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HOW READ CHEST XR -3     ANAS SAHLE ,MD
POSITION                            PA                                                 AP                                 ...
Consolidation
ConsolidationInfection causes                    Non-infection causes                        Broncho-                     ...
Case-1 A 35-year-oldmale presented     with:   1. fever,   2. cough,  3. purulent    sputumfor one week.
POSITION      •PA CXRQUALITY       •GOOD Technical Quality                                          Lower lobe            ...
Case-2 This 75-year-oldfemale presented       with: acute respiratory      failure.  She had been   sick for two   weeks w...
POSITION      •AP CXRQUALITY       •Poor Technical Quality              •(HIGH penetration).                •Tow homogenou...
Case-3• A 30-year-old  male presented  with cough,  shortness of  breath• and loss of  weight over four  months
POSITION      •AP? CXRQUALITY       •Good Technical Quality               •Bilateral infiltrate at lower zoneLESION       ...
disscusion• The CXR shows bilateral infiltrates and air  bronchograms with a perihilar distribution.• The heart size is no...
Case-4• This middle-aged  male had low-  grade fever of one  month’s duration• associated with  productive cough  and loss...
POSITION      •PA CXRQUALITY       •POOR Technical Quality              •rotation                •Hetero-genous density at...
Case-5• This patient presented with stridor due to  thyroid goiter.• was intubated (Fig. 1).• Repeat CXR was done six hour...
AFTER INTUBATED
POSITION      •AP CXRQUALITY       •ACCEPT Technical Quality               •Bilateral perihilar patchy opaciteisLESION    ...
AFTER SIX HOURS
discussion• The first CXR shows a normal cardiac shadow  associated with bilateral perihilar alveolar  infiltrates suggest...
How  read  chest xr  3
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  1. 1. HOW READ CHEST XR -3 ANAS SAHLE ,MD
  2. 2. POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION HomoDensityinfiltratio Heterogenous Centralperiph Silhouet n Wellill defined Zone eral Necrotic sign MEDIASTINAL Central deviasionwided COSTO-PHRENIC ANGEL Freeoblitern OTHER Bone soft tissuediaphragm
  3. 3. Consolidation
  4. 4. ConsolidationInfection causes Non-infection causes Broncho- WEGNER CardiacPneumonia Lymphoma alveolar COP Sarcoid disease failure carcinoma
  5. 5. Case-1 A 35-year-oldmale presented with: 1. fever, 2. cough, 3. purulent sputumfor one week.
  6. 6. POSITION •PA CXRQUALITY •GOOD Technical Quality Lower lobe •Homogenous density in the right lowerLESION zone (with bronchogram) obscured hemidiaphragm •Central trachea? and mediasteinal.MEDIASTINAL •free left costo-phrenic angelsANGELS •NOOTHER
  7. 7. Case-2 This 75-year-oldfemale presented with: acute respiratory failure. She had been sick for two weeks with: 1. fever, 2. cough, 3. purulent sputum
  8. 8. POSITION •AP CXRQUALITY •Poor Technical Quality •(HIGH penetration). •Tow homogenous opacification in both lung: •in the left and right (middle,lower ) zoneLESION obscured aortic arc, and left border of heart extend to chest wall,(air bronchodram) •Central trachea and mediasteinalMEDIASTINAL •Free costo-phrenic angelsANGELS •NOOTHER
  9. 9. Case-3• A 30-year-old male presented with cough, shortness of breath• and loss of weight over four months
  10. 10. POSITION •AP? CXRQUALITY •Good Technical Quality •Bilateral infiltrate at lower zoneLESION •(air bronchogram??) •No kerley line. •No upper zone venous diversion •Central trachea and mediasteinalMEDIASTINAL •Free costo-phrenic angelsANGELS •NOOTHER
  11. 11. disscusion• The CXR shows bilateral infiltrates and air bronchograms with a perihilar distribution.• The heart size is normal.• There are no Kerley B lines or evidence of upper lobe venous diversion.• All these are typical features of PCP
  12. 12. Case-4• This middle-aged male had low- grade fever of one month’s duration• associated with productive cough and loss of weight.
  13. 13. POSITION •PA CXRQUALITY •POOR Technical Quality •rotation •Hetero-genous density at right lower zone (bronchogram) obscuredLESION hemidiaphragm •Central trachea and mediasteinalMEDIASTINAL •Free left costo-phrenic angelsANGELS •NOOTHER
  14. 14. Case-5• This patient presented with stridor due to thyroid goiter.• was intubated (Fig. 1).• Repeat CXR was done six hours later (Fig.2).• What is the main radiological abnormality?
  15. 15. AFTER INTUBATED
  16. 16. POSITION •AP CXRQUALITY •ACCEPT Technical Quality •Bilateral perihilar patchy opaciteisLESION •Diffused but Most in middle zone . •Obscured aortic arc(bronchgram) •Central trachea and mediasteinalMEDIASTINAL •Free left costo-phrenic angelsANGELS •NOOTHER
  17. 17. AFTER SIX HOURS
  18. 18. discussion• The first CXR shows a normal cardiac shadow associated with bilateral perihilar alveolar infiltrates suggestive of acute pulmonary edema.• The development of pulmonary edema with a normal heart size is indicative of an acute event.• The rapid clearance of the pulmonary infiltrates here indicates that the process is rapidly corrected by positive pressure.• In this patient, an important consideration is negative pressure pulmonary edema due to upper airway obstruction from the thyroid Goiter
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