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The Normal Chest X-ray
 

The Normal Chest X-ray

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    The Normal Chest X-ray The Normal Chest X-ray Presentation Transcript

    • The Chest X-ray
      By
      Dr. MehmetKaphoury
      Residence of radio-diagnosis, ASU
    • Preliminary checklist
      Dose
      Centralization
      Patient’s data (name, age, sex, smoking, occupation, residence)
      Clinical history in brief
    • Centralized film
    • Mr. J is a 65-year-old male presents to the OPC complaining of cough & expectoration of bloody sputum 2 weeks ago. His smoking index is 1 pack/40 years. Past history is unremarkable except for frequent morning coughs with whitish sputum all through past 25 years almost everyday..
      What is the best initial step in diagnosis?
      The answer is: a plain CXR
    • Bit-by-bit checklist
      Trachea
      Mediastinum
      Heart
      Cardio-phrenic angles
      Diaphragm
      Costo-phrenic angles
      Lungs
      Bony cage
      Lateral film, if present
      Other findings
    • Trachea
      Central at its upper part
      Deviates slightly to the right at its lower part
      Its lucency decreases caudally
      Comment on:
      • Displacement
      • Caliber
      • Intraluminal ‘things’
      • Paratracheal stripe
      • Carina
    • Mediastinum
      • Central with aortic knuckle to the left and SVC to the right
      • Smooth with no irregularities or festooning
      • Thymus in children
      Comment on:
      • Displacement
      • Widening
      • Fluid level, Air
      • Spine
    • Thymus
      Mediastinum
    • Heart
      One third to the right, 2 thirds to the left
      Learn normal configuration
      Borders can be well defined
      Cardio-thoracic ratio is no more than 50%
      Comment on:
      • Size & configuration
      • Borders (well defined or not)
      • Chambers size and effects of their enlargement
      • Retro-cardiac shadows
      • Pericardial calcification, cysts
    • Aortic knuckle
      Pulmonary trunk
      SVC
      Left atrium
      Left ventricle
      Right atrium
      apex
    • Cardio-phrenic angles
      Acute angles
      Mostly filled with fat pad
      Abnormalities known by blunting of these angles
      Comment on:
      • Blunting of the angles
      • Learn D.D of cardio-phrenic angles opacity
    • Diaphragm
      Dom shaped, right higher than left, left may be higher but not more than 3 cm than the right
      Can be traced all through
      Diaphragmatic hump may be normal
      Cut by the 6th or 7th rib in the mid-calv. line
      Comment on:
      • Level (normal, depressed, elevated)
      • Trace the contour
      • Air under
    • Costo-phrenic angles
      Acute angles
      Lucent
      Comment on:
      • Blunted angles
    • Lungs
      Compare both sides for:
      • Airways
      • Vessels
      • Interstitium(fluid, fibrosis)
      • Opacities (total, lobar, segmental, focal, miliary// homogenous, heterogenous)
      • Cavity
      • Pleura (line, calcification)
      • Apices
    • Bony Cage
      Cervical ribs
      Fractures
      Osteolytic lesions
      Inter-costal spaces