Normal Chest X-ray

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Normal Chest X-ray

  1. 1. CHEST X-RAY DR. NIKHIL MURKEY
  2. 2. STRUCTURES TO BE IDENTIFIED
  3. 3. • 1 SVC• 2 IVC• 3 RA• 4 RV• 5 LV
  4. 4. SCHEME• Patient demography• Technical aspect• Trachea• Heart and mediastinum• Diaphragms• Pleura• CP angles• Hilum• Lung field• Hidden areas• Below diaphragm• Soft tissue• Bones
  5. 5. TECHNICAL ASPECT• Centering• Penetration• Inspiration• Angulation
  6. 6. • Rotation • Medial ends of bilateral clavicles are equidistant from the midline or vertebral bodies
  7. 7. If spinous process appears closer to the right clavicle (red arrow), the patient is rotated toward their own left sideIf spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side
  8. 8. • Penetration • Should see ribs through the heart • Barely see the spine through the heart • Should see pulmonary vessels nearly to the edges of the lungs
  9. 9. Overpenetrated Film• Lung fields darker thannormal—may obscuresubtle pathologies• See spine well beyond thediaphragms• Inadequate lung detail
  10. 10. Underpenetrated Film•Hemidiaphragms are obscured•Pulmonary markings more prominent than they actually are
  11. 11. • Inspiration 1 2 • Should be able to 3 count 9-10 posterior 4 ribs 5 6 • Heart shadow should 7 not be hidden by the diaphragm 8 9 10
  12. 12. • Angulation 1 2 • Clavicle should lay over 3 3rd rib
  13. 13. Apical lordotic Same patient, not lordoticA film which is apical lordotic (beam is angled up towardhead) will have an unusually shaped heart and the usually sharp border of the left hemidiaphragm will be absent
  14. 14. TRACHEA• 25 mm in males 21 mm in females.• Right paratracheal stripe• Widening occurs in Lymphadenopathy, tr acheal malignancy, mediasti nal tumours, mediastinitis, pleural effusion• Normal carinal angle 60-75 degees.
  15. 15. HEART & MEDIASTINUM• Cardio-thoracic ratio• Transverse cardiac diameter• Increase in transverse cardiac diameter by 1.5 cm in significant.• Normal in neonates and AP projection is 60 percent• Cardiac shadow measuring more than 5.5 cm to the right signifies right atrial enlargement
  16. 16. DIAPHRAGM• Position, sharpness of border• Difference should be less than 3 cm between both sides.• Subdiaphragmatic air
  17. 17. PLEURA• Pleural thickening• Calcification• Plaques• Pneumothorax• Effusion.
  18. 18. COSTOPHRENIC ANGLES• Acute• Well defined
  19. 19. LUNG FIELDS• Infiltrates• Increased interstitial markings• Masses• Absence of normal margins• Air bronchograms• Increased vascularity
  20. 20. LUNG FIELDS: USING STRUCTURES / SILHOUETTES Silhouette / Structure Contact with Lung Upper right heart Anterior segment of RUL border/ascending aorta Right heart border RML (medial) Upper left heart border Anterior segment of LUL Left heart border Lingula (anterior) Apical portion of LUL Aortic knob (posterior) Anterior hemidiaphragms Lower lobes (anterior)
  21. 21. LUNG FIELDS: USING STRUCTURES / SILHOUETTESUpper rightheart border / Aortic knobascending aorta (Apical(anterior RUL) portion of LUL ) Upper leftRight heart border heart(medial RML) border (anterior LUL) Left heart borderAnterior (lingula;hemidiaphrag anterior)ms(anteriorlower lobes)
  22. 22. LUNG FIELDS: FISSURES• The fissures can also help you to determine the boundaries of pathology Major Oblique Fissure Separates the LUL from the LLL Separates the RUL/RML from Right Major Fissure the RLL Separates the RUL from the Right Minor Fissure RML
  23. 23. LUNG FIELDS: HIDDEN AREAS• Apices• Mediastinum and hila• Behind the diaphragm
  24. 24. HILA• Position (left 2.5 cm higher than right)• Equal density• Clearly defined lateral borders• Lower lobe pulmonary arteries and upper lobe pulmonary veins• Diameter of pulmonary arteries should measure 10-16 mm in males and 9 – 15 mm in females.• Upper lobe veins lie lateral to the arteries and lower lobe veins lie medial to the arteries.
  25. 25. BRONCHIAL ARTERIES• Usually not visualized• Branches of descending thoracic aorta at T5/6 level• 2 on left; 1 on right• When enlarged appear as multiple small nodules around hila• Enlarged in cyanotic heart disease like TOF, Pulmonary atresia• Other causes include bronchiectasis or bronchial carcinoma
  26. 26. SUBDIAPHRAGMATIC REGION• Free air• Bowel (Chilaiditi syndrome)• Dilated bowel loops
  27. 27. SOFT TISSUE• Breast• Nipple• Skin folds especially in oblique and ill centered X-rays• Companion shadow – upper border of clavicle
  28. 28. BONES• Vertebrae• Clavicle• Ribs• Scapulae• Sternum*
  29. 29. THANK YOU!!!

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