Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

CXR Simple by DrRaghu Ram

1,406 views

Published on

Dr Raghu Ram Chest X ray

Published in: Health & Medicine
  • Be the first to comment

CXR Simple by DrRaghu Ram

  1. 1. 11 ChestChest RadiographyRadiography InterpretationInterpretation Dr. Raghu RamDr. Raghu Ram UppalapatiUppalapati
  2. 2. Lung AnatomyLung Anatomy  TracheaTrachea  CarinaCarina  Right and LeftRight and Left Pulmonary BronchiPulmonary Bronchi  Secondary BronchiSecondary Bronchi  Tertiary BronchiTertiary Bronchi  BronchiolesBronchioles  Alveolar DuctAlveolar Duct  AlveoliAlveoli
  3. 3. Lung AnatomyLung Anatomy  Right LungRight Lung  Superior lobeSuperior lobe  Middle lobeMiddle lobe  Inferior lobeInferior lobe  Left LungLeft Lung  Superior lobeSuperior lobe  Inferior lobeInferior lobe
  4. 4. Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray  PA View:PA View:  Extensive overlapExtensive overlap  Lower lobes extendLower lobes extend highhigh  Lateral View:Lateral View:  Extent of lower lobesExtent of lower lobes
  5. 5. Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray  The right upper lobe (RUL) occupies the upper 1/3 of the rightThe right upper lobe (RUL) occupies the upper 1/3 of the right lung.lung.  Posteriorly, the RUL is adjacent to the first three to five ribs.Posteriorly, the RUL is adjacent to the first three to five ribs.  Anteriorly, the RUL extends inferiorly as far as the 4th rightAnteriorly, the RUL extends inferiorly as far as the 4th right anterior ribanterior rib
  6. 6. Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray  The right middle lobe is typically the smallest of the three, andThe right middle lobe is typically the smallest of the three, and appears triangular in shape, being narrowest near the hilumappears triangular in shape, being narrowest near the hilum
  7. 7.  The right lower lobe is the largest of all three lobes, separated from theThe right lower lobe is the largest of all three lobes, separated from the others by the major fissure.others by the major fissure.  Posteriorly, the RLL extend as far superiorly as the 6th thoracicPosteriorly, the RLL extend as far superiorly as the 6th thoracic vertebral body, and extends inferiorly to the diaphragm.vertebral body, and extends inferiorly to the diaphragm.  Review of the lateral plain film surprisingly shows the superior extent ofReview of the lateral plain film surprisingly shows the superior extent of the RLL.the RLL.
  8. 8. Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray  These lobes can be separated fromThese lobes can be separated from one another by two fissures.one another by two fissures.  The minor fissure separates theThe minor fissure separates the RUL from the RML, and thusRUL from the RML, and thus represents the visceral pleuralrepresents the visceral pleural surfaces of both of these lobes.surfaces of both of these lobes.  Oriented obliquely, the majorOriented obliquely, the major fissure extends posteriorly andfissure extends posteriorly and superiorly approximately to thesuperiorly approximately to the level of the fourth vertebral body.level of the fourth vertebral body.
  9. 9.  The lobar architecture of the left lung is slightly differentThe lobar architecture of the left lung is slightly different than the right.than the right.  Because there is no defined left minor fissure, there areBecause there is no defined left minor fissure, there are only two lobes on the left; the left upperonly two lobes on the left; the left upper
  10. 10. Lt Lower LobesLt Lower Lobes  Left lower lobesLeft lower lobes
  11. 11. Lung Anatomy on Chest X-rayLung Anatomy on Chest X-ray  These two lobes areThese two lobes are separated by a majorseparated by a major fissure, identical to thatfissure, identical to that seen on the right side,seen on the right side, although often slightlyalthough often slightly more inferior in location.more inferior in location.  The portion of the leftThe portion of the left lung that correspondslung that corresponds anatomically to the rightanatomically to the right middle lobe ismiddle lobe is incorporated into the leftincorporated into the left upper lobe.upper lobe.
  12. 12. RUL (Right Upper Lung)RUL (Right Upper Lung)
  13. 13. RML (Right Middle Lung)RML (Right Middle Lung)
  14. 14. RLL (Right Lower Lung)RLL (Right Lower Lung)
  15. 15. LUL (Left Upper Lung)LUL (Left Upper Lung)
  16. 16. LLL (Left Lower Lung)LLL (Left Lower Lung)
  17. 17. Left Side FissureLeft Side Fissure LUL LLL
  18. 18.  A structure is rendered visible on aA structure is rendered visible on a radiograph by the juxtaposition of tworadiograph by the juxtaposition of two different densitiesdifferent densities Chest Radiography: Basic PrinciplesChest Radiography: Basic Principles
  19. 19. Silhouette SignSilhouette Sign  Loss of the expected interface normallyLoss of the expected interface normally created by juxtaposition of two structurescreated by juxtaposition of two structures of different densityof different density  No boundary can be seen between twoNo boundary can be seen between two structures of similar densitystructures of similar density
  20. 20. Right Lower Lobe PneumoniaRight Lower Lobe Pneumonia
  21. 21. Differential X-Ray AbsorptionDifferential X-Ray Absorption  The absence of a normal interface mayThe absence of a normal interface may indicate disease;indicate disease;  The presence of an unexpectedThe presence of an unexpected interface may also indicate diseaseinterface may also indicate disease  The presence of interfaces can be usedThe presence of interfaces can be used to localize abnormalitiesto localize abnormalities
  22. 22. Chest RadiographicChest Radiographic Patterns of DiseasePatterns of Disease  Air space opacityAir space opacity  Interstitial opacityInterstitial opacity  Nodules and massesNodules and masses  LymphadenopathyLymphadenopathy  Cysts and cavitiesCysts and cavities  Lung volumesLung volumes  Pleural diseasesPleural diseases
  23. 23. LUL PneumoniaLUL Pneumonia
  24. 24. Air Space OpacityAir Space Opacity  Components:Components: air bronchogram: air-filled bronchusair bronchogram: air-filled bronchus surrounded by airless lungsurrounded by airless lung confluent opacity extending to pleuralconfluent opacity extending to pleural surfacessurfaces segmental distributionsegmental distribution
  25. 25. Air Space Opacity: DDXAir Space Opacity: DDX  Blood (hemorrhage)Blood (hemorrhage)  Pus (pneumonia)Pus (pneumonia)  Water (edema)Water (edema) hydrostatic or non-cardiogenichydrostatic or non-cardiogenic  Cells (tumor)Cells (tumor)  Protein/fat: alveolar proteinosis andProtein/fat: alveolar proteinosis and lipoid pneumonialipoid pneumonia
  26. 26. Interstitial Opacity: Small NodulesInterstitial Opacity: Small Nodules
  27. 27. Interstitial Opacity:Interstitial Opacity: LinesLines
  28. 28. Interstitial Opacity: Lines & ReticulationInterstitial Opacity: Lines & Reticulation
  29. 29. Interstitial OpacityInterstitial Opacity  Hallmarks:Hallmarks: small, well-defined nodulessmall, well-defined nodules lineslines  interlobular septal thickeninginterlobular septal thickening  fibrosisfibrosis reticulationreticulation
  30. 30. Interstitial Opacity: DDXInterstitial Opacity: DDX  Idiopathic interstitial pneumoniasIdiopathic interstitial pneumonias  Infections (TB, viruses)Infections (TB, viruses)  EdemaEdema  HemorrhageHemorrhage  Non–infectious inflammatory lesionsNon–infectious inflammatory lesions sarcoidosissarcoidosis  TumorTumor
  31. 31. Nodules and MassesNodules and Masses  Nodule: any pulmonary lesion represented inNodule: any pulmonary lesion represented in a radiograph by a sharply defined, discrete,a radiograph by a sharply defined, discrete, nearly circular opacity 2-30 mm in diameternearly circular opacity 2-30 mm in diameter  Mass:Mass: larger than 3 cmlarger than 3 cm
  32. 32. Nodules and MassesNodules and Masses  Qualifiers:Qualifiers: single or multiplesingle or multiple sizesize border definitionborder definition presence or absence of calcificationpresence or absence of calcification locationlocation
  33. 33. MassMass CalcificationCalcification Well-DefinedWell-Defined Ill-DefinedIll-Defined
  34. 34. LymphadenopathyLymphadenopathy  Non-specific presentations:Non-specific presentations: mediastinal wideningmediastinal widening hilar prominencehilar prominence  Specific patterns:Specific patterns: particular station enlargementparticular station enlargement
  35. 35. Right ParatrachealRight Paratracheal LymphadenopathyLymphadenopathy
  36. 36. Right Hilar LANRight Hilar LAN
  37. 37. Right Hilar LANRight Hilar LAN
  38. 38. Left Hilar LANLeft Hilar LAN
  39. 39. Subcarinal LANSubcarinal LAN *
  40. 40. AP Window LANAP Window LAN
  41. 41. Cysts & CavitiesCysts & Cavities  CystCyst: abnormal pulmonary parenchymal: abnormal pulmonary parenchymal space, not containing lung but filled with airspace, not containing lung but filled with air and/or fluid, congenital or acquired, with aand/or fluid, congenital or acquired, with a wall thickness greater than 1 mmwall thickness greater than 1 mm  epithelial lining often presentepithelial lining often present
  42. 42. Cysts & CavitiesCysts & Cavities CavityCavity: Abnormal pulmonary: Abnormal pulmonary parenchymal space, not containing lung butparenchymal space, not containing lung but filled with air and/or fluid, caused by tissuefilled with air and/or fluid, caused by tissue necrosis, with a definitive wall greater thannecrosis, with a definitive wall greater than 1 mm in thickness and comprised of1 mm in thickness and comprised of inflammatory and/or neoplastic elementsinflammatory and/or neoplastic elements
  43. 43. Cysts & CavitiesCysts & Cavities  Characterize:Characterize: wall thickness at thickest portionwall thickness at thickest portion inner lininginner lining presence/absence of air/fluid levelpresence/absence of air/fluid level number and locationnumber and location
  44. 44. Benign Lung Cyst :Benign Lung Cyst : PCPPCP PneumatocelePneumatocele • Uniform wall thicknessUniform wall thickness • 1 mm1 mm • Smooth inner liningSmooth inner lining
  45. 45. Benign Cavities :Benign Cavities : CryptococcusCryptococcus • max wall thicknessmax wall thickness ≤≤4 mm4 mm • minimally irregular inner liningminimally irregular inner lining
  46. 46. Indeterminate CavitiesIndeterminate Cavities • max wall thickness 5-15 mmmax wall thickness 5-15 mm • mildly irregular inner liningmildly irregular inner lining
  47. 47. Malignant Cavities: Squamous Cell CaMalignant Cavities: Squamous Cell Ca • max wall thicknessmax wall thickness ≥≥16 mm16 mm • Irregular inner liningIrregular inner lining
  48. 48. Pleural Disease: Basic PatternsPleural Disease: Basic Patterns  EffusionEffusion angle blunting to massiveangle blunting to massive mobilitymobility  ThickeningThickening  distortion, no mobilitydistortion, no mobility  MassMass  AirAir  CalcificationCalcification
  49. 49. Pleural EffusionPleural Effusion
  50. 50. Pleural EffusionPleural Effusion
  51. 51. Pleural CalcificationPleural Calcification
  52. 52. SOME INTERESTINGSOME INTERESTING X-RAYS & DISCUSSIO NX-RAYS & DISCUSSIO N
  53. 53. Chest breast implantsChest breast implants
  54. 54. Tip of ET Pneumomediastinum
  55. 55.  widewide mediastinummediastinum  obliteration ofobliteration of aortic knobaortic knob  Rt mainstemRt mainstem shift up andshift up and rightright  NG deviateNG deviate to rightto right  pleural cappleural cap Major Vessel Injury Potential X ray findings
  56. 56. Expiration reduces lung volume,Expiration reduces lung volume, making a small pneumo easier to seemaking a small pneumo easier to see
  57. 57. Irregular linear opacities are present in both lungs, especially in the periphery and the bases of the lungs. The heart is slightly enlarged, but this is not related to the pulmonary abnormalities in this case.
  58. 58. Hodgkin’s Disease
  59. 59. 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
  60. 60. LUL Atelectasis: Loss of heart borders/silhouetting. Notice over inflation on unaffected lung
  61. 61. Right Middle and Left Upper Lobe Pneumonia
  62. 62. Pseudotumor: fluid has filled the minor fissure creating a density that resembles a tumor (arrow). Recall that fluid and soft tissue are indistinguishable on plain film. Further analysis, however, reveals a classic pleural effusion in the right pleura. Note the right lateral gutter is blunted and the right diaphram is obscurred.
  63. 63. Pneumonia:a large pneumonia consolidation in the right lower lobe. Knowledge of lobar and segmental anatomy is important in identifying the location of the infection
  64. 64. 24 hours after diuretic therapy
  65. 65. 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.

×