Basic interpretation of cxr
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Basic interpretation of cxr






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    Basic interpretation of cxr Basic interpretation of cxr Presentation Transcript

    • Basic Interpretation of Chest Radiography
      By Dr. ChiaKok King
    • Five Radiographic Opacities
      Air Fat Soft tissue Bone Metal
      least opaque to most opaque
      most lucent to least lucent
      Black to White
    • Radiographic Opacities & Contrasts
      Air Air
      Fat Mineral oil
      Water Water
      Bone Tums
      Metal ???
    • Film Quality
      PA or AP view.
      Upright/Erect or Supine
      Breath : Inspiration or Expiration
      X-ray penetration : Under- or Over-
    • PA vs AP views
      PA view
      Scapula is seen in periphery of thorax
      Clavicles project over lung fields
      Posterior ribs are distinct
      Position of markers
      AP view
      Scapulae are over lung fields
      Clavicles are above the apex of lung fields
      Position of markers
      Anterior ribs are distinct
    • Inspiration vs Expiration
    • Penetration
      With correct exposure you should barely see the intervertebral disc through the heart
      If you see them very clearly the film is overpenetrated
      If you do not see them it is underpenetrated
    • Penetration
    • Rotation
    • Pitfalls to Chest X-ray Interpretation
      Poor inspiration
      Over or under penetration
      Forgetting the path of the x-ray beam
    • Normal Chest X-ray
      Cardiac Structures
      More central in younger infants and children
      More on the L side in older infants and teens
      Cardiac diameter :
      normal individuals < 15.5 cm in males; <14.5 cm in females.
      A change in diameter of greater than 1.5 cm between two X-rays is significant.
    • Cardio-thoracic ratio
      seen on postero-anterior (PA) view only
      >50% is considered abnormal in an adult; more than 66% in a neonate.
      Possible causes of a ratio greater than 50% include:
      cardiac failure
      pericardial effusion
      left or right ventricular hypertrophy
      *AP views make heart appear larger than it actually is.*
    • Normal Chest X-ray
      1. Soft tissue structures
      Shadows, most commonly, breast
      2. Bony structures
      Count the ribs
      8 – 10 ribs should be visible on inspiration
      Clavicle placement at 2-3 intercostal space (if not, may be rotated)
    • Normal Chest X-ray
      3. Diaphragm
      Rounded with sharp pointed costophrenic and costocardiac angles
      Right diaphragm is usually 1-2 cm higher
    • Normal Chest X-ray
      4. Lungs
      Start at the top and compare the R and L
      Trachea should be midline over the thoracic vertebrae and air filled
      Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion
    • Anatomy
    • Anatomy
    • Lobes
      • Right upper lobe:
      • Right middle lobe:
      • Right lower lobe:
      • Left lower lobe:
      • Left upper lobe with Lingula:
      • Lingula:
      • Left upper lobe - upper division:
    • Abnormal Chest X-ray
      Radiopacity (whiteness) = increased density
      Radiotranslucency (blackness) = decreased density
    • Radiopacity
    • Consolidation
      • Lobar consolidation:
      • Alveolar space filled with inflammatory exudate
      • Interstitium and architecture remain intact
      • The airway is patent
      • Radiologically:
      • A density corresponding to a segment or lobe
      • Air bronchogram, and
      • No significant loss of lung volume
    • Consolidation
    • Atelectasis
      Loss of air
      Obstructive atelectasis:
      No ventilation to the lobe beyond obstruction
      Density corresponding to a segment or lobe
      Significant loss of volume
      Compensatory hyperinflation of normal lungs
    • No ventilation to lobe beyond the obstruction
      Trapped air absorbed by pulmonary circulation
      Segmental/lobar density
      Compensatory hyper-inflation of normal lungs.
    • Congestive Heart Failure
      Increased heart size: cardiothoracic ratio >0.5
      • Large hila with indistinct markings
      • Fluid in interlobar fissures
      • Pleural effusions, alveolar edema
    • Congestive Heart Failure
      • Alveolar edema (Bat’s wings)
      • Kerley B lines (Interstitial edema)
      • Cardiomegaly
      • Dilated prominent upper lobe vessels
      • Pleural effusion
    • ARDS
      Interstitial and alveolar edema
      Collapsed or distended alveoli
    • Pneumothorax
    • Right side tension pneumothorax
    • Left Sided Pneumothorax
    • Pleural effusion
    • Right Side Pleural Effusion
    • RLL Pneumonia
    • ????????????
    • Fracture of posterior rib #7
    • ?????????????????????
    • A single, 3cm relatively thin-walled cavity is noted in the left midlung. This finding is most typical of squamous cell carcinoma (SCC). One-third of SCC masses show cavitation
    • Right Squamous Cell Carcinoma
    • ???????????????
    • Right Middle and Left Upper Lobe Pneumonia
    • ????????????
    • Cavitation : cystic changes in the area of consolidation due to the bacterial destruction of lung tissue. Notice air fluid level.
    • Cavitation
    • ????????????
    • Tuberculosis
    • ??????????
    • COPD: increase in heart diameter, flattening of the diaphragm, and increase in the size of the retrosternal air space. In addition the upper lobes will become hyperlucent due to destruction of the lung tissue.
    • Chronic emphysema effect on the lungs
    • ????????
    • CHF:a great deal of accentuated interstitial markings, Curly lines, and an enlarged heart. Normally indistinct upper lobe vessels are prominent but are also masked by interstitial edema.
    • 24 hours after diuretic therapy
    • Chest wall lesion: arising off the chest wall and not the lung
    • Pleural effusion: Note loss of left hemidiaphragm. Fluid drained via thoracentesis
    • Lung Mass
    • The Enlarged Hila
      Causes:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. Sarcoidosis
    • Small Pneumothorax : LUL
    • Right Middle Lobe Pneumothorax: complete lobar collapse
    • Post chest tube insertion and re-expansion
    • Metastatic Lung Cancer: multiple nodules seen
    • Tuberculosis
    • Pleural Effusion
    • Pulmonary Fibrosis
    • Cavitating lesion
    • Miliary shadowing
    • 5. 65 yo male admitted for sepsis. CHF or ARDS?
    • 12. Is the central line correctly positioned?
    • 13. Does ET tube need to be advance or pulled back? Arrow shows location of carina
    • 14. OK for R/T feeding?