When found in the lungs tram tracks are radiologic signs that are usually accompanied by pulmonary edema in cases of congestive heart failure and bronchiectasis tram tracks are caused by bronchial wall thickening and can be detected on a lateral chest x ray. There is dilatation of bronchi with or without thickening of bronchial walls and mucus plugging.
Now compare the previous x ray with the one above here are few examples of tram line shadows.
Tram track appearance in chest x ray. Tram track sign may be used in chest radiography or ct to denote the thickened non tapering parallel walls of cylindrical bronchiectasis. More in detail bronchiectases are shown as parallel line opacities on chest radiography. Mild form shows tram track appearance.
What was seen on the chest x ray it is nothing but the tram line appearance unable to spot it here comes the modified image. It should not be confused with other tram track signs elsewhere in the body. Honey comb shadow 3 overall there appears to be an increase in bronchovascular markings and bronchi seen end on may appear as ring shadows.
Tram track opacities are seen in cylindrical bronchiectasis and 2. Air fluid levels may be seen in cystic bronchiectasis. Case discussion the tram tack sign seen on this chest x ray denoted thickened non tapered walls of the cylindrical bronchiectasis.
In chest radiographs of patients affected by cylindrical bronchiectasis the tram track sign is reproduced by the presence of thickened bronchial branches which may reproduce a tram line appearance fig. Chest x ray in children reading a chest x ray cxr requires a systematic approach. Tram track sign annotated in a 65 year old male with diagnosed bronchiectasis secondary to dilated bronchi within both lower lobes.
It is tempting to leap to the obvious but failure to be systematic can lead to missing barn door pathology overlooking more subtle lesions drawing false conclusions based on a film that is technically poor and hence misleading or even basing management on an inaccurate interpretation. Chest x rays are usually abnormal 1. Tram track sign can be seen on ct and cxr.
The term tram tracks is also used to describe the basement membrane duplication found on light microscopy. The tree in bud sign and the signet ring sign can be seen on ct.