Chest x ray interpretation

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This presentation based on basics on chest x rays and basic knowledge about few important lung pathologies.

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Chest x ray interpretation

  1. 1. Chest X-ray interpretation Harindu Udapitiya, Temporary Lecturer, Division of Pharmacology.
  2. 2. Overview
  3. 3. Before interpreting…… 1. Proper labelling 2. Proper positioning 3. Veiw-PA? AP? Lateral? 4. Exposure 5. Rotation 6. Adequacy of inspiratory effort
  4. 4. Normal Anatomy
  5. 5. Normal Chest X-ray  Cardiac Structures  Position  More central in younger infants and children  More on the L side in older infants and teens  Size  The cardiothoracic ratio should be less than 0.5  A cardiothoracic ratio of greater than 0.5 (in a good quality film) suggests cardiomegaly.
  6. 6. A/B<0.5
  7. 7. Cardiomegaly
  8. 8.  Trachea  The trachea is placed usually just to the right of the midline
  9. 9.  Mediastinum
  10. 10.  Lungs  There are three lobes in the right lung and two in the left.  Right lung 1. Upper lobe 2. Middle lobe 3. Lower lobe.  Left lung 1. Upper lobe; this contains the lingula 2. Lower lobe.
  11. 11.  Pleura  There are two layers of pleura: the parietal pleura and the visceral pleura.  The parietal pleura lines the thoracic cage and the visceral pleura surrounds the lung.
  12. 12.  Diaphragm  Contour  Rounded with sharp pointed costophrenic and costocardiac angles. Blunting of costalphrenic or costocardiac angles suggests plueral effusion.  Right diaphragm is usually 1-2 cm higher
  13. 13. Abnormal Chest X-ray  Radiopacity (whiteness) means increased density  Radiotranslucency (blackness) means decreased density  Radiopacity can be of 3 causes  Alveolar pattern – fluffy, soft, poorly demarcated opacifications < 1 cm in diameter  Possible causes:  Pulmonary edema  Viral pneumonia  Pneumocystis  Alveolar cell carcinoma
  14. 14. Pneumonia
  15. 15. Abnormal Chest X-ray  Interstitial pattern  Consolidation of interstitial tissue (alveolar walls, intralobular vessels, interlobar septa and connective tissue)  Looks like branching lines radiating toward the periphery of the lung  Possible causes:  Interstitial pneumonitis  Pulmonary fibrosis
  16. 16. Pulmonary Fibrosis
  17. 17. Abnormal Chest X-ray  Vascular pattern – assessment of the pulmonary arteries and capillaries  If there is an increase in the size of the pulmonary arteries as they extend out into the lung – pulmonary hypertension  If there is a decrease in size, truncation, or obliteration of a pulmonary artery – embolus  Lack of vascular making in the periphery - pneumothorax
  18. 18. Pulmonary Hypertension
  19. 19. Pulmonary Embolism
  20. 20. Lung pathologies White Lung field Black lung Field Well defined Ill defined  Collapse  Pleural Effusion  Consolidation  Fifrosis  Pulmonary Edema  Infiltration
  21. 21. Pathological Conditions 1. Consolidation 2. Abscess 3. Bronchial Asthma 4. Bronchiectasis 5. COPD 6. Lung Collapse 7. Heart Failure 8. Pulmonary fibrosis
  22. 22. 9. Hiatus hernia 10. Pleural Effusion 11. Pneumothorax 12. TB 13. Carcinoma 14. Lymphoma 15. Pericardial Effusion 16. Mitral Stenosis
  23. 23.  17. ASD
  24. 24. 1.Consolidation  Causes  Pneumonia  Bronchial carcinoma  Lymphoma  Inflammatory conditions
  25. 25.  Radiological features  Airbronchogram  Silhouette sign  Lower border
  26. 26. R.Middle lobe Pneumonia
  27. 27. R.Lower Lobe pneumonia
  28. 28. 2.Abscess
  29. 29. 3.Bronchial asthma I. Hyperinflation II. Diaphragmatic flattening III. Bronchial wall thickening IV. Hilar enlargement
  30. 30. 4.Bronchiectasis I. Tram line opacification II. “Bundle of graphes appearance”
  31. 31. 5.COPD
  32. 32. 7.Lung Collapse
  33. 33.  DD I. Lung collapse II. Lower lobe consolidation III. Pleural effusion IV. Raised hemi diaphragm
  34. 34. 8.Pulmonary fibrosis
  35. 35. 9.Pleural Effusion
  36. 36. 10.Pneumothorax
  37. 37. 11.Hiatus hernia
  38. 38. 12.TB
  39. 39. Miliary TB
  40. 40. 13.Bronchial carcinoma
  41. 41. 14.Lymphoma
  42. 42. 15.Pericardial effusion
  43. 43. 16.Mitral Stenosis
  44. 44. 17.ASD
  45. 45.  1.Basics on normal chest x ray  2.Basics on Abnormal chest x ray  3.Pathological conditions

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