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.