts
CONGENITAL
bronchogenic, neuroenteric, enteric

PERICARDIAL CYST
THYMIC CYST
CYSTIC TUMORS
lymphangioma, teratoma, teratodermoid
PANCREATIC CYST
CT Thymic Mass
Thymoma, thymic hyperplasia, Germ cell tumor, lymphoma, thymolipoma
VENTILATION PERFUSION MISMATCH
Mismatched Perfusion Defects
PE, Bronchial Ca TB (apical segments), Fat/tumor Embolism, Post Radiotherapy
VENTILATION PERFUSION MISMATCH
Mismatched Ventilation Defects
COPD, Pneumonia, Ca, Lung collapse, pleural effusion
ACUTE UPPER AIRWAYS OBSTRUCTION
Choanal Atresia
Laryngeotracheobronchitis
Acute Eppiglotitis
Retropharyngeal abcess
Edema
Foreign Body
Retropharyngeal hemorrhage
CHRONIC UPPER AIRWAYS OBSTRUCTION IN A CHILD
NASAL
choanal atresia, nasal angiofibroma (teenage male), antachoanal polyp

SUPRAGLOTTIC
Tonsils, adenoids, laryngeomalacia, micrognathia, cysts

GLOTTIC
Laryngeal papilloma/polp/cyst

SUBGLOTTIC
Tracheomalacia, subglottic hemangioma, prolonged tachael intubation, external compressin, respiratory papilomatosis
CHRONIC UPPER AIRWAYS OBSTRUCTION IN AN ADULT
SUPRAGLOTTIC
Carcinoma of the Larynx

GLOTTIC
Vocal cord paralysis, Ca Glottis
SUBGLOTTIC AND TRACHEAL
Tracheal malignancy, infraglottic Ca of larynx, prolonged tacheal intubation, external compressin
Unilateral transradiant Hemithorax
ROTATION

CHEST WALL
Mastectomy, Poland Syndrome, Poliomyelitis

PLEURA
Pneumothorax

LUNG
Emphysema, Macleods, Congenital lobar emphysema

PULMONARY VESSELS
PE
Bilateral Translucent Hemithiraces
With Overexpansion of the Lungs
COPD
Asthma
Acute Bronchiolitis (1st year of life)
Bilateral Translucent Hemithiraces
With Normal or Small Lungs
(no lung markings)
Congenital disease producing oligaemia
Pulmonary artery Stenosu Multiple PE
Schistosomiasis
Metastatic Trophoblastic Disease
Bronchial Stenosis or Occlusion
IN THE LUMEN
foreign body, mucus plug

IN THE WALL
CA Bronchus, bronchial adenoma, sarcoid granuloma

OUTSIDE THE WALL
Lymph nodes, mediastinal tumor anomalous origin of the left pulmonary artery from the right pulmonary artery
Increased Density of a Hemithorax

With Central Mediastinum
consolidation
pleural effusion
mesothelioma
Increased Density of a Hemithorax

With Mediastinal Displacement away from the dense hemithorax
pleural effusion
diaphragmatic hernia
Increased Density of a Hemithorax

With Mediastinal Displacement towards the dense hemithorax
collapse
post pneumonectomy
lymphangitis carcinamatosis
pulmonar agenesis and hypoplasia
Pneumatoceles
INFECTION
Staph Areus
Strep Pneumoniae
Klebsiela
Hemophilus
Legionella

TRAUMATIC
Interstitial Emphysema

NEOPLASTIC
Following tx of pulmonary Mets
Slowly Resolving or Recurrent Pneumonia
Bronchial Obstruction
Inappropriate Chemotherapy
Repeated Aspiration (scleroderma, pharyngeal pouch)
Underlying lung pathology
Immunological incompetance
Pnemonias that resolve through fibrosis (TB, Fungi)
Pneumonia with Enlarged Hilum
SECONDARY PNEMONIA
Ca Broncus
PRIMARY PNEUMONIAS
TB, Viral pnemonias, Primary Histoplasmosis, Coccidiodomycosis
Lobar Pneumonia
Strep Pneumoniae
Klebsiella
Staph aureus
TB
Staph pyogenes
Consolidation with Bulging Fissures
INFECTION WITH ABUNDANT EXUDATE
Klebsiella, Strep, MAI, Yersinia pestis

ABCESS
Stap aureus


CA BRONCHUS
BRONCHIECTASIS
SECONDARY TO CHILDHOOD INFECTIONS
measles, pertussis

SECONDARY TO BROCHIAL OBSTRUCTION
foreign body, mucus plug

CHRONIC ASPIRATION

CONGENITAL STRUCTURAL DEFECTS
Kartegners syndrome, Williams-Campell syndrome

IMMUNODEFICIENCY STATES

COLLAGEN VASCULAR DISEASES
Single Pulmonary Lesions
GRANULOMA
Tuberculoma
Histoplasmoma
MALIGNANT NEOPLASMS
Ca Bronchus
Metastasis
Alveolar Cell Carcinoma
BENIGN NEOPLASMS
Adenoma
Hamartoma
INFECTIONS
Pneumonia
Hydatid
CONGENITAL
Sequestration
Bronchogenic Cyst
VASCULAR
Pulmonary Infarction
Hematoma
AVM
Tree in Bud
INFECTION
TB, Bronchopneumonia, Fungal

BRONCHIAL DISEASE
Brochiolitis

CONGENITAL DISORDER
CF, Immotile cilia syndrome

Others
ABPA, Lymphangitis, EG

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