Based on the provided chest x-ray, the ET tube tip is located above the carina and in the proper position within the trachea. It does not appear to need adjustment. Feeding through the R/T tube would be appropriate.

1. Basic Interpretation of Chest RadiographyBy Dr. ChiaKok King

2. Five Radiographic OpacitiesAir Fat Soft tissue Bone Metalleast opaque to most opaquemost lucent to least lucentBlack to White

3. Radiographic Opacities & ContrastsAir AirFat Mineral oilWater WaterBone TumsMetal ???

4. Film QualityPA or AP view.Upright/Erect or SupineBreath : Inspiration or ExpirationX-ray penetration : Under- or Over-Rotation

5. PA vs AP viewsPA viewScapula is seen in periphery of thoraxClavicles project over lung fieldsPosterior ribs are distinctPosition of markersAP viewScapulae are over lung fieldsClavicles are above the apex of lung fieldsPosition of markersAnterior ribs are distinct

6. Inspiration vs Expiration

7. Penetration With correct exposure you should barely see the intervertebral disc through the heartIf you see them very clearly the film is overpenetratedIf you do not see them it is underpenetrated

8. Penetration

9. Rotation

11. Pitfalls to Chest X-ray InterpretationPoor inspirationOver or under penetrationRotationForgetting the path of the x-ray beam

12. Normal Chest X-rayCardiac StructuresPositionMore central in younger infants and childrenMore on the L side in older infants and teensSizeCARDIO-THORACIC RATIO!Cardiac diameter :normal individuals < 15.5 cm in males; <14.5 cm in females.A change in diameter of greater than 1.5 cm between two X-rays is significant.

13. Cardio-thoracic ratioseen on postero-anterior (PA) view only>50% is considered abnormal in an adult; more than 66% in a neonate.Possible causes of a ratio greater than 50% include:cardiac failurepericardial effusionleft or right ventricular hypertrophy*AP views make heart appear larger than it actually is.*

14. Normal Chest X-ray1. Soft tissue structuresShadows, most commonly, breast2. Bony structuresCount the ribs8 – 10 ribs should be visible on inspirationClavicle placement at 2-3 intercostal space (if not, may be rotated)

15. Normal Chest X-ray3. DiaphragmContourRounded with sharp pointed costophrenic and costocardiac anglesRight diaphragm is usually 1-2 cm higher

16. Normal Chest X-ray4. LungsStart at the top and compare the R and LTrachea should be midline over the thoracic vertebrae and air filledLung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion

17. Anatomy

18. Anatomy

19. Lobes Right upper lobe: Right middle lobe: Right lower lobe: Left lower lobe: Left upper lobe with Lingula:Lingula: Left upper lobe - upper division:Abnormal Chest X-rayRadiopacity (whiteness) = increased densityRadiotranslucency (blackness) = decreased density

20. Radiopacity

21. ConsolidationLobar consolidation:

22. Alveolar space filled with inflammatory exudate

23. Interstitium and architecture remain intact

24. The airway is patent

25. Radiologically:

26. A density corresponding to a segment or lobe

27. Air bronchogram, and

28. No significant loss of lung volumeConsolidation

29. AtelectasisLoss of airObstructive atelectasis:No ventilation to the lobe beyond obstructionRadiologically:Density corresponding to a segment or lobeSignificant loss of volumeCompensatory hyperinflation of normal lungs

30. No ventilation to lobe beyond the obstructionTrapped air absorbed by pulmonary circulationSegmental/lobar densityCompensatory hyper-inflation of normal lungs.Atelectasis

31. Congestive Heart FailureIncreased heart size: cardiothoracic ratio >0.5Large hila with indistinct markings

32. Fluid in interlobar fissures

33. Pleural effusions, alveolar edemaCongestive Heart FailureAlveolar edema (Bat’s wings)

34. Kerley B lines (Interstitial edema)

35. Cardiomegaly

36. Dilated prominent upper lobe vessels

37. Pleural effusion

38. ARDSCongestionInterstitial and alveolar edemaCollapsed or distended alveoliBilateral

39. Pneumothorax

40. Right side tension pneumothorax

41. Left Sided Pneumothorax

42. Pleural effusion

43. Right Side Pleural Effusion

44. RLL Pneumonia

45. ????????????

46. Fracture of posterior rib #7

47. ?????????????????????

48. A single, 3cm relatively thin-walled cavity is noted in the left midlung. This finding is most typical of squamous cell carcinoma (SCC). One-third of SCC masses show cavitation

49. Right Squamous Cell Carcinoma

50. ???????????????

51. Right Middle and Left Upper Lobe Pneumonia

52. ????????????

53. Cavitation : cystic changes in the area of consolidation due to the bacterial destruction of lung tissue. Notice air fluid level.

54. Cavitation

55. ????????????

56. Tuberculosis

57. ??????????

58. COPD: increase in heart diameter, flattening of the diaphragm, and increase in the size of the retrosternal air space. In addition the upper lobes will become hyperlucent due to destruction of the lung tissue.

59. Chronic emphysema effect on the lungs

60. ????????

61. CHF:a great deal of accentuated interstitial markings, Curly lines, and an enlarged heart. Normally indistinct upper lobe vessels are prominent but are also masked by interstitial edema.

62. 24 hours after diuretic therapy

64. Chest wall lesion: arising off the chest wall and not the lung

66. Pleural effusion: Note loss of left hemidiaphragm. Fluid drained via thoracentesis

68. Lung Mass

69. The Enlarged HilaCauses:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. Sarcoidosis

72. Small Pneumothorax : LUL

74. Right Middle Lobe Pneumothorax: complete lobar collapse

75. Post chest tube insertion and re-expansion

77. Metastatic Lung Cancer: multiple nodules seen

79. Tuberculosis

80. Pleural Effusion

81. Pulmonary Fibrosis

82. Cavitating lesion

83. Miliary shadowing

84. 5. 65 yo male admitted for sepsis. CHF or ARDS?