Published on March 16, 2014
X RAY CHEST
1. Patient particulars 2. View- PA / AP / LATERAL / OBLIQUE 3. Exposure/penetration 4. Centralisation 5. Skeleton 6. Lung fields 7. Cardiovascular silhouette 8. Mediastinum 9. Costo phrenic & cardio phrenic angles 10. Diaphragm 11. Soft tissue abn. 12. Conclusion
Radiologically, lung fields are divided into 3 ZONES…… UPPER ZONE - From above upto 2nd costal cartilage MIDDLE ZONE - 2ND TO 4TH Costal cartilage LOWER ZONE - Below 4th costal cartilage
Patient particulars View- Pa / AP / Lateral / Oblique
Should see ribs through the heart Barely see the spine through the heart Should see pulmonary vessels nearly to the edges of the lungs
OVERPENETRAT ED FILM • Lung fields darker than normal—may obscure subtle pathologies • See spine well beyond the diaphragms • Inadequate lung detail
Underpenetrated Film •Hemidiaphragms are obscured •Pulmonary markings more prominent than they actually are
Should be able to count 9-10 posterior ribs Heart shadow should not be hidden by the diaphragm 1 2 3 4 5 6 7 8 9 10
Medial ends of bilateral clavicles are equidistant from the midline or vertebral bodies
If spinous process appears closer to the right clavicle (red arrow), the patient is rotated toward their own left side If spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side
Check for Symmetry Deformities Fractures Masses Calcifications Lytic lesions
Check for Cardiomegaly Mediastinal and Hilar contours Trachea- upper med. Apex of heart- lower med.
Check sharpness of borders Right is normally higher than left Check for free air, gastric bubble, pleural effusions >1.5 cm - normal < 1.0 cm- flat diaphragm
To help you determine abnormalities and their location… Use silhouettes of other thoracic structures
This is chest radiograph, PA view with normal exposure, no rotation and without any apparent bony abnormality. Trachea is placed centrally & lung fields are clear with normal broncho-vescicular markings. Cardiovascular silhouette is within normal limits with normal cardiothoracic ratio. Mediastinum, costo-phrenic, cardio-phrenic angles, dome of diaphragm & soft tissue shadow within normal limits.
Remember… be systematic!
a) PNEUMONIA b) COLLAPSE c) FIBROSIS d) PULMONARY INFARCTION e) CA LUNG f) TUBERCULOSIS
Multiple bilateral cavitary lesions with air- fluid levels
1. LUNG ABSCESS 2. HYDROPNEUMOTHORAX 3. INFECTED LUNG CYST
PERICARDIAL EFFUSION DCMP RHD IHD ASD VSD SYST HTN
Non homogenious infiltrates
Non homogenious infiltrates
1. PULMONARY TB 2. RESOLVING BACTERIAL PNEUMONIA 3. ALVEOLAR CELL CA 4. PULMONARY EDEMA 5. FUNGAL INFECTION OF LUNG
1) EMPHYSEMA 2) B/L PNEUMOTHORAX 3) LARGE MULTIPLE BULLAE 4) B. ASTHMA 5) OVER EXPOSED FILM
Normal broncho-vescicular markings 2/31/3
UPTO 2/3 – Normal BEYOND 2/3 – Chronic bronchitis
Fibosis Collapse infiltration
Foreign body ? Trachea ? esophagus
Ans. Is…Lateral X-Ray Chest. & Symptoms
1) Pneumothorax 2) Bullae 3) Lung cyst 4) Obtructive emphysema 5) Mastectomy 6) Poor technique
1. Miliary tb 2. Tropical eosinophilia 3. Pneumoconiosis 4. Lymphangitis carcinomatosa 5. Extrisic allergic alveolitis 6. Haemosiderosis 7. Sarcoidosis 8. Fungal ds
Homogenious opacity Homogenious opacity
1) Pleural effusion 2) Empyema thorasis 3) Collapse 4) Consolidation 5) Thickened pleura 6) Pleural mesothelioma 7) Agenesis of lung 8) Surgical removal 9) Fibrosis
Right lung opacity
Left lung opacity
Ca lung Loculated pleural effusion
Thank you all The besT
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