This document provides an overview of chest x-ray (CXR) basics and techniques. It discusses the main types of radiologic imaging used for pulmonary examinations, including plain CXR, CT, ultrasound and others. The bulk of the document focuses on performing and interpreting plain CXRs, outlining the key steps of evaluating technical quality, anatomical structures, and differentiating common radiographic findings such as consolidation, cavitary lesions, and pulmonary nodules. It provides examples of normal and abnormal CXR presentations of various pulmonary diseases.

1. Mahmoud Elhusseiny Abolmagd MSc, MD
lecturer of Pulmonary & Critical Care Medicine
Mansoura University
BASICS OF CXR

2. Plain chest x-ray.
Chest x-ray with dye: bronchogram.
Computerized tomography.
Chest ultrasound.
Lung scintigraphy or isotopic study.
 Ventilation-perfusion scanning.
 Positron emission tomography (PET).
Pulmonary angiography.
Magnetic Resonance Imaging (MRI).
RADIOLOGIC IMAGING
CHEST X-RAY 2

3. PLAIN CHEST X-RAY
CHEST X-RAY 3

4. CHEST X-RAY 4

5. CHEST X-RAY 5

6. • Most common radiological investigation
• around 40% of all investigations
• Standard component of a pulmonary
examination
CHEST X-RAY 6

7. WHY WE DO CXR ?
* For diagnosis.
* Follow up for.
-Treatment response
-Complications
• Pre-operative fitness.
• Pre -employment.
• Medico legal
CHEST X-RAY 7

8. ADVANTAGES OF CXR
Simple.
Safe.
Non invasive.
Rapid.
Cheap.
Informative
CHEST X-RAY 8

9. LIMITATIONS OF CXR
*Chest diseases with normal CXR.
-Asthma - Early Cancer
-Embolism - Bronchitis
*Suggest but does not diagnose.
CHEST X-RAY 9

10. Technical quality; projection, penetration, degree of inspiration, &
centralization.
Lung fields.
Look at the hilum.
Trachea
Heart and mediastinum.
SUGGESTED SCHEME FOR
VIEWING THE PA FILM:
CHEST X-RAY 10

11. Diaphragm.
Pleural spaces.
Hidden areas.
Soft tissues.
Bones.
CHEST X-RAY 11

12. Technical Quality
1.Projection
2.Penetration
3.Centralization
4.Degree of inspiration
CHEST X-RAY 12

13. 1 2
PROJECTION (VIEW)
CHEST X-RAY 13

14. CHEST X-RAY 14
PA
FILM

15. CHEST X-RAY 15
PORTABLE (AP)
FILM

16. CHEST X-RAY 16

17. CHEST X-RAY 17

18. CHEST X-RAY 18
PENETRATION

19. CENTRALIZATION
CHEST X-RAY 19

20. CHEST X-RAY 20

21. EFFECT OF OBLIQUITY ON
HEART SIZE
CHEST X-RAY 21

22. CHEST X-RAY 22

23. • The anterior end of 6th rib or posterior ends of 10th rib are above the right
hemidiaphragm.
• If more ribs are visible the patient is hyperinflated.
• If fewer are visible, the film is expiratory.
DEGREE OF INSPIRATION
CHEST X-RAY 23

24. CHEST X-RAY 24

25. CHEST X-RAY 25

26. CHEST X-RAY 26

27. EXPIRATORY FILM
inspiratory expiratory

28. CHEST X-RAY 28

29. Identification of right from
left hemi thorax
CHEST X-RAY 29

30. CHEST X-RAY 30

34. CHEST X-RAY 34

35. CHEST X-RAY 35

36. CHEST X-RAY 36

37. The Mediastinum
and Heart
CHEST X-RAY 37

38. CHEST X-RAY 38

39. The diaphragm
CHEST X-RAY 39

40. CHEST X-RAY 40

41. CHEST X-RAY 41

42. CHEST X-RAY 42

43. CHEST X-RAY 43

44. The lung zones
CHEST X-RAY 44

45. CHEST X-RAY 45

46. Upper zone
Middle zone
Lower zone
CHEST X-RAY 46

48. Radiological differential
diagnosis of plain chest x-ray
CHEST X-RAY 48

49. CHEST X-RAY 49

50. CHEST X-RAY 50

51. CHEST X-RAY 51

52. CHEST X-RAY 52

53. 1) CONSOLIDATION:
• Air bronchogram is an important sign, showing that
shadowing is intrapulmonary, it is a hallmark for
consolidation.
• It is not seen within pleural effusion
• Causes of consolidation :
* pneumonia.
* Pulmonary infarction.
CHEST X-RAY 53

54. CHEST X-RAY 54

55. CHEST X-RAY 55

56. CHEST X-RAY 56

57. CHEST X-RAY 57

58. CHEST X-RAY 58

59. CHEST X-RAY 59

60. CHEST X-RAY 60

61. CHEST X-RAY 61

62. CHEST X-RAY 62

63. CHEST X-RAY 63

64. * TB
* Fungal infection
* Lung abscess
* Bronchogenic carcinoma.
* Metastatic tumors
CHEST X-RAY 64
2) CAVITARY LESION:

65. CHEST X-RAY 65

66. CHEST X-RAY 66

67. CHYLOTHORAX 67

68. It is a single discrete pulmonary opacity must be 3cm or less in
diameter that is surrounded by normal lung tissue & not
associated with adenopathy or atelectasis
* Tumor (bronchogenic carcinoma).
* Infection (TB, fungi, hydatid)
* Pulmonary infarction.
*Collagen (RA, Wagener's granulomatosis).
3) SOLITARY PULMONARY
NODULE:
CHEST X-RAY 68

69. CHEST X-RAY 69

70. CHEST X-RAY 70

71. • Metastasis.
• TB.
• Fungi.
• Hydatid cysts.
• Arteriovenous malformation.
4) MULTIPLE PULMONARY
NODULES:
CHEST X-RAY 71

72. CHEST X-RAY 72

73. CHEST X-RAY 73

74. It is defined as 2-5mm nodule
Causes:
• TB
• Pneumoconsiosis as silicosis, coalminer disease.
• Metastases.
• Fungal infection.
5)MILIARY SHADOWS:
CHEST X-RAY 74

75. Courtesy of Dr. Nestor Muller, Dpt Radiology Vancouver General Hospital
CHEST X-RAY 75

76. Courtesy of Dr. Nestor Muller, Dpt Radiology Vancouver General Hospital
CHEST X-RAY 76

77. Normal CXR Abnormal CXR
CHEST X-RAY 77

79. CHEST X-RAY 79

80. CHEST X-RAY 80

81. CHEST X-RAY 81

82. * Idiopathic interstitial fibrosis.
* Collagen disease as SLE.
* Pneumoconsiosis as coal miner's, silicosis, and
asbestosis.
6) DIFFUSE BILATERAL RETICULO-
NODULAR SHADOWS:
CHEST X-RAY 82

83. CHEST X-RAY 83

84. CHEST X-RAY 84

85. CHEST X-RAY 85

86. CHEST X-RAY 86

87. CHEST X-RAY 87

89. a- Unilateral:
• TB
• Malignancy (bronchial
carcinoma, lymphoma)
• Pulmonary artery aneurysm
• Technical (rotation of the
patient).
b- Bilateral:
• Sarcoidosis
• Lymphoma
• TB
• Pulmonary hypertension
7) HILAR ENLARGEMENT:
CHEST X-RAY 89

90. CHEST X-RAY 90

91. CHEST X-RAY 91

92. CHEST X-RAY 92

93. Atelectasis
Pneumonia
Effusion
CHEST X-RAY 93

94. Atelectasis
Pneumonia
Effusion
CHEST X-RAY 94

95. Atelectasis
Pneumonia
Effusion
CHEST X-RAY 95

96. * Pleural effusion.
* Surgical pneumonectomy.
* Pulmonary collapse.
* Mediastinal huge mass.
* Pulmonary agenesis.
8)OPAQUE HEMITHORAX:
CHEST X-RAY 96

97. CHEST X-RAY 97

98. CHEST X-RAY 98

99. CHEST X-RAY 99

100. CHEST X-RAY 100

101. CHEST X-RAY 101

102. CHEST X-RAY 102

103. CHEST X-RAY 103

104. * Unilateral emphysema or bulla.
* Pneumothorax.
9) UNILATERAL HYPER-
TRANSLUCENCY:
CHEST X-RAY 104

105. CHEST X-RAY 105

106. CHEST X-RAY 106

107. CHEST X-RAY 107

108. CHEST X-RAY 108

109. CHEST X-RAY 109

110. CHEST X-RAY 110

112. CHEST X-RAY 112

113. CHEST X-RAY 113

114. CHEST X-RAY 114

115. CHEST X-RAY 115

116. * Intrapulmonary:
• Granuloma (TB, histoplasmosis).
• Tumor (hamartoma).
• Alveolar microlithiasis.
* Pleural:
• TB, asbestosis
10) CALCIFICATION ON CXR:
CHEST X-RAY 116

117. CHEST X-RAY 117

118. CHEST X-RAY 118

119. CHEST X-RAY 119

120. CHEST X-RAY 120

121. CHEST X-RAY 121

122. CHEST X-RAY 122

123. PAVM REVIEW 123

124. Miscellaneous
CHEST X-RAY 124

125. CHEST X-RAY 125

128. CHEST X-RAY 128

129. CHEST X-RAY 129

130. CHEST X-RAY 130

131. CHEST X-RAY 131

132. CHEST X-RAY 132

133. CHEST X-RAY 133

134. CHEST X-RAY 134

135. CHEST X-RAY 135

136. BLACK BRONCHOSCOPY 136

137. CHEST X-RAY 137

138. CHEST X-RAY 138

139. CHEST X-RAY 139

140. CHEST X-RAY 140

141. CHEST X-RAY 141

142. CHEST X-RAY 142

143. BLACK BRONCHOSCOPY 143

144. CHEST X-RAY 144