LECTYRE OF THE CHEST X-RAY
A.WEISS M.DD.E.S ,Chirurgie Générale, Viscérale et LaparoscopiqueA.F.S/A.F.S.A/DU - FRANCE
Aims
• Basics .• Best exam results .• Appreciate the role radiology plays .• Instil an interest in radiology .
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Contents
• Densities• Techniques• Anatomy• CXR Interpretation• Common Pathologies• Questions
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Densities The big two densities are:
(1) WHITE - Bone (2) BLACK - Air
The others are:
(3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the
film, it is:
(5) BRIGHT WHITE - Man-made
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TECHNIQUEP-A ( relation of x-ray beam to patient )
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TECHNIQUELateral
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TECHNIQUELateral Decubitus
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I.D
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ORIENTATION - ROTATION
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PENETRATIONLOW HIGH
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INSPIRATION - EXPIRATION
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ORGANS
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LECTURE OF THE NORMAL CHEST X - RAY
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ANATOMY
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LOBES RIGHT UPPER LOBE
LOBES RIGHT MIDDLE LOBE
LOBES RIGHT LOWER LOBE
LOBES LEFT LOWER LOBE
• LOBES LEFT UPPER LOBE WITH LINGULA
LOBES LINGULA
LOBES LEFT UPPER LOBE – UPPER DIVISION
HEART
•- RIGHT BORDER : EDGE OF ( R ) ATRIUM
•- LEFT BORDER : ( L ) VENTRICLE + ATRIUM
•- POSTERIOR BORDER : REFT VENTRICLE
•- ANTERIOR BORDER : RIGHT VENTRICLE
HEART
HEART
HEART
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LECTURE OF THE NORMAL CHEST X - RAY
1. Superior vena cava
2. Inferior vena cava 3. Right atrium (blue) 4. Right ventricle
(blue) 5. Left ventricle (red) 6. Aorta 7. Pulmonary trunk
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MEDIASTINUM
HILUM
Made of :
1. Pulmonary Art.+Veins2. The Bronchi
Left Hilus higher (max 1-2,5 cm)
Identical : size, shape, density
HILUM
RIBS
LECTURE OF THE NORMAL CHEST X - RAY
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LATERAL CXR
LATERAL CXR
LATERAL CXR
LECTURE OF THE NORMAL CHEST X - RAY
POSTERIOR-ANTERIOR VIEW
LATERAL VIEW
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LECTURE OF THE NORMAL CHEST X - RAY
1. Rib 2. Sternum 3. Breast 4. Position of oblique fissure 5. Position of horizontal
fissure
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LECTURE OF THE NORMAL CHEST X - RAY
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LECTURE OF THE NORMAL CHEST X - RAY
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NORMAL POSITION OR NOT ?
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LECTURE OF THE NORMAL CHEST X - RAY
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CXR Interpretation
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TECHNICAL DETAILS
•Type•Orientation•Rotation •Penetration•Inspiration - expiration
LUNGS
•Lungs• Density• Symmetry• Lesions
HEARTSIZE
HEART •Size of heart •Size of individual chambers of heart
•Size of pulmonary vessels
•Evidence of stents, clips, wires and valves
•Outline of aorta and IVC and SVC
MEDIASTINUM:• Width • Contour• AP window
HILA• Size• Location
REVIEW AREAS• Apices• Behind the heart• CP angles• Below the diaphragm• Soft tissues ( breast, surgical emphysema) • Ribs & clavicle •Vertebrae
IDENTIFY THE LESION → LOCALISE THE LESION →
DESCRIBE THE LESION → GIVE DD
NEVER STOP LOOKING, CARRY ON WITH YOUR SYSTEMATIC
APPROACH!!
Pathology
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EMPHYSEMA
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EMPHYSEMA
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HYDROTHORAX - HEMOTHORAX
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HYDROTHORAX - HEMOTHORAX
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PLEURAL EFFUSION
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HYDROTHORAX - HEMOTHORAX
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PNEUMOTHORAX
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Pneumothorax
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PNEUMOTHORAX
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PNEUMOTHORAX
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CARDIAC TAMPONADE
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CARDIOMEGALY
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RUL PNEUMONIA
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RML PNEUMONIA
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RLL PNEUMONIA
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LLL PNEUMONIA
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HILAR M L
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HILAR LYMPHADENOPATHY
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THE ENLARGED HILA
Causes
1. Adenopathies (neoplasia, infection)
2. Primary Tumor
3. Vascular
4. Sarcoidosis
MULTIPLE MASSES
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tumor
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PNEUMONIA
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PNEUMOPERITOINE
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PNEUMOPERITOINE
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PNEUMOPERITOINE
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TUBERCULOSIS
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TUBERCULOSIS
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CERVICAL RIB
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THANK YOUAbdul.Kader WEISS 2009
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