Chest x rays

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  • PA view of a patient with right middle lobe pneumonia, showing consolidation of the right middle lobe and loss of the right heart silhouette.
    Lateral view of the same patient. The right middle lobe appears wedge-shaped on this view.
  • Patient with multiple bilateral pulmonary abscesses, due to tuberculosis. Note the air-fluid levels within several of these cavitary lesions.
  • The chest x-ray shows a shadow in the left lung, which was later diagnosed as lung cancer
  • Chest x rays

    1. 1. X RAY CHEST
    2. 2. 1. Patient particulars 2. View- PA / AP / LATERAL / OBLIQUE 3. Exposure/penetration 4. Centralisation 5. Skeleton 6. Lung fields 7. Cardiovascular silhouette 8. Mediastinum 9. Costo phrenic & cardio phrenic angles 10. Diaphragm 11. Soft tissue abn. 12. Conclusion
    3. 3. Radiologically, lung fields are divided into 3 ZONES…… UPPER ZONE - From above upto 2nd costal cartilage MIDDLE ZONE - 2ND TO 4TH Costal cartilage LOWER ZONE - Below 4th costal cartilage
    4. 4.  Patient particulars  View- Pa / AP / Lateral / Oblique
    5. 5. Should see ribs through the heart Barely see the spine through the heart Should see pulmonary vessels nearly to the edges of the lungs
    6. 6. OVERPENETRAT ED FILM • Lung fields darker than normal—may obscure subtle pathologies • See spine well beyond the diaphragms • Inadequate lung detail
    7. 7. Underpenetrated Film •Hemidiaphragms are obscured •Pulmonary markings more prominent than they actually are
    8. 8.  Should be able to count 9-10 posterior ribs  Heart shadow should not be hidden by the diaphragm 1 2 3 4 5 6 7 8 9 10
    9. 9. Medial ends of bilateral clavicles are equidistant from the midline or vertebral bodies
    10. 10. If spinous process appears closer to the right clavicle (red arrow), the patient is rotated toward their own left side If spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side
    11. 11. Check for  Symmetry  Deformities  Fractures  Masses  Calcifications  Lytic lesions
    12. 12. Check for Cardiomegaly Mediastinal and Hilar contours Trachea- upper med. Apex of heart- lower med.
    13. 13.  Check sharpness of borders  Right is normally higher than left  Check for free air, gastric bubble, pleural effusions  >1.5 cm - normal  < 1.0 cm- flat diaphragm
    14. 14.  To help you determine abnormalities and their location…  Use silhouettes of other thoracic structures
    15. 15. This is chest radiograph, PA view with normal exposure, no rotation and without any apparent bony abnormality. Trachea is placed centrally & lung fields are clear with normal broncho-vescicular markings. Cardiovascular silhouette is within normal limits with normal cardiothoracic ratio. Mediastinum, costo-phrenic, cardio-phrenic angles, dome of diaphragm & soft tissue shadow within normal limits.
    16. 16. Remember… be systematic!
    17. 17. Consolidation
    18. 18. a) PNEUMONIA b) COLLAPSE c) FIBROSIS d) PULMONARY INFARCTION e) CA LUNG f) TUBERCULOSIS
    19. 19. Multiple bilateral cavitary lesions with air- fluid levels
    20. 20. 1. LUNG ABSCESS 2. HYDROPNEUMOTHORAX 3. INFECTED LUNG CYST
    21. 21.  PERICARDIAL EFFUSION  DCMP  RHD  IHD  ASD  VSD  SYST HTN
    22. 22. Non homogenious infiltrates
    23. 23. Non homogenious infiltrates
    24. 24. 1. PULMONARY TB 2. RESOLVING BACTERIAL PNEUMONIA 3. ALVEOLAR CELL CA 4. PULMONARY EDEMA 5. FUNGAL INFECTION OF LUNG
    25. 25. Dextrocardia
    26. 26. Emphysema
    27. 27. emphysema
    28. 28. 1) EMPHYSEMA 2) B/L PNEUMOTHORAX 3) LARGE MULTIPLE BULLAE 4) B. ASTHMA 5) OVER EXPOSED FILM
    29. 29. Normal broncho-vescicular markings 2/31/3
    30. 30. UPTO 2/3 – Normal BEYOND 2/3 – Chronic bronchitis
    31. 31.  Fibosis  Collapse  infiltration
    32. 32. Foreign body ? Trachea ? esophagus
    33. 33. Ans. Is…Lateral X-Ray Chest. & Symptoms
    34. 34. pneumothorax
    35. 35. 1) Pneumothorax 2) Bullae 3) Lung cyst 4) Obtructive emphysema 5) Mastectomy 6) Poor technique
    36. 36. Miliary tuberculosis
    37. 37. 1. Miliary tb 2. Tropical eosinophilia 3. Pneumoconiosis 4. Lymphangitis carcinomatosa 5. Extrisic allergic alveolitis 6. Haemosiderosis 7. Sarcoidosis 8. Fungal ds
    38. 38. Homogeneous opacity
    39. 39. Homogenious opacity
    40. 40. Homogenious opacity
    41. 41. Homogenious opacity Homogenious opacity
    42. 42. 1) Pleural effusion 2) Empyema thorasis 3) Collapse 4) Consolidation 5) Thickened pleura 6) Pleural mesothelioma 7) Agenesis of lung 8) Surgical removal 9) Fibrosis
    43. 43. Right lung opacity
    44. 44. Left lung opacity
    45. 45.  Ca lung  Loculated pleural effusion
    46. 46. Thank you all The besT

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