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Chest x ray basic interpretation

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A comprehensive approach to Interpretation of Chest XRay with common pathologies

Published in: Health & Medicine

Chest x ray basic interpretation

  1. 1. JSS Medical College, Mysuru Basic Interpretation of Chest X-Ray Dr.Vikram Patil Assistant Professor, Radiology JSS Medical College and Hospital, Mysuru
  2. 2. JSS Medical College, Mysuru Air Fat Soft tissue Bone Metal least opaque to most opaque most lucent to least lucent Black to White Different tissues in our body absorb X-rays at different extents Before we start : 5 Radiographic Densities
  3. 3. JSS Medical College, Mysuru Before Interpreting the Radiograph … 1. Patient identification details 2. X-Ray view-PA or AP…. 3. Breath : Inspiration or Expiration 4. X-ray penetration : Under or Over penetrated 5. Rotation
  4. 4. JSS Medical College, Mysuru PA view AP view Scapula Seen in periphery of thorax Seen over lung fields Clavicles Project over lung fields Above the apex of lung fields Ribs Posterior ribs distinct Anterior ribs are distinct Marker PA AP View
  5. 5. JSS Medical College, Mysuru Inspiration Expiration Good Inspiration: • 6 anterior ribs visible • 10 posterior ribs visible
  6. 6. JSS Medical College, Mysuru Penetration Over-penetrated Under-penetrated If intervertebral disc are very clearly seen in the film If intervertebral disc are not seen in the film Correct exposure : Barely able to see the intervertebral disc through the heart
  7. 7. JSS Medical College, Mysuru Rotation
  8. 8. JSS Medical College, Mysuru Normal Lateral ViewNormal PA view Normal Radiograph
  9. 9. JSS Medical College, Mysuru ABCDEFGHI approach • Airway • Bones and Soft tissue • Cardia • Diaphragm • Effusions • Fields(Lung fields) • Gastric Bubble • Hila and mediastinum • Impression
  10. 10. JSS Medical College, Mysuru A-Airway
  11. 11. JSS Medical College, Mysuru B-Bones and Soft Tissues
  12. 12. JSS Medical College, Mysuru C-Cardia
  13. 13. JSS Medical College, Mysuru T CR CL CT RATIO = CR + CL / T CR + CL = TRANSVERSE CARDIAC DIAMETER T = TRANSVERSE THORACIC DIAMETER (at max TC dia) C-Cardia
  14. 14. JSS Medical College, Mysuru D-Diaphragm
  15. 15. JSS Medical College, Mysuru E-Effusions(Pleura)
  16. 16. JSS Medical College, Mysuru F-Lung Fields
  17. 17. JSS Medical College, Mysuru Lobar anatomy
  18. 18. JSS Medical College, Mysuru Lobar anatomy..
  19. 19. JSS Medical College, Mysuru Hidden Areas….
  20. 20. JSS Medical College, Mysuru Gastric Bubble
  21. 21. JSS Medical College, Mysuru H-Hilum and mediastinum
  22. 22. JSS Medical College, Mysuru Mediastinum
  23. 23. JSS Medical College, Mysuru Abnormal Chest X-ray • Radiopacity (whiteness) = increased density • Radiotranslucency (blackness) = decreased density
  24. 24. JSS Medical College, Mysuru Radio-opacity • Without Volume loss – Pneumonia, Pulmonary edema, hemorrhage, mass • With Volume loss – Atelectasis, Collapse
  25. 25. JSS Medical College, Mysuru Lobar Pneumonia • Involves single lobe • Unilateral • Air bronchogram Interstitial Pneumonia •Involves interstitial space •Ground glass appearance •Bilateral, symmetrical Bronchopneumonia •Central bronchi involved •Patchy bilateral disease •Asymmetrical •Peribronchial cuffing
  26. 26. JSS Medical College, Mysuru Subtypes of Interstitial opacities Reticular Too many lines Nodular Too many dots Reticulo-nodular Too many lines and dots
  27. 27. JSS Medical College, Mysuru Silhouette Sign • Loss of normally visible border of an intrathoracic structure caused by an adjacent pulmonary density
  28. 28. JSS Medical College, Mysuru Atelectasis- partial collapse Lobar collapse -collapse of an entire lobe •Elevation of the ipsilateral hemidiaphragm •Crowding of the ipsilateral ribs •Shift of the mediastinum towards the side •Crowding of pulmonary vessels or air bronchograms •Hyperinflation of adjacent normal lung
  29. 29. JSS Medical College, Mysuru Golden S sign • Central mass obstructing the upper lobe bronchus . • Should raise suspicion of a primary Bronchogenic Carcinoma • First described by R Golden
  30. 30. JSS Medical College, Mysuru Sarcoidosis Staging I Bilateral Hilar adenopathy II Bilateral Hilar adenopathy with diffuse pulmonary infiltrates III Diffuse pulmonary infiltrates without hilar adenopathy IV Severe fibrosis
  31. 31. JSS Medical College, Mysuru Lung Malignancy
  32. 32. JSS Medical College, Mysuru NF Mets Nipple shadow
  33. 33. JSS Medical College, Mysuru Effusions …. Meniscus sign + Subpulmonic effusion Hydropneumothorax Phantom tumor
  34. 34. JSS Medical College, Mysuru Pleural … Tubercular Pleurisy Asbestosis Mesothelioma
  35. 35. JSS Medical College, Mysuru Loculated Empyema
  36. 36. JSS Medical College, Mysuru Complete U/L Lung agenesis
  37. 37. JSS Medical College, Mysuru Pulmonary Arterial Hypertension Enlargement of the pulmonary trunk and main pulmonary arteries Disproportionately small peripheral vessels Oligemic lungs Prune tree appearance
  38. 38. JSS Medical College, Mysuru Pulmonary Venous Hypertension Upper lobe veins in first intercostal space >3mm Interstitial edema with Kerley B lines Airspace edema with confluent airspace opacities PCWP mildly increased PCWP around 20 PCWP around 25
  39. 39. JSS Medical College, Mysuru Pulmonary Edema ARDS Distribution Bat winged pattern Diffuse bilateral coalescent opacities Time Develops over 1 week Develops by 12-24 hrs of insult Cardia Cardiomegaly No Cardiomegaly Kerley lines Present Absent Pleural effusions Usually Present Usually absent Air Bronchogram Present Absent On Diuretic Therapy Usually resolves Fairly constant over time Pulm Edema vs ARDS
  40. 40. JSS Medical College, Mysuru Radiotranslucency
  41. 41. JSS Medical College, Mysuru Pneumothorax
  42. 42. JSS Medical College, Mysuru Tension Pneumothorax Inspiratory Film Expiratory Film
  43. 43. JSS Medical College, Mysuru Cavity Thin wall-TB <4mm Thick wall-Malignancy >16mm Air crescent sign-Aspergilloma Air fluid level-Abscess
  44. 44. JSS Medical College, Mysuru Emphysema • Hyperinflation: – Flattened hemi-diaphragms: most reliable sign – Increased radiolucency of the lungs – Increased retrosternal airspace – Increased antero-posterior diameter of chest – Widely spaced ribs
  45. 45. JSS Medical College, Mysuru Congenital Lobar Emphysema
  46. 46. JSS Medical College, Mysuru Air at Unusual Locations Subcutaneous Emphysema Perforation Pneumomediastinum Pneumopericardium
  47. 47. JSS Medical College, Mysuru ICU- Tubes & Lines Tip at Junction of SVC & Right atrium
  48. 48. JSS Medical College, Mysuru Mediastinal abnormalities • Hilum overlay sign: On a frontal Chest X-ray, Mass projected at the level of the hilum is either anterior or posterior to the hilum.
  49. 49. JSS Medical College, Mysuru Posterior mediastinal mass Spine Sign Cervicothoracic sign Mediastinal masses
  50. 50. JSS Medical College, Mysuru EXTRAMEDULLARY HEMATOPOESIS • Smooth lobular mass in paravertebral gutter, in lower thorax • Bilateral and symmetrical • Due to compensatory expansion of marrow in congenital hemolytic anaemia Thoraco-abdominal sign: Lesion extends below the dome of diaphragm-Lesion in the posterior chest Lesion terminates at the dome –Lesion in the anterior chest
  51. 51. JSS Medical College, Mysuru Hiatus Hernia with gastric volvulus
  52. 52. JSS Medical College, Mysuru Looks Normal????
  53. 53. JSS Medical College, Mysuru Coarctation of aorta
  54. 54. JSS Medical College, Mysuru Kartegeners Syndrome
  55. 55. JSS Medical College, Mysuru Take home message • Look carefully for patient identification details and technical issues • Be systematic in approach • It’s a chest X-ray, not a lung x-ray. • Concentrate on hidden areas • Compare with old films and lateral films
  56. 56. JSS Medical College, Mysuru This presentation will be made available on www.jssmcradiology.com Thank you

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