The Chest X-ray<br />By<br />Dr. MehmetKaphoury<br />Residence of radio-diagnosis, ASU<br />
Preliminary checklist<br />Dose<br />Centralization<br />Patient’s data (name, age, sex, smoking, occupation, residence)<b...
Centralized film<br />
Mr. J is a 65-year-old male presents to the OPC complaining of cough & expectoration of bloody sputum 2 weeks ago. His smo...
Bit-by-bit checklist<br />Trachea<br />Mediastinum<br />Heart<br />Cardio-phrenic angles<br />Diaphragm<br />Costo-phrenic...
Trachea<br />Central at its upper part<br />Deviates slightly to the right at its lower part<br />Its lucency decreases ca...
Caliber
Intraluminal ‘things’
Paratracheal stripe
Carina</li></li></ul><li>Mediastinum<br /><ul><li>Central with aortic knuckle to the left and SVC to the right
Smooth with no irregularities or festooning
Thymus in children</li></ul>Comment on:<br /><ul><li>Displacement
Widening
Fluid level, Air
Spine</li></li></ul><li>Thymus<br />Mediastinum<br />
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The Normal Chest X-ray

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The Normal Chest X-ray

  1. 1. The Chest X-ray<br />By<br />Dr. MehmetKaphoury<br />Residence of radio-diagnosis, ASU<br />
  2. 2. Preliminary checklist<br />Dose<br />Centralization<br />Patient’s data (name, age, sex, smoking, occupation, residence)<br />Clinical history in brief<br />
  3. 3. Centralized film<br />
  4. 4. Mr. J is a 65-year-old male presents to the OPC complaining of cough & expectoration of bloody sputum 2 weeks ago. His smoking index is 1 pack/40 years. Past history is unremarkable except for frequent morning coughs with whitish sputum all through past 25 years almost everyday.. <br />What is the best initial step in diagnosis?<br />The answer is: a plain CXR<br />
  5. 5. Bit-by-bit checklist<br />Trachea<br />Mediastinum<br />Heart<br />Cardio-phrenic angles<br />Diaphragm<br />Costo-phrenic angles<br />Lungs<br />Bony cage<br />Lateral film, if present<br />Other findings<br />
  6. 6. Trachea<br />Central at its upper part<br />Deviates slightly to the right at its lower part<br />Its lucency decreases caudally<br />Comment on:<br /><ul><li>Displacement
  7. 7. Caliber
  8. 8. Intraluminal ‘things’
  9. 9. Paratracheal stripe
  10. 10. Carina</li></li></ul><li>Mediastinum<br /><ul><li>Central with aortic knuckle to the left and SVC to the right
  11. 11. Smooth with no irregularities or festooning
  12. 12. Thymus in children</li></ul>Comment on:<br /><ul><li>Displacement
  13. 13. Widening
  14. 14. Fluid level, Air
  15. 15. Spine</li></li></ul><li>Thymus<br />Mediastinum<br />
  16. 16. Heart <br />One third to the right, 2 thirds to the left<br />Learn normal configuration<br />Borders can be well defined<br />Cardio-thoracic ratio is no more than 50%<br />Comment on:<br /><ul><li>Size & configuration
  17. 17. Borders (well defined or not)
  18. 18. Chambers size and effects of their enlargement
  19. 19. Retro-cardiac shadows
  20. 20. Pericardial calcification, cysts</li></li></ul><li>Aortic knuckle<br />Pulmonary trunk<br />SVC<br />Left atrium<br />Left ventricle<br />Right atrium<br />apex<br />
  21. 21. Cardio-phrenic angles<br />Acute angles<br />Mostly filled with fat pad<br />Abnormalities known by blunting of these angles<br />Comment on:<br /><ul><li>Blunting of the angles
  22. 22. Learn D.D of cardio-phrenic angles opacity</li></li></ul><li>Diaphragm<br />Dom shaped, right higher than left, left may be higher but not more than 3 cm than the right<br />Can be traced all through<br />Diaphragmatic hump may be normal<br />Cut by the 6th or 7th rib in the mid-calv. line <br />Comment on:<br /><ul><li>Level (normal, depressed, elevated)
  23. 23. Trace the contour
  24. 24. Air under</li></li></ul><li>Costo-phrenic angles<br />Acute angles<br />Lucent<br />Comment on:<br /><ul><li>Blunted angles</li></li></ul><li>Lungs <br />Compare both sides for:<br /><ul><li>Airways
  25. 25. Vessels
  26. 26. Interstitium(fluid, fibrosis)
  27. 27. Opacities (total, lobar, segmental, focal, miliary// homogenous, heterogenous)
  28. 28. Cavity
  29. 29. Pleura (line, calcification)
  30. 30. Apices</li></li></ul><li>Bony Cage<br />Cervical ribs<br />Fractures<br />Osteolytic lesions<br />Inter-costal spaces<br />

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