Radiographic Findings of Pulmonary Infiltrates

Exhibit #1

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Two areas of consolidation are identified. The first is in the right upper lobe and the second is seen in the retrocardiac region (left lower lobe). Note both are best seen on lateral projection.

Patchy white areas of coalescent density may represent anything filling the air space. The differential possibilities include areas of hemorrhage, bacteria infection, water from edema, cells infiltrating the air space; i.e., alveolar cell carcinoma on proteinaceous material. The history helps narrow down and direct the differential possibilities.

In this case, the patient is an 18 y. o. with L/O VSD, ASD and pulmonic stenosis with 10d hx of fever, chills, nausea, vomiting, and productive cough. He had staph aureus pneumonia.

Exhibit #2

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This patient has significant loss of volume in the left upper lobe. This is identified in the lateral projection by anterior displacement of the major fissure. In addition to the generalized increase in denisty on the left, caused by this volume loss. There is also loss of bronchial definition. The infiltrate has the appearance of too many interstitial lines. This is due to viral pneumonia. Many entities can cause an abnormal interstitial (too many lines) appearance. Differential diagnosis is lengthy and cannot be directed without history.

Exhibit #3

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Fluffy alveolar densities (air space disease) is identified in both perihilar regions and in both upper lobes.

The cardiac silhouette is at the top limits of normal size and there is a Swan Ganz catheter in place. There is complete lack of definition of bronchioles and the peribronchial markings are hazy at best.

In this case the air spaces are filled with edema fluid as caused by pulmonary edema. This patient is post-operative from coronary bypass grafting.