broad and can defeat even the most experienced radiologist. It is seldom possible to reach a diagnosis on the basis of the chest radiograph alone: high-resolution CT of the chest is usually required and sometimes a lung biopsy. The following features should be noted: type of shadowing (lines, dots or rings) reticular (crisscrossing lines) companion shadow (lines paralleling bony landmarks) nodular (many small dots) rings or cysts ground glass consolidation (diffuse opacity with air bronchograms) location (where is the lesion worst?) upper (e.g., sarcoid, tuberculosis, silicosis/pneumoconiosis, ankylosing spondylitis, Langerhans cell histiocytosis) lower (e.g., cryptogenic fibrosing alveolitis, connective tissue disease, asbestosis, drug reactions) central (e.g., pulmonary edema, alveolar proteinosis, lymphoma, Kaposi's sarcoma, PCP) peripheral (e.g., cryptogenic fibrosing alveolitis, connective tissue disease, chronic eosinophilic pneumonia, bronchiolitis obliterans organizing pneumonia) lung volume increased (e.g., Langerhans cell histiocytosis, lymphangioleiomyomatosis, cystic fibrosis, allergic bronchopulmonary aspergillosis) decreased (e.g., fibrotic lung disease, chronic sarcoidosis, chronic extrinsic allergic alveolitis) Pleural effusions may occur with cancer, sarcoid, connective tissue diseases and lymphangioleiomyomatosis. The presence of a pleural effusion argues against pneumocystis pneumonia. Reticular (linear) pattern (sometimes called "reticulonodular" because of the appearance of nodules at the intersection of the lines, even though there are no true nodules present) idiopathic pulmonary fibrosis connective tissue disease sarcoidosis radiation fibrosis asbestosis lymphangitis carcinomatosa PCP Nodular pattern sarcoidosis silicosis/pneumoconiosis extrinsic allergic alveolitis Langerhans cell histiocytosis lymphangitis carcinomatosa miliary tuberculosis metastases Cystic cryptogenic fibrosing alveolitis (late stage "honeycomb lung") cystic bronchiectasis Langerhans cell histiocytosis lymphangioleiomyomatosis Ground glass extrinsic allergic alveolitis desquamative interstitial pneumonia alveolar proteinosis infant respiratory distress syndrome (RDS) Consolidation pneumonia alveolar haemorrhage alveolar cell carcinoma vasculitis Signs The silhouette sign is especially helpful in localizing lung lesions. (e.g., loss of right heart border in right middle lobe pneumonia), The air bronchogram sign, where branching radiolucent columns of air corresponding to bronchi is seen, usually indicates air-space (alveolar) disease, as from blood, pus, mucus, cells, protein surrounding the air bronchograms. This is seen in Respiratory distress syndrome Disease mimics Disease mimics are visual artifacts, normal anatomic structures or harmless variants that may simulate diseases and abnormalities. Limitations While chest radiographs are a relatively cheap and safe method of investigating diseases of the chest, there are a number of serious chest conditions that may be associated with a normal chest radiograph and other means of assessment may be necessary to make the diagnosis. For example, a patient with an acute myocardial infarction may have