Radiology for Undergraduate Part 1


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Chest X-Rays How to interpret, description of commonly found X-Ray abnormalities in Medical Wards

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Radiology for Undergraduate Part 1

  1. 1. Chest Roentgenogram<br />DR. S. ASWINI KUMAR. MD<br />Professor of Medicine<br />Medical College Hospital<br />Thiruvananthapuram<br />
  2. 2. Chest Roentgenogram<br />4/15/2010<br />2<br />X-Ray machine<br /> X-Rays produced by it<br />Pass through the human body<br />Black and white film<br />Placed on the opposite side<br />
  3. 3. Chest X-Ray-Views <br />4/15/2010<br />3<br />PA view<br />Postero-anterior view<br />X-Rays-Posterior to anterior<br />Delineates the heart and lungs<br />Spine is not in focus <br />
  4. 4. Chest X-Ray Views<br />4/15/2010<br />4<br />Lateral view<br />Lesions of lung and mediastinum<br />Right or left lateral view<br />Spine posteriorly - heart anteriorly<br />Useful in detecting the lobe of lung<br />
  5. 5. Densities<br />4/15/2010<br />5<br />The background - black<br />The soft tissues - light white<br />The bone - dense white<br />Fluid, blood - white as well<br />The air - black<br />
  6. 6. How do you read a Chest X-Ray PA<br />4/15/2010<br />6<br />Soft tissue shadows<br />Position of trachea and mediastinum<br />Costo and cardiophrenic angles<br />Study the lung parenchyma <br />Study the heart shadow<br />
  7. 7. The fissures and lobes of Lung<br />4/15/2010<br />7<br />
  8. 8. Right Upper Lobe<br />4/15/2010<br />8<br />
  9. 9. Right Upper Lobe in the lateral view<br />4/15/2010<br />9<br />
  10. 10. Right Middle Lobe in the PA view<br />4/15/2010<br />10<br />
  11. 11. Right lower lobe consolidation<br />4/15/2010<br />11<br />
  12. 12. Right Middle Lobe Silhouette in Lateral View<br />4/15/2010<br />12<br />
  13. 13. Extend of left upper lobe of lung<br />4/15/2010<br />13<br />
  14. 14. Extend of left lower lobe of lung<br />4/15/2010<br />14<br />
  15. 15. Consolidation of lung<br />4/15/2010<br />15<br />
  16. 16. Pleural Effusion Left Side<br />4/15/2010<br />16<br />Dense homogenous opacity<br />Left lower zone outer aspect <br />A higher level in axilla<br />Obliteration of angles<br />No air bronchograms<br />
  17. 17. Massive Pleural Effusion Right Side<br />4/15/2010<br />17<br />Tracheal shift to left side<br />Dense homogenous opacity<br />No air bronchograms<br />Obliteration of cardiophrenic<br />Obliteration of costophrenic<br />
  18. 18. Bilateral pleural Effusion<br />4/15/2010<br />18<br />Trachea & mediastinum central<br />2 shadows both lower zones<br />Higher levels in axillae<br />Cardiophrenic angles obliteralted<br />Costophrenic angles obliteralted<br />
  19. 19. Encysted Pleural effusion<br />4/15/2010<br />19<br />Rounded and oval shadows<br />Correspond to the fissures<br />One to horizontal fissure<br />The other oblique fissure<br />CP and CP angles are free<br />
  20. 20. Cavity - Left Lung<br />4/15/2010<br />20<br />Right lung is normal<br />Thin walled cavity - left middle<br />Homogenous opacity - lower part<br />An air fluid level above opacity<br />CP and CP obliteralted<br />
  21. 21. Lung abscess - Right side<br />4/15/2010<br />21<br />Left lung is normal<br />A thick walled cavity Rt middle<br />Hhomogenous opacity lower part<br />An air fluid level above opacity<br />CP & CP angles not obliteralted<br />
  22. 22. Lung abscess - Left upper lobe<br />4/15/2010<br />22<br />Right lung is normal<br />Thick walled cavity left upper<br />A thick opacity - lower part<br />Air fluid level above the opacity<br />CP & CP angles not obliteralted<br />
  23. 23. Infilterative lesions of lung<br />4/15/2010<br />23<br />A close up of apex left lung<br />Non-homogenous opacities <br />Thin walled cavities <br />Minimal air fluid levels<br />early lesions of PTB<br />
  24. 24. Breaking down Consolidation<br />4/15/2010<br />24<br />left lung - few infiltrates<br />Involvement of Rt UZ<br />Non-homogenous opacity <br />Breaking down of opacity<br />Formation of a cavity<br />
  25. 25. Cavity - Right upper lobe<br />4/15/2010<br />25<br />The left lung is normal<br />Disease of Rt upper zone/lobe<br />Thin walled cavity<br />No air fluid levels inside<br />Cavity characteristic of PTB<br />
  26. 26. Fibrosis – Left Upper Lobe<br />4/15/2010<br />26<br />The right lung - few infiltrates<br />The trachea is shifted to left<br />Mediastinum is shifted to left<br />Intercostal spaces are narrowed <br />There are cavities inside<br />
  27. 27. Bilateral Upper lobe Fibrosis<br />4/15/2010<br />27<br />Trachea shifted to right<br />The mediastinum is central <br />Both upper zones thin cavities<br />Fibrotic bands<br />Compensatory emphysema<br />
  28. 28. Miliary Mottling<br />4/15/2010<br />28<br />All areas both the lung fields<br />Multiple small 1-2 mm rounded<br />Best seen in middle and lower<br />Miliary mottling<br />Hematogenous spread of TBB <br />
  29. 29. Reticulo-nodular Opacities<br />4/15/2010<br />29<br />All areas both the lung fields<br />Multiple small 2-4 mm rounded<br />Middle and lower zones<br />Reticulonodular shadows<br />Granulomatous spread of TB<br />
  30. 30. Bronchopneumonia<br />4/15/2010<br />30<br />Patient with acute dyspnoea<br />Both the lung fields are involved<br />Middle and lower zones<br />Fluffy non-homogenous opacities<br />No air bronchograms<br />
  31. 31. Adult Respiratory Distress Syndrome<br />4/15/2010<br />31<br />Patient with acute dyspnoea<br />Both the lung fields are involved<br />Middle and lower zones<br />Fluffy non-homogenous opacities<br />No air bronchograms<br />
  32. 32. Emphysema of lungs<br />4/15/2010<br />32<br />Chest is elongated<br />Diaphragm pushed down<br />Ribs are horizontally placed<br />Lung markings are reduced<br />Heart elongated and tubular<br />
  33. 33. Pneumothorax Right side<br />4/15/2010<br />33<br />The chest is emphysematous<br />Minimal tracheal shift<br />Right side no lung markings<br />Complete collapse compression<br />Air in the pleural cavity<br />
  34. 34. Hydro-Pneumothorax Right side<br />4/15/2010<br />34<br />Left lung normal lung markings<br />Right lung has no lung markings<br />Right lung-completely collapsed<br />Compression by the air<br />Air-fluid level in pleural space<br />
  35. 35. Massive Hydropneumothorax Left side<br />4/15/2010<br />35<br />Homogenous opacity left thorax<br />Small air fluid level at the apex<br />No higher level in the axilla<br />Left heart border not visible<br />CP & CP angles obliteralted<br />
  36. 36. Bronchiectasis in Plain X-Ray Chest<br />4/15/2010<br />36<br />Both the lung fields are affected<br />Nonhomogenous opacities<br />No air bronchgrams<br />Bilateral and basal<br />Few cystic lesions also<br />
  37. 37. Mass lesion in the lungs<br />4/15/2010<br />37<br />Right lung parenchyma<br />A homogenous opacity<br />Central hyperdense lesion<br />Peripheral streaks<br />No air bronchograms<br />
  38. 38. Lung mass with Collapse<br />4/15/2010<br />38<br />The right lung is involved<br />Dense homogenous opacity<br />No air bronchgrams<br />Tracheal shift to the right side<br />Collapsed right upper lobe<br />
  39. 39. Solitary Nodule of Lung<br />4/15/2010<br />39<br />The right lung is involved<br />Dense homogenous opacity RMZ<br />No air bronchgrams<br />Round shadow & clear margins<br />Could be a mass lesion or an inter lobar effusion<br />
  40. 40. Cannon Ball shadows<br />4/15/2010<br />40<br />Both the lung fields are affected throughout<br />Dense homogenous opacities middle and lower zones<br />Again there are no air bronchgrams<br />Rounded shadow with not so clear margins<br />Could be a secondaries from any other primary site<br />
  41. 41. Pleural Calcification<br />4/15/2010<br />41<br />Both the lung fields are relatively clear<br />Dense homogenous opacity lateral part of middle zone<br />It is dense and white with irregular margins<br />These are due to pleural thickening<br />May be there is additional calcification of pleura<br />
  42. 42. Emphysematous Bulla<br />4/15/2010<br />42<br />The chest is emphysematous and elongated<br />There is an additional area of hypertransleucencies<br />There is a large air space in the left middle zone laterally<br />The wall of the lesion is very thin <br />There is no mediastinal shift to suggest pneumothorax<br />
  43. 43. Right Upper Lobe Collapse<br />4/15/2010<br />43<br />A dense opacity in upper zone<br />There is a lower margin<br />Absorption collapse of the lobe<br />Due to bronchial obstruction<br />Right Upper Lobe Atelectasis<br />
  44. 44. Right Middle lobe Collapse<br />4/15/2010<br />44<br />A more diffuse type of shadow<br />Seen in the right middle zone<br />a linear triangular shadow<br />in the lateral view suggestive<br />Right Middle Lobe Atelectasis<br />
  45. 45. Right Lower lobe Collapse<br />4/15/2010<br />45<br /> A linear opacity <br />near the right diaphragm<br />shift of the right border of heart<br />Posterior triangular shadow in<br />Seen in a lateral view-<br />
  46. 46. Thank You For The Patient Hearing<br />4/15/2010<br />46<br />