Radiology , chest x ray , checklist, educational radiology from radiology tips

1. CXR
R A D I O LO G Y T I P S
R E F - O N C A L L X R AY S M A D E E A S YRadiology Tips

2. Lookat the lungs.
In particular,look at the apices.
Thereare a lotof overlapping bonystructureshere which can make interpretation difficult.
Tumoursare often missedhere
Some pathologies have a predilection for the apices,
such as TB
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3. The costophrenic angles are another important place to look.
Many pathologies start here.
Septal lines in early heart failure are found here as are pleural
effusions,
which blunt the costophrenic angles
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4. There is a considerable amount of lung (left lower
lobe) hidden behind the heart.
Cancers can be hidden here;look also for left lower
lobe collapse and consolidation
Loss of the contour of the hemidiaphragm behind the
heart (arrow) can be a clue, so always look for
this
structure.
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5. Radiology Tips
Remember the hemidiaphragms.
The right hemidiaphragm is normally higher
than the left as it has the liver underneath it.
Look for free air under the hemidiaphragms
on an erect CXR
A grossly raised hemidiaphragm may be due to
diaphragmatic paralysis caused by a phrenic nerve palsy.
Subpulmonic effusions can
cause an apparent raised hemidiaphragm
They generally occur in
patients lying supine or semi-erect for long periods
There is lung tissue in the posterior
costophrenic region below the diaphragmatic
outline on a PA film – another important review
area.

6. Radiology Tips
Don’t forget the pulmonary hila.
These contain pulmonary vessels, lymph nodes
and bronchi (arrow).
Enlargement of the hilum, e.g.
dilated pulmonary arteries in pulmonary
hypertension, lung cancer affecting the
bronchus and enlarged lymph nodes in
malignancy or certain infections such as TB.
The lateral margin of the hila should be
concave in outline. Bulging convexity of the
hilar outline should be considered abnormal.
The left hilum is normally a little higher than
the right.
If the hila are in the wrong position it may
indicate loss of volume in one lung.

7. Radiology Tips
The heart and mediastinum are important.
Look at the transverse diameter of the heart, which should
be half or less of the diameter of the bony thorax on a PA
film.
The mediastinum should not be widened. It should be less
than 7 cm on a PA film. Widening raises the concern of
aortic dissection, although again enlargement of any
structure within the mediastinum may lead to widening.
Look at the aortic knuckle (arrow 1), a posterior
mediastinal structure.
Loss of its contour may indicate posterior pathology, or a
problem with the aorta itself.

8. Radiology Tips
Remember to look at the bones.
Look at the ribs, clavicles and shoulders.
Look for missing and fractured ribs.
Remember the difference between a posterior and
anterior rib as this is important for description.
Posterior ribs are horizontal (arrow 1) and anterior
ribs are directed inferiorly (arrow 2).
Think of the bucket handle model of respiration you
learned in physiology.
In expiration the front of the rib slopes downwards
and when you breathe in the ribs become more
horizontal to increase the AP diameter of the chest.

9. Radiology Tips
Don’t forget the soft tissues (arrow).
These may contain air or may be swollen.