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chest x ray interpretation.pptx
- 2. BREAKTHROUGH DISCOVERY! • William Conrad Roentgen – 1895
- 3. HOW DOES THE PICTURE FORMED • AMOUNT OF X RAY ABSORBED • Capo4 -22 • Ca co3- 15 • Water—1 • Carbon- 0.7 • Fat -0.5 • Paraffin -0.4 • Air- 0.0001
- 4. PICTURE ... Different tissues absorb X-rays at different extents: • Bone- high absorption (white) • Tissue- somewhere in the middle absorption (grey) • Air- low absorption (black)
- 5. VIEWS • PA • AP • LATERAL • DECUBITUS • APICAL tube angled up 50-60 degree -Apex LORDOTIC tube angled 50-60 degree downwards---middle lobe collapse • OBLIQUE • Supine
- 6. QUALITY OF FILM • Name ,age, sex, date , id no • Side • Inspiratory (sixth rib / tenth rib) • No rotation • Penetration visible down to T8 -T9 • Scapula • Full film (All area seen)
- 11. 8 • Inspiration One minute later • expiration
- 12. READING THE CHEST X RAY • To avoid over looking the areas out side the chest , A- B-C Rule has to be followed. Abdomen Bony cage Chest Soft tissue
- 13. SOFT TISSUE • Amount • Any bulge / absence • FB • • Calcification • Air • Mass
- 14. MASTECTOMY LEFT
- 18. RIB • Companion shadow • Indistinct inferior border is normal for middle and lower rib(when we look for rib erosion) Dense First costal cartilage calcification may obscure UZnotch • Normally on inferior surface just lateral to tubercle • confused with pathological notch
- 19. BONY LESION
- 21. BORDERS OF MEDIASTINUM AND HEART 1Edge of Superior Vena Cava 2. Right Atrium 3. Aortic knuckle 4. Edge of Main Pulmonary Artery 5. Left Atrial Appendage 6. Left Ventricle
- 25. DIAPHRAGM • Right is higher than left( ½ space) • –Lt is pushdown by heart • May lie at same level • Left is higher – in 3% • Difference > 3 cm is significant
- 26. Lymphatics • Normally not seen • Thickening of lymphatics and surrounding connective tissue produces Kerley lines • Enlarged broncho pulmonary node - lobulated hilar mass
- 27. KERLEY A • 1-2 mm thick • non branching • radiating from hilum • 2-6 cm long • thickened deep interlobular septa KERLEY B • 1-2 mm thick • non branching • Transverse line at lung base perpendicular to pleura • 1-3 cm long • thickened interlobular septa
- 28. CP ANGLE • Normally –acute angle • Obliterated when diaphragm becomes flat • Low density ill defined opacity-normal due to Fat pad
- 29. HILUM • Left hilum at higher level than right-97%Left PA alies aboveLMB • Same level -3% • Both hila –equal density similar size • Concave lateral border-superior pulmonary v meet basal pulmonary artery • Normally LN are not seen
- 30. BELOW DIAPHRAGM Look for • Pneumoperitonium • Dilated bowel • Abscess • Displaced gastric bubble • Intramural gas • Calcified spot
- 31. LOCALISATION
- 32. SILHOUETTE SIGN • Described by Felson in 1950 “Loss of an interface by adjacent disease helps in localization of a lesion by studying the diaphragm, cardiac and aortic outlines”
- 33. LOCALIZING DISEASE FROM THE SILHOUETTE SIGN RLL RML LLL Lingula
- 36. ML CONSOLIDATION
- 41. RLL. POST BASAL Posterior diaphragm silhouetted
- 42. APPLICATION OF SILHOUETTE SIGN • Cervico thoracic sign • Thoraco abdominal sign • Hilum overlay signs
- 44. ANTERIOR MASS • contact with soft tissues rather than the aerated lung • cephalic border of a shadow disappears as it approaches the clavicle
- 45. HILUM CONVERGENCE SIGN • Pulmonary artery branches converge towards the hilar mass • Then the hilar mass may be an enlarged pulmonary artery
- 46. HILUM OVERLAY SIGN • Hilar vessels are seen through an opacity at hilum • Then lesion is either anterior or posterior to it
- 48. AIR BRONCHOGRAM • Described by Fleischner-1941 • Named by Felson-1973 • A sign that indicate lesion is intra pulmonary (reverse is not true) • When lung parenchyma are opacified , surrounding bronchi will be visualised due to contrast between air and opaque lung • supplying bronchus should not be occluded
- 49. AIR BRONCHOGRAM
- 50. LLL PNEUMONIA
- 51. LUL PNEUMONIA
- 52. COLLAPSE RUL
- 54. • Pulmonary hemorrhage Pulmonary infarction Goodpasture’s • Tumors BAC,Lymphoma,leukemia,metastatic adenocarcinoma
- 55. BATS WING SHADOW • Perihilar distribution with peripheral lung remaining translucent • Pulmonary edema may be unilateral clear rapidly with treatment • PCP,Goodpasture’s syndrome ,Alveolar cell cacinoma,Alveolar proteinosis
- 59. MILIARY SHADOWING • Any discrete opacity 2- 4 mm in diameter • Uniform size • Wide spread • Common in TB • Dense calcification seen in metallic dust disease
- 61. GROUND GLASS APPEARANCE • Finely granular pattern of pulmonary opacity in which normal anatomical details are partially obscured • Seen with interstitial or air space pattern
- 62. PLEF
- 64. ENCYSTED PLEF
- 65. ENCYSTED PLEF
- 66. SUB PUL EFFUSION
- 73. MASS
- 76. CYSTS
- 77. CAUSES OF MILIARY SHADOWING Infections • Miliary TB • Histiocytosis • Blastomycosis • Coccidiiodomycosis • Chickenpox Dust inhalation • Silicosis • CWP • Tin,beryllium,barium
- 79. RETICULAR PATTERN • Numerous interlacing line shadows • fine reticulation--simulates a very fine mesh • coarse reticulation--characterized by large cystic spaces 1 cm or more in diameter that are ringed by soft tissue • medium reticulation--characterized by 3-10 mm spaces between the reticular mesh
- 82. DIFFUSE BILATERAL RETICULONODULAR • Upper zone • Tuberculosis/fungal • Extrinsic allergic alveolitis • Ankylosing spondylitis • Sub acute sillicosis • Chronic sarcoidosis • Progressive massive fibrosis
- 83. • Midzone • Pulmonary edema • Pulmonary alveolar proteinosis • Pneumocystis carini pneumonia
- 84. Lower zone • Cryptogenic fibrosing alveolitis • Collagen vascular diseases • Asbestosis • Tropical eosinophilia • Bronchopneumonia • Chronic aspiration
- 85. HONEY COMBING • Thin walled cysts representing air spaces 5-10 mm diameter with walls 2-3 mm thick • Occurs in parenchymal destruction leading to end stage fibrosis • Dilatation of respiratory bronchioles and alveolar ducts • IPF,CTD,Sarcoidosis • Increased risk of pneumothorax
- 88. LINE & BAND SHADOWS • Linear opacities < 5 mm in diameter are line shadows • Linear densities with diameter >5 mm in diameter are band shadows
- 89. NODULAR PATTERN • Homogeneous and well circumscribed • Round opacities < 1 cm in diameter
- 92. PULMONARY INFARCT • Irregular thick wedge shaped line with base adjacent to pleura or • Non specific area of peripheral consolidation at lung base • Splinting of diaphragm , pleural reaction • Resolution slower than infection
- 94. SOLITARY PULMONARY NODULE • Single discrete pulmonary opacity • Surrounded by normal lung tissue • Not associated with atelecatasis or adenopathy • Approximately circular • 2-30 mm in diameter (<3 cm )
- 95. Calcification • indicate benign lesion • hamartoma—Popcorn “Carcinoma may arise from old calcified focus” “Metastasis from bone or cartilagenous tumor may have calcification”
- 96. MULTIPLE PULMONARY NODULE • Mostly metastasis or TB • Other—lymphoma ,hamartoma,fungi , hydatid,round pneumonia, wegener , sarcoidois, infarct, AVM , caplan