Chest Xray

CHEST RADIOLOGY

Prepared By :1.Belal Alrefaei2.Merry Admaso3.Bshara

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The 12-Step:

1: Name 2: Date 3: Old films 4: What type of view(s) 5: Penetration 6: Inspiration 7: Rotation 8: Angulation 9: Soft tissues / bony structures 10: Mediastinum 11: Diaphragms 12: Lung Fields

Quality Control

Findings

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Chest X-Ray

Findings

Is heart enlarged or normal?

Signs of heart failure and fluid overload?

Does patient have pneumonia or collapsed lung?

Is there evidence of emphysema?

Are there findings of an aortic aneurysm?

Is there fluid in the sac that surrounds the lung?

Is there free air under the diaphragm?

Is there a tumor in the lung that could represent cancer?

NORMAL CHEST X-RAY

PA LATERAL

Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2) Anterior or Posterior) or (3) Superior or Inferior.

NORMAL HEARTBORDERS

Note cardiac chambers that account for margins on the chest X-ray

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1. R Atrium2. R Ventricle3. Apex of L Ventricle

4. Superior Vena Cava5. Inferior Vena Cava6. Tricuspid Valve

7. Pulmonary Valve8. Pulmonary Trunk9. R PA 10. L PA

LEFT 4TH RIB POSTERIOR AND ANTERIOR PORTIONS

POSTERIOR

ANTERIOR

4

A

P

AORTIC ARCH

LT. HEMI DIAPHRAGM

NORMAL CHEST ANATOMYLATERAL CHEST XRAY

COLON GAS

TRACHEA

OBLIQUE FISSURE

HORIZONTAL FISSURE

RT. HEMI DIAPHRAGM

Diaphragm-AP view

Diaphragm- Lateral view

LT.

LT.

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RT.

LT.

CARINA

LT. MAIN BRONCHUS

RT. MAIN BRONCHUS

TRACHEA

OBLIQUE FISSURE(major)

OBLIQUE FISSUREmajor

HORIZONTAL FISSUREminor

BRONCHOGRAM—CONTRAST OUTLINING AIRWAY

HORIZONTAL FISSURE

FISSURES DIVIDE

LUNGS INTO LOBES

RIGHT lung has:

UPPER

MIDDLE lobes

LOWER

LEFT lung has:

UPPER lobes

LOWER

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INTERESTING CASES

INFECTION

NEOPLASTIC

CARDIOVASCULAR

TRAUMA

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15 RUL pneumonia

16 RML pneumonia

RLL pneumonia17

18 LUL pneumonia

19 LLL pneumonia

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Pulmonary Fibrosis

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Miliary TB Snow Storm Apperance

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TB

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24 Cavitating lesion

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CaVity

26 Hilar Lymphadenopathy - BL

PNEUMOTHORAX

PLEURAL EFFUSION

PLEURAL EFFUSION

NORMAL

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PLEURAL EFFUSION

30 Pleural Effusion

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Bilateral pleural effusions

PNEUMOTHORAX

33 Pneumothorax

TENSION PNEUMOTHORAX

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TENSION PNEUMOTHORAX

36Hyperinflation

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Hemothorax

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Aortic dissection with hemothorax

39 RUL collapse

40 LLL collapse

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Chest mass, emphysema

Hilar mass

43 Emphysema

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Subcutaneous emphysema

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ARDS

Congestion Interstitial

and alveolar edema

Collapsed or distended alveoli

Bilateral

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Bulla

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SARCOIDOSIS Granulomatous

Inflammation Bilateral &

symmetrical hilar & mediastinal LAD

Generalized fibrosis

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ATELECTASIS No ventilation to lobe beyond the

obstruction Trapped air absorbed by pulmonary

circulation Segmental/lobar density Compensatory hyper-inflation of

normal lungs.

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NORMAL HEART CARDIOMEGLY

52 Dextrocardia

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Cardiomegaly

Cardiac silhouette

greater than 50% of width of

thorax

CARDIOMEGLY

CONGESTIVE HEART FAILURE

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Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)

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Congestive Heart Failure Increased heart size:

cardiothoracic ratio >0.5

Large hila with indistinct markings

Fluid in interlobar fissures

Pleural effusions, alveolar edema

57 Heart failure

58Pericardial effusion

59Pulmonary Edema

60Pulmonary Embolism

61Kerley B line

62VSD

63ASD

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Tetrology Of Fallot(Boot Shaped)

65Aortic dissection

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67 Multiple Masses

Free air beneath diaphragm

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Free air

69 Air under the diaphragm

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Empyema after trauma

Clavicle fracture

Cavitary lesion

Opacified hemithorax

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Pneumonectomy

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Entire mediastinum shifted left, indicating volume loss

Opacified left hemithorax

Trachea shifted left, indicating volume loss

Pneumonectomy

73 Hiatus hernia

PULMONARY METASTATIC NODULES

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Clavicle dislocation

Medial clavicle is displaced inferiorly

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Clavicle fracture, distal

LT.

Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.

FRONTAL LATERAL

WHAT AND WHERE IS IT?

Air stripe

Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.

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Diaphragm rupture

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Smoke inhalation, chronic changes

Right Lower Lobe

Pneumonia

Right side tension

pneumothorax

Fracture of posterior rib #7

Right Side

Pleural Effusio

n

Left Sided Pneumothorax