This document provides an overview of chest x-ray interpretation. It begins with learning outcomes and a review of thoracic anatomy including the trachea, heart, lungs, diaphragm, and pleural surfaces. It discusses the importance of image quality and provides a systematic approach to reading chest x-rays. Common abnormalities like pneumothorax, consolidation, effusions, and masses are described. The document also reviews lines, tubes, and normal variants that may appear on chest x-rays.
Pulmonary Lobar Collapse: Essential Considerations 14 Dr. Muhammad Bin ZulfiqarDr. Muhammad Bin Zulfiqar
This presentation is from 15th chapter of Grainger and Allison--Diagnostic Radiology A TEXTBOOK OF MEDICAL IMAGING.
My aim behind all these presentation is to provide authentic images. As our all radiology revolve around images of diseases. We can put these ppts in our androids for study and references.
Pulmonary Lobar Collapse: Essential Considerations 14 Dr. Muhammad Bin ZulfiqarDr. Muhammad Bin Zulfiqar
This presentation is from 15th chapter of Grainger and Allison--Diagnostic Radiology A TEXTBOOK OF MEDICAL IMAGING.
My aim behind all these presentation is to provide authentic images. As our all radiology revolve around images of diseases. We can put these ppts in our androids for study and references.
Describes cross sectional anatomy of the mediastinum , and lobar and segmental anatomy of the lung with teaching points and radiological guidelines and multiple examples of lobar and segmental pathologies and how we localize these pathologies .Also the types of chest CT images and indications of chest CT.
Describes cross sectional anatomy of the mediastinum , and lobar and segmental anatomy of the lung with teaching points and radiological guidelines and multiple examples of lobar and segmental pathologies and how we localize these pathologies .Also the types of chest CT images and indications of chest CT.
in this tutorial i am speaking about chest x-ray quality that include :
1- Inclusion
2- inspiration/lung
3- volume
4- projection
5- penetration
6- Rotation
7- artifact
i try to make it easy and simple for medical students and junior doctors to help them in clinical life.
Urinary system – common pathological correlationKochi Chia
Presentation on common urinary system pathologies and radiological findings. Just a brief explanation. Further info can be obtained from www.radiopaedia.org and www.radiologyassistant.nl
Learn Chest X-Ray With Its Normal Positioning & Radio-AnatomyDr.Santosh Atreya
Learn Chest X-Ray With Its Normal Positioning & Radio-Anatomy..For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
A chest x ray is a fast and painless imaging test that uses certain electromagnetic waves to create pictures of the structures in and around your chest. This test can help diagnose and monitor conditions such as pneumonia, heart failure, lung cancer, tuberculosis, sarcoidosis, and lung tissue scarring, called fibrosis
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
2. Learning Outcomes
By the end of this lecture you should be able to:
• Identify bony and soft tissue
anatomy
• Use a systematic approach to
reading a CXR
• Identify lines and tubes
• Recognise common chest
abnormalities
• Be aware of normal variants
6. Basic Anatomy
Trachea
Positioned centrally, but may angle to
the right.
The trachea gradually shifts to the
right with age.
Don’t use the Trachea to judge how
rotated the image may be!
Bifurcation
Carina
13. Basic Anatomy
Hilar
• Made up of the major bronchi,
pulmonary arteries and veins on
the medial aspect of each lung
• Anchors the lungs to the heart,
trachea, and surrounding
structures
14. Basic Anatomy
Hilar
• The left hilum is commonly higher
than the right
• Changes in density, size or
positioning of the hilar is highly
indicative of abnormality
15. Basic Anatomy
Hilar enlargement
• Lymphadenopathy and tumours
• Pulmonary venous hypertension
(LVF, mitral stenosis or mitral reflux)
• Pulmonary arterial hypertension
(primary pulmonary hypertension
and lung diseases such as COPD)
• Increased pulmonary blood flow
17. Basic Anatomy
Pleural surfaces
Only visible when there is an
abnormality present
• Pleural thickening
• Fluid in the pleural spaces
• Air in the pleural spaces
18. Basic Anatomy
Diaphragm
• The hemidiaphragms are not at
the same level.
• The left hemidiaphragm is
commonly higher than the right by
one intercostal rib space height
(~2 cm)
21. The importance of image quality
Rotation
Side lifted from detector appears lighter. Hila can look distorted
22. The importance of image quality
Rotation
Side lifted from detector appears lighter. Hila can look distorted
Inspiration
Less than 6 anterior/8 posterior ribs causes crowding of diaphragm and hila
23. The importance of image quality
Rotation
Side lifted from detector appears lighter. Hila can look distorted
Inspiration
Less than 6 anterior/8 posterior ribs causes crowding of diaphragm and hila
Penetration
Under-exposed = can cause false positives for pulmonary fibrosis or oedema
24. The importance of image quality
Rotation
Side lifted from detector appears lighter. Hila can look distorted
Inspiration
Less than 6 anterior/8 posterior ribs causes crowding of diaphragm and hila
Penetration
Under-exposed = can cause false positives for pulmonary fibrosis or oedema
Angulation
Clavicles projected over apexes
25. Systematic review of the CXR
1. Trachea
2. Lung Fields
3. Silhouette Sign
4. Mediastinum & Heart
5. Fissures
6. Hila
7. Diaphragm and below diaphragm
8. Bones
9. Soft tissue
10. Abnormal densities
Don’t forget satisfaction of search!
27. Silhouette Sign
On a normal CXR, the outline (silhouette) of the heart
borders; aortic arch; ascending and descending aorta and
hemidiaphragms should be clearly visible where they are in
contact with a specific portion of the lung due to the
natural subject contrast.
28. Silhouette Sign
The silhouette sign is a loss of this clearly defined border.
Identify exactly which silhouette is obliterated - this will
indicate where the lung pathology is located.
29. Pushed or Pulled?
When lung anatomy has shifted, it’s important to decide if
it has been pulled to one side, or pushed away from the
other.
30. Pushed or Pulled?
Pushed
• Massive pleural effusion
• Structures displaced to
other side
• Diaphragm depressed
• Ribs widened
Pulled
• Lobular collapse
• Structures displaced to
the same side
• Diaphragm pulled up
• Ribs crowded
36. Endotracheal Tube
Inserted into the trachea to establish
and maintain a patent airway
The tip of the ET tube should be
approximately 5 cm above the carina
Carina
Tip of ET
tube
37. PICC Line
Peripherally Inserted Central Catheter
Intravenous access for a prolonged
period (e.g., chemotherapy, extended
antibiotic therapy, or total parenteral
nutrition)
38. PICC Line
• Inserted under Interventional
Radiology or Theatre C-arm
• Inserted into peripheral vein in the
arm (cephalic, basilic or brachial)
• Tip rests in the distal superior vena
cava or cavoatrial junction.
39. CVC Line
Central Venous Catheter
• inserted into the superior vena
cava or right atrium
• Inserted without X-ray guidance,
so check CXR required
White arrow:
PICC Line
Black arrow:
CVC Line
41. Pneumothorax
Air trapped in the pleural space
Causes include:
• Penetrating injury to the lung
• Rib fractures
• Air blisters breaking open under
pressure changes (diving or high
altitude flight)
• Medical interventions (biopsies,
pacemaker insertions, etc.)
42. Pneumothorax
In some cases, intra-pleural air volume
will increase, exerting pressure on the
mediastinal and intra-thoracic
structures.
This is known as a
Tension Pneumothorax
Positivepressure
43. Pneumothorax
In some cases, intra-pleural air volume
will increase, exerting pressure on the
mediastinal and intra-thoracic
structures.
This is known as a
Tension Pneumothorax
This is a medical
emergency!
Positivepressure
44. Tension
Pneumothorax
Additional possible signs:
• Ipsilateral increased intercostal
spaces
• Shift of the mediastinum to the
contralateral side
• Depression of the hemidiaphragm
(Ipsilateral = same side / Contralateral = opposite side)
Increased space
Flattened
Shift
45. Consolidation
• Alveoli and small airways fill with
fluid, giving dense white
appearance
• Consolidation does not necessarily
imply an infection
Area of
consolidation
(Upper Right
Lobe)
Horizontal
fissure
47. Pleural effusion
• Pleural effusion is excess fluid that
accumulates in the pleural cavity
• Impairs breathing by restricting
the expansion of the lungs
Curved meniscus with blunting
of costaphrenic and
cardiophrenic angles
48. Pleural effusion
• Need at least 175ml of pleural fluid
before it becomes visible on a PA
image
• On a lateral image effusion of >75ml
can be visible
• At least 500ml must be present to be
seen on a supine CXR
50. Pulmonary Oedema
• Fluid accumulation in the air
spaces and parenchyma
(functional parts) of the lungs
• Impairs gas exchange can lead to
fatal respiratory distress or cardiac
arrest
• Due to either left ventricular
failure (LVF) or injury to the lung
51. Lung Mass
• Lung cancer is the most common
fatal malignancy worldwide in
both men and women
• Lesions are smaller than 3cm
• Masses are larger than 3cm
Solitary Pulmonary
Nodule
Widespread
pulmonary
metastases
52. Lung Mass
• Cavitation or calcification - highly
associated with malignancy
• Lobulated or scalloped margins -
intermediate probability
• Smooth margins - more likely
benign (unless metastatic in origin)
Malignant
cancerous
mass
57. Dextrocardia situs inversus totalisDextrocardia
Complete transposition (right to left reversal) of all of the abdominal
organs
Heart points toward the right side of the
chest
