Basic interpretation of cxr

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Basic interpretation of cxr

  1. 1. Basic Interpretation of Chest Radiography<br />By Dr. ChiaKok King<br />
  2. 2. Five Radiographic Opacities<br />Air Fat Soft tissue Bone Metal<br />least opaque to most opaque<br />most lucent to least lucent<br />Black to White<br />
  3. 3. Radiographic Opacities & Contrasts<br />Air Air<br />Fat Mineral oil<br />Water Water<br />Bone Tums<br />Metal ???<br />
  4. 4. Film Quality<br />PA or AP view.<br />Upright/Erect or Supine<br />Breath : Inspiration or Expiration<br />X-ray penetration : Under- or Over-<br />Rotation<br />
  5. 5. PA vs AP views<br />PA view<br />Scapula is seen in periphery of thorax<br />Clavicles project over lung fields<br />Posterior ribs are distinct<br />Position of markers<br />AP view<br />Scapulae are over lung fields<br />Clavicles are above the apex of lung fields<br />Position of markers<br />Anterior ribs are distinct<br />
  6. 6. Inspiration vs Expiration<br />
  7. 7. Penetration<br /> With correct exposure you should barely see the intervertebral disc through the heart<br />If you see them very clearly the film is overpenetrated<br />If you do not see them it is underpenetrated<br />
  8. 8. Penetration<br />
  9. 9. Rotation<br />
  10. 10.
  11. 11. Pitfalls to Chest X-ray Interpretation<br />Poor inspiration<br />Over or under penetration<br />Rotation<br />Forgetting the path of the x-ray beam<br />
  12. 12. Normal Chest X-ray<br />Cardiac Structures<br />Position<br />More central in younger infants and children<br />More on the L side in older infants and teens<br />Size<br />CARDIO-THORACIC RATIO!<br />Cardiac diameter :<br />normal individuals < 15.5 cm in males; <14.5 cm in females.<br />A change in diameter of greater than 1.5 cm between two X-rays is significant.<br />
  13. 13. Cardio-thoracic ratio<br />seen on postero-anterior (PA) view only<br />>50% is considered abnormal in an adult; more than 66% in a neonate.<br />Possible causes of a ratio greater than 50% include:<br />cardiac failure<br />pericardial effusion<br />left or right ventricular hypertrophy<br />*AP views make heart appear larger than it actually is.*<br />
  14. 14. Normal Chest X-ray<br />1. Soft tissue structures<br />Shadows, most commonly, breast<br />2. Bony structures<br />Count the ribs<br />8 – 10 ribs should be visible on inspiration<br />Clavicle placement at 2-3 intercostal space (if not, may be rotated)<br />
  15. 15. Normal Chest X-ray<br />3. Diaphragm<br />Contour<br />Rounded with sharp pointed costophrenic and costocardiac angles<br />Right diaphragm is usually 1-2 cm higher<br />
  16. 16. Normal Chest X-ray<br />4. Lungs<br />Start at the top and compare the R and L<br />Trachea should be midline over the thoracic vertebrae and air filled<br />Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion<br />
  17. 17. Anatomy<br />
  18. 18. Anatomy<br />
  19. 19. Lobes<br /><ul><li> Right upper lobe:</li></li></ul><li><ul><li> Right middle lobe:</li></li></ul><li><ul><li> Right lower lobe:</li></li></ul><li><ul><li> Left lower lobe:</li></li></ul><li><ul><li> Left upper lobe with Lingula:</li></li></ul><li><ul><li>Lingula:</li></li></ul><li><ul><li> Left upper lobe - upper division:</li></li></ul><li>Abnormal Chest X-ray<br />Radiopacity (whiteness) = increased density<br />Radiotranslucency (blackness) = decreased density<br />
  20. 20. Radiopacity<br />
  21. 21. Consolidation<br /><ul><li>Lobar consolidation:
  22. 22. Alveolar space filled with inflammatory exudate
  23. 23. Interstitium and architecture remain intact
  24. 24. The airway is patent
  25. 25. Radiologically:
  26. 26. A density corresponding to a segment or lobe
  27. 27. Air bronchogram, and
  28. 28. No significant loss of lung volume</li></li></ul><li>Consolidation<br />
  29. 29. Atelectasis<br />Loss of air<br />Obstructive atelectasis:<br />No ventilation to the lobe beyond obstruction<br />Radiologically:<br />Density corresponding to a segment or lobe<br />Significant loss of volume<br />Compensatory hyperinflation of normal lungs<br />
  30. 30. No ventilation to lobe beyond the obstruction<br />Trapped air absorbed by pulmonary circulation<br />Segmental/lobar density<br />Compensatory hyper-inflation of normal lungs.<br />Atelectasis<br />
  31. 31. Congestive Heart Failure<br />Increased heart size: cardiothoracic ratio >0.5<br /><ul><li>Large hila with indistinct markings
  32. 32. Fluid in interlobar fissures
  33. 33. Pleural effusions, alveolar edema</li></li></ul><li>Congestive Heart Failure<br /><ul><li>Alveolar edema (Bat’s wings)
  34. 34. Kerley B lines (Interstitial edema)
  35. 35. Cardiomegaly
  36. 36. Dilated prominent upper lobe vessels
  37. 37. Pleural effusion</li></li></ul><li>
  38. 38. ARDS<br />Congestion<br />Interstitial and alveolar edema<br />Collapsed or distended alveoli<br />Bilateral<br />
  39. 39. Pneumothorax<br />
  40. 40. Right side tension pneumothorax<br />
  41. 41. Left Sided Pneumothorax<br />
  42. 42. Pleural effusion<br />
  43. 43. Right Side Pleural Effusion<br />
  44. 44. RLL Pneumonia<br />
  45. 45. ????????????<br />
  46. 46. Fracture of posterior rib #7<br />
  47. 47. ?????????????????????<br />
  48. 48. 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<br />
  49. 49. Right Squamous Cell Carcinoma<br />
  50. 50. ???????????????<br />
  51. 51. Right Middle and Left Upper Lobe Pneumonia<br />
  52. 52. ????????????<br />
  53. 53. Cavitation : cystic changes in the area of consolidation due to the bacterial destruction of lung tissue. Notice air fluid level.<br />
  54. 54. Cavitation<br />
  55. 55. ????????????<br />
  56. 56. Tuberculosis<br />
  57. 57. ??????????<br />
  58. 58. 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.<br />
  59. 59. Chronic emphysema effect on the lungs<br />
  60. 60. ????????<br />
  61. 61. 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.<br />
  62. 62. 24 hours after diuretic therapy<br />
  63. 63.
  64. 64. Chest wall lesion: arising off the chest wall and not the lung<br />
  65. 65.
  66. 66. Pleural effusion: Note loss of left hemidiaphragm. Fluid drained via thoracentesis<br />
  67. 67.
  68. 68. Lung Mass<br />
  69. 69. The Enlarged Hila<br />Causes:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. Sarcoidosis<br />
  70. 70.
  71. 71.
  72. 72. Small Pneumothorax : LUL<br />
  73. 73.
  74. 74. Right Middle Lobe Pneumothorax: complete lobar collapse<br />
  75. 75. Post chest tube insertion and re-expansion<br />
  76. 76.
  77. 77. Metastatic Lung Cancer: multiple nodules seen<br />
  78. 78.
  79. 79. Tuberculosis<br />
  80. 80. Pleural Effusion<br />
  81. 81. Pulmonary Fibrosis<br />
  82. 82. Cavitating lesion<br />
  83. 83. Miliary shadowing<br />
  84. 84. 5. 65 yo male admitted for sepsis. CHF or ARDS?<br />
  85. 85. 12. Is the central line correctly positioned?<br />
  86. 86. 13. Does ET tube need to be advance or pulled back? Arrow shows location of carina<br />
  87. 87. 14. OK for R/T feeding?<br />

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