by silhouetting and the hilum overlay sign with adjacent structures. If either hemidiaphragm is blurred, for example, this suggests the lesion to be from the corresponding lower lobe. If the right heart border is blurred, than the pathology is likely in the right middle lobe, though a cavum deformity can also blur the right heard border due to indentation of the adjacent sternum. If the left heart border is blurred, this implies a process at the lingula. Abnormalities Nodule A lung nodule is a discrete opacity in the lung which may be caused by: Neoplasm: benign or malignant Granuloma: tuberculosis Infection: round pneumonia Vascular: infarct, varix, granulomatosis with polyangiitis, rheumatoid arthritis There are a number of features that are helpful in suggesting the diagnosis: rate of growth Doubling time of less than one month: sarcoma/infection/infarction/vascular Doubling time of six to 18 months: benign tumor/malignant granuloma Doubling time of more than 24 months: benign nodule neoplasm calcification margin smooth lobulated presence of a corona radiata shape site If the nodules are multiple, the differential is then smaller: infection: tuberculosis, fungal infection, septic emboli neoplasm: e.g., metastases, lymphoma, hamartoma sarcoidosis alveolitis auto-immune disease: e.g., granulomatosis with polyangiitis, rheumatoid arthritis inhalation (e.g., pneumoconiosis) Cavities A cavity is a walled hollow structure within the lungs. Diagnosis is aided by noting: wall thickness wall outline changes in the surrounding lung The causes include: cancer infarct (usually from a pulmonary embolus) infection: e.g., Staphylococcus aureus, tuberculosis, Gram negative bacteria (especially Klebsiella pneumoniae), anaerobic bacteria, and fungus Granulomatosis with polyangiitis Pleural abnormalities Fluid in space between the lung and the chest wall is termed a pleural effusion. There needs to be at least 75 mL of pleural fluid in order to blunt the costophrenic angle on the lateral chest radiograph and 200 mL of pleural fluid in order to blunt the costophrenic angle on the posteroanterior chest radiograph. On a lateral decubitus, amounts as small as 50ml of fluid are possible. Pleural effusions typically have a meniscus visible on an erect chest radiograph, but loculated effusions (as occur with an empyema) may have a lenticular shape (the fluid making an obtuse angle with the chest wall). Pleural thickening may cause blunting of the costophrenic angle, but is distinguished from pleural fluid by the fact that it occurs as a linear shadow ascending vertically and clinging to the ribs. Diffuse shadowing The differential for diffuse shadowing is very