By Jonathan Corne; Kate Pointon
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1 1 3. Right lower lobe collapse. There is a whiteness immediately above the diaphragm (1) causing a loss of its outline. On the lateral film there is a white triangle at the lower posterior part of the lung field (2). Note how the outline of the right heart border is maintained. 1 4. Left upper lobe collapse. This is difficult to spot. Remember that most of the left upper lobe lies in front of, as opposed to above, the left lower lobe. When it collapses it causes a haze to appear over the whole of the left lung field.
As with a plain chest X-ray it is important that you have a scheme to work with. Remember, you never look down on a patient, so all CT images are taken as though you are looking up the body from the feet, and the left structures are on the right! 1. Start with the mediastinal windows. Identify the image that shows the arch of the aorta (1) and on this slice: a. Look for the trachea, the black circle medial to the arch (2). b. Look for the superior vena cava (SVC) (3) which lies to the right of the aorta, and tends to be oval rather than round because the blood is under low pressure.
Look at the following four films on pages 22–25. 1. Look at the right heart border and follow it up from the diaphragm. From the diaphragm to the hilum the heart border is formed by the edge of the right atrium (1). From the hilum upwards it is formed by the superior vena cava (2). 2. Follow the left heart border up from the diaphragm. From the diaphragm up to the left hilum it consists of the left ventricle (3). The left border is then concave at the lower level of the left hilum and here it is made up of the left atrial appendage (4).