A NUMBER of technical factors and incidental anatomical and physiological variations can mimic or mask pathology of the lung, while diseases of different aetiologies may present with a similar radiographic appearance, all of which can often make diagnosis of lung disease challenging. The key to interpretation is to rely on the general principles of radiology and pattern recognition to help identify and classify genuine changes. This, in turn, allows a list of likely differential diagnoses to be compiled, which is important when planning further diagnostic tests or treatment. An article in last month's issue (In Practice, April 2008, volume 30, pp 182-189) described how to acquire high-quality thoracic radiographs and discussed the principles of interpretation, the normal appearance of the lung and the features of abnormal bronchial and vascular patterns. This article describes the features of alveolar, interstitial and mixed lung patterns, nodules, masses and pulmonary mineralisation, and outlines the causes of decreased pulmonary opacity.
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