The left superior intercostal vein drains the left posterosuperior hemithorax and is considered to be part of the azygos venous system even though it does not directly drain into the azygos vein.
Origin and course
The left superior intercostal vein forms by the union of the 2nd...
The left upper lobe (LUL) is one of two lobes in the left lung. It is separated from the left lower lobe by the left oblique fissure and subdivided into four bronchopulmonary segments, two of which represent the lingula.
Location and structure
The left upper lobe lies in the upp...
The left upper lobe anterior segment is one of the four bronchopulmonary segments of the left upper lobe. It is the most anterior of the segments in the left upper lobe lying below and anterior to the apicoposterior segment and above the oblique fissure.
The left upper lobe apicoposterior segment is one of the bronchopulmonary segments of the left upper lobe. As its name suggests, it is the most apical and posterior of the segments within the left upper lobe and is supplied by the left apicoposterior segmental bronchus.
It is the equivalent seg...
The left main bronchus divides into the left upper lobe bronchus and the left lower lobe bronchus. It is one of the secondary lobar bronchi.
The left upper lobe bronchus is very short and divides immediately into the segmental bronchi. There are usually 10 individual segmental b...
Left upper lobe collapse has distinctive features but can be challenging to identify on chest radiographs by the uninitiated.
For a general discussion refer to the article on lobar collapse.
The left upper lobe collapses anteriorly becoming a thin sheet...
Getting a film with left upper lobe collapse in the exam is one of the many exam set-pieces that can be prepared for.
This frontal chest radiograph shows a hazy (or veil-like*) opacification of the left hemithorax that is associated with superior displacement left hilum and horizon...
The left upper lobe inferior lingular segment is one of the four bronchopulmonary segments of the left upper lobe. It lies below the superior lingular segment of the left upper lobe.
The left upper lobe superior lingular segment is one of the four bronchopulmonary segments of the left upper lobe. It lies below the apicoposterior and anterior segments of the left upper lobe.
The left ventricle is one of four heart chambers. It receives oxygenated blood from the left atrium and pumps it into the systemic circulation via the aorta.
The left ventricle is conical in shape with an anteroinferiorly projecting apex and is longer with thicker walls than the ...
Legionella pneumonia, also known as Legionnaires' disease, refers to pulmonary infection primarily with the organism Legionella pneumophila. It is sometimes classified as atypical pneumonia.
Legionella pneumonia tends to be more prevalent among immunocompromised patients. Legione...
Leptospirosis results from infection of the zoonoses Leptospira sp. The condition can have multi-organ manifestations. Commonly affected organs include:
lung: pulmonary leptospirosis
liver: hepatic leptospirosis
central nervous system: CNS leptospirosis
skeletal muscle: muscular leptospirosi...
The lesser diaphragmatic apertures allow the passage of smaller structures from the thoracic cavity to abdominal cavity across the diaphragm. They are very much smaller than the other diaphragmatic apertures:
two in the right crus of the diaphragm: transmit greater and lesser right splanchnic n...
The ligamentum arteriosum (or arteriosus) is the small fibrous remnant of the fetal ductus arteriosum, located between and connecting the proximal left pulmonary artery and the undersurface of the junction of the aortic arch and descending aorta, at the aortic isthmus. The left recurrent larynge...
Light chain deposition disease (LCDD) is a rare disease.
It can affect multiple organ systems.
renal manifestations of light chain deposition disease - renal involvement is a constant feature, resulting in proteinuria with or without nephrotic syndrome and renal failure.
Pulmonary manifestations of light chain deposition disease are rare when considering the full disease spectrum of light chain deposition disease.
The light chains are secreted by a plasma clone and deposit in the alveolar walls, small airways, and vessels.
Lines and tubes are important components in chest radiographic evaluation.
Nasogastric (NG) tube
See: nasogastric tube positioning.
NG tube tip ≥10 cm distal to the gastro-oesophageal junction
i.e. below the left hemidiaphragm
insertion into trachea or bron...
Lingula (plural lingulae) can refer to a number of different anatomical structures:
lingula (sphenoid bone)
History and etymology
Lingula is the diminutive form of lingua, Latin for the tongue. Thus lingula is used for a small tongue-l...
The lingula is a combined term for the two lingular bronchopulmonary segments of the left upper lobe:
superior lingular segment
inferior lingular segment
The two lingular segments are the most anterior of the segments in the left upper lobe lying below the apicoposterior and anterior segments...
Lipoblastoma of the lung is a fat derived thoracic tumour.
They occur during infancy and early childhood. More than 90% of cases are diagnosed in children less than 3 years of age, with nearly 75% occurring before the age of 12 months
Lipoblastomas are rare soft-tissue...
Lipoid pneumonia can either result from aspiration of oily substances (exogenous lipoid pneumonia) or endogenous accumulation of lipid substances in the alveoli (endogenous lipoid pneumonia).
Most patients are asymptomatic and often discovered incidentally.
Lipomatosis is a condition where there is diffuse excessive fat deposition within the body. This can especially affect certain regions.
neck and upper region of trunk
lipomatous hypertrophy of the interatrial septum
lipomatous metaplasia of th...
Liquefactive necrosis is a form of necrosis where there is transformation of the tissue into a liquid viscous mass.
In liquefactive necrosis, the affected cell is completely digested by hydrolytic enzymes leading to a soft, circumscribed lesion which can consist of fluid with remains...
This is a basic article for medical students and other non-radiologists
Lobar collapse is relatively common and occurs following obstruction of a bronchus. Gas is resorbed from the lung parenchyma distal to the obstruction resulting in the collapse of the lung, with volume reduction and negativ...
Lobar collapse refers to the collapse of an entire lobe of the lung. As such it is a subtype of atelectasis (although collapse is not entirely synonymous is atelectasis), which is a more generic term for 'incomplete expansion'. Individual lobes of the lung may collapse due to obstruction of the ...
Lobar pneumonia (also known as non-segmental pneumonia or focal non-segmental pneumonia 7) is a radiological pattern associated with homogenous, fibrinosuppurative consolidation of one or more lobes of a lung in response to bacterial pneumonia.
The radiological appearance of lobar pneumonia is...
A localised (solitary) mediastinal malignant mesothelioma is a rare variant of malignant pleural mesothelioma and is thought to arise from mesothelial cells of the pericardium.
There are too few report cases to be dogmatic in regards to epidemiological or radiographic features.
Localised pulmonary emphysema is not a commonly used term but generally given the to describe pulmonary emphysema confined to a particular location with the lung (may involve a lobe,segment or subsegment). It has also been used to describe focal areas of enlargement or destruction of air spaces ...
Localised pulmonary haemorrhage is a descriptive term for a pulmonary haemorrhage restricted to a particular focal region of the lung. It can range from involving a small focus of haemorrhage to a whole lobe.
Focal pulmonary haemorrhage can occur from a number of causes:
A loculated pneumothorax is a form of pneumothorax where a pocket of pleural air is trapped within a localised area. They may occur in a number of situations including in patients with acute respiratory disease treated with mechanical ventilation 1 and status post pleural aspiration in the conte...
Simple pulmonary eosinophilia (also known as Löffler syndrome) is a type of pulmonary eosinophilia that typically presents with transient radiographic infiltrates, minimal constitutional upset, and an elevated eosinophil count in peripheral blood.
The cause is not usually ...
Löfgren syndrome is a specific acute clinical presentation of systemic sarcoidosis, consisting of:
hilar adenopathy: see thoracic manifestations of sarcoidosis
arthritis: see musculoskeletal manifestations of sarcoidosis
Low attenuation lymphadenopathy suggests underlying necrosis and can be seen in:
metastatic carcinoma (or lymphoma)
infections (tuberculous or fungal)
low attenuation lymphadenopathy
high attenuation lymphadenopathy
The distribution of bronchiectasis can help in narrowing the differential diagnosis. Lower lobe bronchiectasis is the commonest zonal predilection in bronchiectasis 2. It is mostly idiopathic but can be typically seen in
post infective bronchiectasis
recurrent childhood infections
A lower respiratory tract infection (LRTI) is a very broad term which can mean inflammation of the respiratory tract below the level of the larynx. This term may include a pneumonia (which is often given to described more organised consolidation within the lungs). There is also overlap with the ...
The lower zone is one of the four chest radiograph zones.
on frontal chest radiographs, extends inferiorly from the inferior aspect of the hilum to the hemidiaphragm
The Luftsichel sign is seen in some cases of left upper lobe collapse and refers to the frontal chest radiographic appearance due to hyperinflation of the superior segment of the left lower lobe interposing itself between the mediastinum and the collapsed left upper lobe.
Lumbar (or 13th) ribs are a rare anatomical variant and represent transitional vertebrae at the thoracolumbar junction with a prevalence of ~1% 1. It presents as an additional rib coming off T13 or L1 (depending on numbering classification) and may be unilateral or bilateral. Lumbar ribs are mos...
The lungs are the functional units of respiration and are key to survival. They contain 1500 miles of airways, 300-500 million alveoli and have a combined surface area of 70 square meters (half a tennis court). Each lung weighs approximately 1.1 Kg. They are affected by a wide range of patholog...
Lung abscesses are circumscribed collections of pus within the lungs. They are often complicated to manage and difficult to treat and, in some cases, may be life threatening.
As a result of the widespread availability of antibiotics, the incidence of lung abscesses has dramaticall...
Lung architectural distortion in thoracic radiology refers to a descriptive term give when the normal pulmonary bronchial, vascular, fissural or septal anatomy is disrupted and manifested as loss of smooth course of the fissures, crowding of dilated bronchioles or vessels with angulated course 1...
Lung atelectasis refers to collapse or incomplete expansion of pulmonary parenchyma. Note that the term "atelectasis" is typically used when there is partial collapse, whereas the term "collapsed lung" is typically reserved for when the entire lung is totally collapsed.
Lung cancer, or frequently, if somewhat incorrectly, known as bronchogenic carcinoma, is the most common cause of cancer in men, and the 6th most frequent cancer in women worldwide. It is the leading cause of cancer mortality worldwide in both men and women and accounts for approximately 20% of ...
Lung cancer screening with low-dose CT (LDCT) is an imaging strategy that is beginning to be adopted for high-risk patients in some health systems. Lung cancer is the most common cause of cancer death worldwide, and there is accumulating higher level evidence that a mortality benefit exists with...
The IASLC (International Association for the Study of Lung Cancer) 7th edition lung cancer staging system was proposed in 2010 and has now been updated and superseded by the 8th edition, published in 2016.
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) used to be staged di...
The IASLC (International Association for the Study of Lung Cancer) 8th edition lung cancer staging system was introduced in 2016 and supersedes the IASLC 7th edition.
It is as follows:
T: primary tumour
Tx: primary tumour cannot be assessed or tumour proven by the presence of mal...
This is a basic article for medical students and non-radiologists
Lung cancer is the most common cancer worldwide and refers to malignancy originating in the airways or pulmonary parenchyma.
Patients may be asymptomatic until locally advanced or metastatic disease. The m...
Lung carcinomas of the salivary gland type are also known as salivary gland–type tumours of the lung (SGTTLs) or bronchial gland neoplasms.
The usual consignation to the group of non-small cell lung cancer (NSCLC) may be unfortunate because the clinical behavior of SGTTLs can be quite differen...
A commonly used mnemonic for recalling the features of consolidation is:
A: acinar rosettes
A: air bronchogram/alveologram
B: bat-wing distribution
C: coalescent/confluent ill-defined "fluffy" appearance
C: consolidation: diffuse, perihilar/bibasilar, lobar/segmental...
A lung decortication is a cardiothoracic surgical procedure usually performed for situations such as a chronic thoracic empyema or a chronic haemothorax where a diseased, often chronically infected, pleura is debrided from the adjacent lung and removed. It is also sometimes performed of selected...
Lung entrapment is a term given to non-expandable lung due to active pleural inflammation, malignancy, or haemothorax.
The term is similar but not entirely synonymous with trapped lung, which is due to pleural inflammation from remote disease resulting in fibrous thickening of the pleura.
Lung fissures are a double-fold of visceral pleura that either completely or incompletely invaginates lung parenchyma to form the lung lobes.
Each lung has an oblique fissure separating the upper lobes from the lower lobes and the right lung has a horizontal fissure that separates the right up...
Lung hyperinflation is a common feature of patients with chronic obstructive pulmonary disease (COPD). It is also linked to ageing and other chronic diseases that cause airflow obstruction.
The airflow limitation during expiration is produced by two factors:
destruction of the lung ...
Lung parenchyma is the portion of the lung involved in gas transfer - the alveoli, alveolar ducts and respiratory bronchioles. However, some authors include other structures and tissues within the definition.
parenchymal lung disease
Lung-RADSTM (or lung imaging reporting and data system) is a classification proposed to aid with findings in low dose CT screening exams for lung cancer. The goal of the classification system is to standardize follow-up and management decisions. The system is similar to the Fleischner criteria b...
Lung torsion is a very rare situation typically described as an adverse event after a pneumonectomy. In extremely rare situations it can also occur after less invasive procedures such as video-assisted thoracic surgery (VATS) 11 or even spontaneously in the native lung.
It has a ...
Lung transplant complications can occur at variable time intervals following transplantation. It is important for radiologists to be aware of specific complications as chest imaging is routinely used in post transplant assessment.
When reporting a postoperative radiograph or CT, it is importan...
Lung volume reduction surgery (LVRS) is an emerging promising palliative treatment option for select patients with severe, debilitating pulmonary emphysema. It usually involves bilateral wedge resection of 20-30% of the most diseased lung through a median sternotomy. It has been proposed that L...
Lymphangioleiomyomatosis (LAM) is a rare multi-system disorder that can occur either sporadically or in association with the tuberous sclerosis complex (TSC) and is often considered a forme fruste of TSC.
It can affect several regions in the body
thorax: thoracic manifestations of lymphangiol...
Lymphangitic carcinomatosis, or lymphangitis carcinomatosa, is the term given to tumour spread through the lymphatics of the lung and is most commonly seen secondary to adenocarcinoma.
The demographics will reflect that of the underlying malignancy (see below).
A mnemonic for the causes of lymphangitic carcinomatosis is:
Certain Cancers Spread By Plugging The Lymphatics
L: larynx and lung
Lymphocele of the thoracic duct (thoracic duct cyst) is usually asymptomatic or less commonly may present as left supraclavicular fossa mass 1.
The clinical significance of a thoracic duct cyst lies in its misidentification as a pathological lesion at radiological assessment, whi...
Lymphocytic interstitial pneumonitis (LIP) is a benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs. It is classified as a subtype of interstitial lung disease. It also falls under the umbrella of non-lymphomatous pulmonary lymphoid disorders.
Lymphomatoid granulomatosis (LG), also known as angiocentric lymphoma or angiocentric immunoproliferative lesion, is a rare type of non-Hodgkin's lymphoma.
There is a recognised association with antecedent infection with the Epstein Barr virus (EBV).
It can affect a variety of org...
Pulmonary manifestations of lymphomatoid granulomatosis are important since the lung is one of the most frequent sites of involvement in lymphomatoid granulomatosis. It falls under the group of pulmonary angiitis and granulomatosis.
Some consider the condition to be midway between ov...
Macrocystic honeycombing refers to a morphological sub type of honeycombing. Many publications consider the individual lung cysts to be greater than 4mm to be classified into this category. This form is considered to be more associated with UIP 3.
Major aortopulmonary collateral arteries (MAPCAs) are persistent tortuous fetal arteries that arise from the descending aorta and supply blood to pulmonary arteries in the lungs usually at the posterior aspect of hilum.
Embryologically, the intersegmental arteries regress with the no...
Malignant pleural disease usually heralds a poor prognosis, whether it represents a primary pleural malignancy or metastatic involvement.
Clinical presentation is variable. Patients may be asymptomatic or have pleuritic pain. If associated with a sizeable pleural effusio...
A number of staging systems have been described for staging of malignant pleural mesothelioma. Below is the International Mesothelioma Interest Group TNM staging system.
T - Tumour
Tx: primary tumour cannot be assessed
T0: no evidence of primary tumour
Marijuana (cannabis or bong) lung refers to the presence of large apical bullae in patients who regularly smoke marijuana. A definite causative link between smoking marijuana and bullous lung disease has not been established, and the association may just be coincidental.
The Masaoka staging system is commonly adopted for thymomas 1-3, and is the most important determinant of survival following surgical resection 4:
stage I: intact thymic capsule
stage II: capsular invasion into adjacent mediastinal fat or pleura
stage III: macroscopic invasion into adjacent o...
Mastocytosis is a disorder of excessive mast cell proliferation, which is now classified as a myeloproliferative neoplasm. Two clinical entities fall under the mastocytosis umbrella: cutaneous (urticaria pigmentosa) and systemic mastocytosis (with or without cutaneous manifestations). The articl...
Maximum Intensity Projection (MIP) consists of projecting the voxel with the highest attenuation value on every view throughout the volume onto a 2D image 1.
Such an algorithm is rather simple: for each XY coordinate, only the pixel with the highest Hounsfield number along the Z-axis is represe...
Mean pulmonary arterial pressure (MPAP) can be estimated by echocardiogram ultrasound study. It is calculated by the formula:
(PASystolic pressure +2 PADiastolic pressure) / 3
Normal MPAP is less than 20 mmHg and considered elevated when it exceeds 25 mmHg at rest or 30 mmHg with exertion.
Meconium aspiration occurs secondary to intrapartum or intrauterine aspiration of meconium, usually in the setting of fetal distress, and usually in term or post-term infants.
Up to 10-15% of live births after 34 weeks can present with meconium stained fluid but only 1-5% of neona...
Medial pneumothorax refers to the abnormal collection of air on medial aspect of the pleural cavity. This occurs when the quantity of air is small.
Chest radiograph (supine)
Seen as a linear lucent area along the medial aspect of lung at the interface of the pleural surf...
Medial stripe sign refers to an area of increased lucency at the interface of the medial lung and the mediastinum in case of medial pneumothorax. A small volume of pneumothorax generally accumulates anteriorly or medially which can be difficult to detect hence this sign holds a certain significa...
Mediastinal haemangioma is a location specific subtype of a haemangioma.
There incidence account for less than 0.5% among all mediastinal masses 1.
Up to half of patients may be asymptomatic 1. Others may present with non-specific symptoms, such as cough, c...
Mediastinal lipomatosis refers to a condition where there is a deposition of a large amount of mature adipose tissue in the mediastinum. It is a relatively common benign cause of mediastinal widening.
It is the result of increased deposition of normal unencapsulated fat 1.
Mediastinal lymphadenopathy associated with interstitial lung disease can be a frequent feature although its presence has limited value in the differential diagnosis. In certain forms of interstitial lung disease, the extent of lymph node enlargement may correlate to disease activity or progress...
Mediastinal lymph node enlargement can occur from a wide range of pathologies. It may occur on its own or in association with other lung pathology.
Although mediastinal lymphadenopathy is used interchangeably - by some - with "mediastinal lymph node enlargement", they are not synon...
Mediastinal lymphoma is common, either as part of disseminated disease or less commonly as the site of primary involvement.
Lymphomas are responsible for approximately 15% of all primary mediastinal masses, and 45% of anterior mediastinal masses in children 1. Only 10% of lymphoma...
Mediastinal mass may be caused by a wide variety of neoplastic and non-neoplastic pathologies. It is helpful to identify the location of the mass since this significantly reduces the breadth of the differential diagnosis.
There are four conceptual compartments of the mediastinum which are larg...
Mediastinal paragangliomas are rare tumours derived from chromaffin cells (neuroectodermal cells) associated with sympathetic ganglion of the autonomic nervous system. They can arise from two major cluster of sympathetic ganglion cells: paraaortic (aorticopulmonary) and paravetebral (aorticosymp...
A mediastinal pseudocyst is the extension of pancreatic pseudocyst into the posterior mediastinum through oesophageal or aortic hiatus or rarely through the foramen of Morgagni. It is a rare complication of acute or chronic pancreatitis.
It can present with symptoms due t...
Mediastinal teratomas are germ cell tumours located in the anterior mediastinum.
Mediastinal teratomas are the most common extra-gonadal germ cell tumours. They account for approximately 15% of anterior mediastinal masses in adults and approximately 25% of anterior mediastinal mas...
The differential diagnoses for mediastinal widening include:
traumatic aortic injury
aberrant right subclavian artery
azygous continuation of the IVC
pulmonary masses abutting the mediastinum
The mediastinum is a space in the thorax that contains a group of non-delineated organs and their surrounding connective tissue. It lies in the midline of the chest between the pleura of each lung and extends from the sternum to the vertebral column.
The mediastinum contains all...
The International Thymic Malignancy Interest Group (ITMIG) classification of mediastinal compartments was developed to reflect a division of the mediastinum based on cross-sectional imaging. It was in part an effort to consolidate prior discrepant classification systems in use by different medic...
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc. may also be visible
Mega oesophagus or diffuse oesophageal dilatation can be caused by a variety of conditions.
Some of the more common causes are given below 1-3:
malignant stricture, e.g. oesophageal canc...
Melioidosis is an infectious disease caused by Burkholderia pseudomallei (previously known as Pseudomonas pseudomallei) and is a multisystem disorder which may affect the lungs, brain, visceral organs, or musculoskeletal system.
Melioidosis is a disease of the monsoon season in th...
The melting ice cube sign describes the resolution of pulmonary haemorrhage following pulmonary embolism (PE).
When there is pulmonary haemorrhage without infarction following PE, the typical wedge-shaped, pleural-based opacification (Hampton's hump) resolves within a week while preserving its...