This document provides an overview of the basic approach to interpreting chest X-rays. It discusses evaluating technical adequacy, the cardiothoracic ratio, mediastinal contours, lung zones, and bony structures. Common normal variants like the azygos lobe fissure are also addressed. The lateral view is described as helpful for localization of abnormalities and differentiating hilar masses. Key areas like pleural effusions, diaphragm abnormalities, and the anterior mediastinum are highlighted. An inside-to-outside approach is suggested starting with technical adequacy and moving outward.

1. Basic approach to chest X-ray
interpretation
Lecture 5
Dr. Kosar kamal ahmed

2. Basics
First we should be familiar with normal CXR

3. Basics

4. Technical adequacy
• Rotation
• Inspiration
• Angulation
• Penetration

5. Technical adequacy
• Rotation
• Inspiration
• Angulation
• Penetration

6. Technical adequacy
• Rotation
• Inspiration
• Penetration
• Angulation

7. Technical adequacy
• Rotation
• Inspiration
• Angulation
• Penetration

8. Common normal variants
• Keat’s atlas of normal
variants
• Azygos lobe fissure

9. Variants
• Azygos lobe fissure

10. Variants
• An apparent nodule formed by joint between
first rib and calcified cartilage

11. Variants
Pectus excavatum

12. How to interpret a CXR ?
• Heart failure
• Interstitial lung
disease
• Pulmonary mass
• Pulmonary abscess
• Pleural effusion
• Diaphragmatic hernia
• Hilar pathology
• LAP

13. A suggested form of tics
an inside-outside approach
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures

14. Inside to outside approach
• Technical adequacy
• Cardiothoracic ratio + CP
angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures
Normal ( clear CP angles )
For pl. effusion click button

15. pleural fluid and effusion

16. pleural fluid and effusion
• Sub-pulmonic effusion
Is there any thing
look like this ?

17. Eventration of the diaphragm or paralysis of
hemidiaphragm

18. Eventration of the diaphragm and D. paralysis

19. pleural fluid and effusion

20. pleural fluid and effusion
Blunting of the
costophrenic angle

21. pleural fluid and effusion

22. pleural fluid and effusion
Meniscus sign

23. pleural fluid and effusion
Meniscus sign

24. pleural fluid and effusion
• Layering effusion
• Lamellated effusion
• Loculated effusion ( vanishing
tumor )
What is the clue ? What to do next ?
Take a lateral view

25. Lateral view CXR ( our best friend )
• On a normal lateral view the
contours of the heart are
visible and the IVC is seen
entering the right atrium.
• The retrosternal space should
be radiolucent, since it only
contains air. Any radiopacity in
this area is suspective of a
proces in the anterior
mediastinum or upper lobes of
the lung.

26. Lateral view CXR ( our best friend )
• As you go from superior to
inferior over the vertebral
bodies they should get darker,
because usually there will be
less soft tissue and more
radiolucent lung tissue (red
arrow).
• If this is not the case, look carefully for
pathology in the lower lobes.

27. Lateral view CXR ( our best friend )
What additional information can be
obtained by lateral view ?
In our field lateral view is for
localization

28. Lateral view CXR ( our best friend )
•The right diaphragm should be
visible all the way to the anterior
chest wall (red arrow).
•The left diaphragm can only be
seen to a point where it borders the
heart (blue arrow).

29. Lateral view CXR ( our best friend )
•From lateral view we can differentiate between hilar
masses ( LN or vascular lesions

30. Lateral view CXR ( our best friend )
From lateral view we can differentiate between hilar masses ( LN or vascular
lesions
Hilar LAPPulm. HTN

31. Lateral view CXR ( our best friend )
• On the Paview the superior mediastinum is widened.
• The lateral view is helpful in this case because it demonstrates a density in the retrosternal
space.
• Now the differential diagnosis is limited to a mass in the anterior mediastinum (4 T's).

32. Lateral view CXR ( our best friend )
• 4 T s :
• Thymoma
• Teratoma
• Thyroid ( retrosternal )
• Terrible lymphoma

33. Let’s go back to where we skipped
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures

34. End of part one
Thank you for your attension