basic introduction of common chest lesions

1. Chest x ray
how to solve it
Dr/ Allam Elsayed Allam

2. Aim of presentation
1. to know the main anatomical structures.
2. main different views, when you call ,when you call.
3. adequate or not adequate film
4. Main and the commonest pathology

3. introduction
• What are x-rays?
• X-rays: a form of electromagnetic energy
• Travel at the speed of light
• Electromagnetic spectrum
– Gamma Rays
– X-rays
– Visible light
– Infrared light
– Microwaves
– Radio waves

4. Three things can happen
• X-rays can:
– Pass all the way through the body
– Be deflected or scattered
– Be absorbed

5. X-rays Passing Through Tissue
• Depends on the energy of the x-ray and the atomic
number of the tissue
• Higher energy x-ray - more likely to pass through
• Higher atomic number - more likely to absorb the x-ray
So
• X-rays that pass through the body to the film render the
film dark (black)
• X-rays that are totally blocked do not reach the film and
render the film light (white)
• Air = low atomic # = x-rays get through = image is dark
• Metal = high atomic # = x-rays blocked = image is light
(white)

6. 5 Basic Radiographic Densities
• Air
• Fat
• Soft tissue/fluid
• Mineral
• Metal

7. Main anatomical points

9. Standard technquine

10. Standard technquine

11. Other technquine

12. P-A vs. A-P view

13. Technically Adequate Chest X-ray
1. Penetration
2. Inspiration
3. Rotation
4. angulation

14. Penetration
Adequate: should see the thoracic spine through the heart
If under-penetration: left hemi-diaphragm / lung
base is not visible and increased pulmonary vascular marking
If over-penetration: the verse

15. Inspiration
adequate: Should 10 posterior ribs is visible
if poor inspiration:

16. Common pathology
 cardiomegally
 pleural effusion.
 Pneumothorax
Pulmonary disease.

17. Cardiomegally

18. Causes of false cardiomegally
A-P film.
 pregnancy.
Ascitis.
Pecuts excavatum

19. Pleural effusion
the Commenst 2 forms:
1. Blunted costo-phrenic angle.
2. Meniscus sign .

23. Pneumothorax

26. Pulmonary disease
(airspace vs interstitial )
 airspace disease:
 Soft tissue opacity
 Indistinct borders
 Respect segmental or lobar boundary
 May shows air-bronchogram
Interstitial disease:
 Inhomogeneous
 Linear( reticular) / dots( nodular) opacities or mixed of
both ( reticulo-nodular)
 Not respect lobar boundaries
 No air-bronchogram

29. Common causes of airspace disease
pneumonia : ----inflammatory exudates.
Pulmonary edema : --- transudate
Pulmonary hemorrhage: blood

30. Interstitial disease

32. Common causes
 Pulmonary fibrosis
 Sarcoidosis
 Cystic fibrosis
 Metastatic
 Lung carcinoma
 Tubercoloma
 Hamartoma

33. QUIZZES

34. Technical error

35. Technical error

36. diagnosis

37. diagnosis

38. diagnosis

39. diagnosis