1. Rhumatoid arthritis

2. B A C Boutonniere Deformity
A. Soft-tissue swelling and early erosions in the PIP
B. Soft tissue swelling/Marginal erosion/Periarticular osteopenia/Joint space reduction
C. Boutonniere deformity C

3. Giant cell artritis- Stroke

4. Because RBCs contains Calcium
Ischemic Stroke
“Black – Hypodense”
Hemorrhagic Stoke
“White – Hyperdense”
Because RBCs contains Calcium

5. Subarachnoid Hemorrhage
Aneurysm

6. Posterior reversible encephalopathy syndrome (PRES)
Multiple cortico-subcortical areas of hyperdense signal involving the occipital and parietal lobes bilaterally
due to HTN

7. Arteriovenous Malformations ( AVM )

8. Herpes Simplex Encephalitis-MRI more sensitive, especially for identifying edema

9. Celiac disease
shows jejunization of the ileal fold pattern; this is characteristic of celiac disease.
multiple concentric strictures

10. Celiac disease
Flocculation and segmentation of barium with mild dilatation of the bowel

11. Renal failure
intra venous pyelogram

13. RENAL ARTERY STENOSIS- Angiogram

14. Hodgkin lymphoma It might come as a Case :
Chest pain, cough, SOB, or combination of those may be present due to a large mediastinal mass or lung involvement; rarely, hemoptysis occurs

15. ULCERATIVE COLITIS X-Ray Abdomen Toxic Megacolon:
Transverse and Descending
colon affected

16. Sickle cell dis

17. Splenic sequestration
Splenic sequestration is an acute emergency and can be fatal in 1-2 hours secondary to circulatory hypovolemia.
Treatment is with volume resuscitation and blood transfusion.
The CT image shows splenomegaly with a mass-like process (arrows) from splenic sequestration.

18. Acute chest syndrome (vaso-occlusive crisis affecting the lungs): -new pulmonary infiltrate on the chest radiograph combined with one or more manifestations such as fever, cough, sputum production, tachypnoea, dyspnoea, or new-onset hypoxia.
Lung infections tend to predominate in children, and infarcts predominate in adults.
Acute chest syndrome

19. Acute Chest Syndrome. 
There is:
1. bilateral lower lobe airspace disease (white arrows).
2.biconcave vertebral bodies (blue oval)
3.avascular necrosis of the visible humeral head (yellow arrow)

20. Moyamoya disease Moyamoya disease
 is a cerebrovascular disorder caused by blocked arteries at the base of the brain in an area of the basal ganglia.
The name “moyamoya” means “puff of smoke”
The disease primarily affects children, but it can also occur in adults.
Moyamoya disease

21. Hair-on-end appearance
Skeletal changes in sickle cell anemia.
Expanded medullary cavity.
Diploic space:
widened due to marrow hyperplasia.
Trabeculae are vertically oriented to the inner table, giving a hair-on-end appearance.
Hair-on-end appearance

22. Renal papillary necrosis
Repeated vascular occlusion infarcts lead to necrosis of the renal medullary pyramids and papillae. This causes sloughing of papillae, which obstructs the urinary tract.
Renal papillary necrosis: Pyelographic image in a patient with sickle cell disease showing central cavities within multiple papillae, "egg-in-a-cup" appearance .

23. Dactylitis
known as hand foot syndrome is an early manifestation of sickle cell disease in first 2 years of life which results from bone infarcts in the diaphyses of small long bones.
Advanced dactylitis. Lytic processes are present at the first and fifth metacarpals, along with periostitis, which is most prominent in the third metacarpal.
Dactylitis

24. Large left MCA infarction
Sickle cell anemia
Case:
A 12-year-old boy with HgbSS disease presents to the pediatric emergency department with altered mental status, left-sided gaze paralysis with his head tilted to the left, and flaccid paralysis of the right arm and leg. A CT scan of the brain was obtained immediately.
Large left MCA infarction

25. Thalassemia

26. A fracture is noted in the distal radius
A fracture is noted in the distal radius. Evidence of medullary expansion and cortical thinning is observed
Biconcave "fish vertebrae" secondary to marrow hyperplasia, osteopenia, and softening of the vertebral end-plates.

27. Occupational lung dis.

28. Asbestosis an occupational lung disease caused by inhalation of asbestos fibers, and shows extensive pleural plaques and diffuse interstitial fibrotic disease of the lungs.

29. Asbestosis
Asbestosis is a risk factor bronchogenic carcinoma and malignant mesothelioma.
Mesotheliomas may have latency period up to 50 years.
Tumor growth occurs along the lower part of the chest.
Extends into the parenchyma, brachial plexus, and SVC.
Treatment combinations of chemotherapy, radiation, and surgery has limited success.
Median survival is only 11 months and the disease is almost always fatal.
The CT scan of mesothelioma with extensive pleural thickening, effusion, and lung volume reduction in the affected hemithorax.

30. Asbestosis: Treatment
Honey comping
Calcium deposit

31. HYPERSENSITIVTY PNEUMONITIS
Diagnosis of HP: Symptoms include: fever, chills, malaise, cough, dyspnea, and headaches 4-6 hours after heavy exposure to an inciting agent in acute HP. Sub-acute and chronic forms are characterized by: cough, progressive dyspnea, fatigue, anorexia, and weight loss.
Physical signs include fever, tachypnea, diffuse fine basilar crackles; with muscle wasting, clubbing, and RDS in severe cases.
CXR may show micronodular or reticular opacities

32. HYPERSENSITIVTY PNEUMONITIS
Inhalation challenges:
BAL
PFT
Lung biobsy
Treatment:
Antigen avoidance
Corticosteroids .
Patients with significant fibrosis have a poorer prognosis.
Adjunctive
HRCT will show:
Acute disease : Ground-glass opacities
Subacute phase: Diffuse micronodules lesions
Chronic phase: Extensive fibrosis honeycombing and air trapping

33. Egg shell calcification
Silicosis
Small silicon particles are inhaled into the distal alveoli generate silicon-based free radicals that damage cell membranes.
Alveolar macrophages ingest the particles and release inflammatory mediators.
The result is inflammation that damages cells and the extracellular matrix leading to fibrosis.
Silica particles outlive the alveolar macrophages, thus continuing the cycle of injury.
Egg shell calcification

34. Common Silicosis Symptoms:
Shortness of breath following physical exertion.
Severe cough.
Fatigue.
Loss of appetite.
Chest pains.
Fever.
Cyanosis (bluish skin)
Chest X-ray, demonstrating silicosis with progressive massive fibrosis.

35. Peribronchial and subpleural nodules identical to sarcoid
Berylliosis
Patients may present with: cough, chest pain, arthralgias, fatigue, and weight loss. Physical signs uncommon other than inspiratory crackles. Diagnosis is made by beryllium lymphocyte proliferation test from blood or bronchoalveolar lavage. Treatment focuses on exposure avoidance and corticosteroid therapy for 4-6 weeks. Prognosis is highly variable and ranges from complete recovery to lung transplantation.
Peribronchial and subpleural nodules  identical to sarcoid
Non-necrotizing granulomas on lung biopsy on H-E stain.

36. Bird fancier's lung
This disease is inflammation of the alveoli in the lungs. In bird fanciers lung medical tests will show a normal range of results and it will be identified by X-ray or CT scans showing a ground glass appearance. In the chronic form there is usually anorexia, weight loss, tiredness and progressive interstitial fibrosis. Condition is occasionally fatal.

37. FARMER’S LUNG A B
Radiological characteristics in farmer's lung disease. (A) Chest HRCT in a patient with acute farmer's lung. Ground glass infiltrates and centrilobular nodules can be observed. (B) Chest HRCT in a patient with chronic farmer's lung. Note the reticular pattern in middle fields with low-grade ground glass infiltrate.

38. w
Wilson’s disease

39. MRI Brain: Wilson disease
Hyperintensity of the basal ganglia T1

40. T2-weighted axial MRI demonstrates the “face of the giant panda” in the midbrain (arrow).
Diagnostic of Wilson’s disease

41. Aortic dissection (AD)

42. The transesophageal echocardiogram (TEE)

43. Chest X-Ray With aortic dissection Mediastinum widening
Obliteration of the aortic knob,

44. Calcium sign: Aortic dissection
The calcium sign on CXR suggests aortic dissection.
separation of the intimal calcification
Normally our aorta has a ca deposition with aging on intimal layer. b\w the inner and outer layer of aorta u find major separation .. Intimal tear

45. nearly 100% diagnostic for AD
 CTA with contrast:
nearly 100%  diagnostic for AD
Type A aortic dissection

46. (MRI) is better .
Stanford type B dissecting aneurysm

47. Heart falure

48. Severe CHF with Pulmonary edema

49. PFT

50. Pleural Effusion

51. Right side Pleural Effusion

52. Pneumothorax left side
Comes in exam
Pneumothorax

53. Tension Pneumothorax
completely absent lung markings on the right, with the right lung collapsed and pushed across into the left hemithorax, along with the mediastinal contents

54. TB
CHEST X-RAY SHOWING TB RIGHT UPPER LOBE WITH CAVITATION

55. Miliary TB
X-ray chest shows multiple nodules 1-2 mm which appear like millet seeds

56. 1 Hx of 5 days +white shadow (consolidation)
Right middle lobe pneumonia
(abnormal whiteness in the right lung)

57. 2 Right more black Lung collapse No land marking Sudden
Right Pneumothorax
Treatment by aspiration of air

58. 3 Left pleural effusion Fluid + loss of costophrenic angle
Finding of pleural effusion on examination :
Stony dullness percussion
Absent or reduce hear sound

59. So breathlessness because of edema 4
White shadows in lung
Renal failure
So breathlessness because of edema 4
Pulmonary edema
(Bilateral white lung fields)

60. 5
Pulmonary tuberculosis

61. 6 Malignant pleural effusion with pulmonary metastases
Transudate: less protein – watery
congestive cardiac failure , nephrotic, liver cirrhosis
Exudate: inflammatory
carcinoma , pneumonia , SLE
This pleural effusion is exudate

62. 7
Consolidation left lung
pneumonia

63. 8 Right pleural effusion
Next investigation - Aspiration of this effusion and sent for cytology, microbiology and chemistry

64. 9
Hodgkin’s lymphoma
Mediastinal lymphadenopathy with H/O supraclavicular and axillary lymphadenopathy . Confirm by lymph node biopsy
Because of pruritus

65. 10
Patient has pulmonary edema secondary to mitral and aortic valve disease
Wide shadow in lung and cardiomegaly

66. 11 11 Pericardial effusion Pericardium heart not effecting no edema
Big but lung field is clear
There is enlargement of heart shadow

67. 12
Bilateral hilar lymphadenopathy
TB, lymphoma , sarcoidosis
Likely cause with this clinical history - SARCOIDOSIS

68. 7
Consolidation left lung

69. Chronic obstructive pulmonary disease (COPD) (Bilateral black lungs)13
Chronic obstructive pulmonary disease (COPD)
heart tubular because of hyper inflated lung
(Bilateral black lungs)

70. Chronic Obstructive Pulmonary Disease (COPD)

71. 1.What does this X-ray chest show?
Cavitating lesion left lung
2.What is the likely diagnosis?
Abscess
Neoplasm

72. Right hilar shadow (lymph node, tumor)

73. 1.What abnormality is seen in the X-ray ?
Bilateral hilar lymphadenopathy
2.What is likely diagnosis?
Sarcoidosis
Lymphoma

74. Straight left atrium enlarged mitral stenosis

75. Aortic Aneurysm
(mediastinum is widened to the left of midline with increased convexity around the aortic arc)

76. How to read chest X-ray Identify problems as ABCDEF
A – Airway (Trachea position)
B – Bones (Ribs)
Breast shadow in female
C – Cardiac enlargement
Costrophrenic and Cardiophrenic angles
D – Diaphragm (evidence of free air below diaphragm)
E – Edges (Apices of lung for fibrosis)
F – Fields (Lung fields for any abnormality)

77. CHEST X-RAY Black Lung Field White Lung Field
Chronic obstructive pulmonary disease
Pneumothorax
Tension Pneumothorax
Pulmonary embolus
Pleural effusion
Consolidation
Collapse
Cavitating lung lesion
Left ventricular failure ( Pulmonary edema )
Fibrosis
Pneumonectomy
Asbestos plaques
Bronchiectasis
Miliary shadowing

78. 1. What abnormality does this chest X-ray show?
Bilateral hilar lymphadenopathy
2.What is the likely diagnosis?
Lymphoma
Sarcoidosis: systemic disorders like TB
Leukemia

79. What abnormality is shown?
Mediastinal mass
What could be the cause?
Lymphoma
Thymoma
Metastatic carcinoma
Leukemia

80. 1.What does the X-ray show? Narrowing of lower end of Esophagus
This patient had progressive dysphagia. Barium swallow was done.
1.What does the X-ray show?
Narrowing of lower end of Esophagus
2.What is the diagnosis?
Achalasia

81. 1.What does this X-ray show? Rounded White shadow left apex
Chest X-ray of middle aged man
1.What does this X-ray show?
Rounded White shadow left apex
Pneumonia shadow : not purely white with blackish .. Alveoli
2.What is likely diagnosis?
Most likely left apical carcinoma, Pancoast tumor

82. 1.What this X-ray chest is showing?
This patient is presented with weight loss.
1.What this X-ray chest is showing?
Chest X-ray shows multiple rounded shadows in the lung fields
2.What is the diagnosis?
Multiple secondaries - cannonball secondaries (primary carcinoma site in kidney or testes)

83. 1.What does the skull X-ray show?
Multiple lytic lesions in the skull
2.Give two causes.
Multiple myeloma
Multiple secondaries