simple clarification of main CXR principles

1. Rania Ma’adat

3. What to check first
 Name, Age, Date , sex
 Clinical info. History “not always”
 Technical factors:

4. 1-Marker
Marker to determine
right or left side =
direction of the
picture

5. 2- Centralization
The distance between
the medial end of the
clavicle and the
spinous processes
“Should” be equal
bilaterally.

6. 3- Full inspiration
We count , 9 posterior ribs, 7 anterior ribs
6th rib is perpendicular to the diaphragm

8. Exposure
The retro cardiac vertebrae are just visible

9. Lung zones
 Upper
 Middle
 Lower
any lesion is said
to be located in
one of these zones

10. abnormalities
 Remember that:
Bone is white on X-ray
Air is black
Tissue is grey
 Abnormal findings are:
 Consolidation
 Collapse, hyper inflation
 Pleural sac abnormality
 Bone abnormality

11. Consolidation
 Any abnormal white batches except those
of normal anatomy slide 2 is said to be
consolidation.
1- fibrosis
2- mass
3-tracheal shift “ not mediated” slide 5, Aotic
aneurysm, esophageal problem
4- lymph node enlargement
5- pneumonia “ at the base of the lung”
etc

12.  Right lung
pneumonia

14.  Right lung mass

15.  Aortic aneurysm

16.  Multiple nodules=
Lung metastases

17. 2- collapse
 Absent part of
the lung usually
with obstruction
normal lung
tissue but
missed part

18. Hyper inflation
 Main sign is flat
diaphragm

19. Pleural abnormality
 We have visceral and parietal pleura
accumulation of air, fluid, blood or pus
can lead to CXR abnormality.
1- Pneumothorax: Air “black”
2- Pleural effusion: Fluid “white”
3- Hemothorax: blood “white”
4- Empyema: pus “white”

20.  Plueral
effusion
 No air
bronchogram
 No
costophrenic
angle
 Upper border
of fluid is
concave

21. Hemopneumothorax
 Similar to
pnuemothorax but
the upper border is
flat cuz of air

22. pneumothorax

23. Bone abnormalities
 Ribs fracture

24. Notes:
 Air under diaphragm is always
abnormal! The main cause is bowel
perforation

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Best of luck!