chest xrays

1. In the Name of Allah, The Most Merciful, The Most Beneficent

2. CHEST X-RAYS
AND THEIR INTERPRETATION
PRESENTED BY
SAAD SALEEM

3. By This Presentation We Will Learn
• Objectives of a chest x-ray
• Views of chest x-rays
• Interpretation of chest x-rays
• Specific diseases which can be identified in chest x-
rays

4. Objectives Of A Chest X-ray
• To identify normal cardiothoracic anatomical
structures demonstratable on x-rays
• To recognize radiographic signs of lung
pathologies

5. Views Of Chest X-rays
• There are basically two types of views which can be
taken in chest radiographs
• 1: STANDARD VIEWS
A) Posterioanterior (PA)
B) Lateral
C) Anterioposterior (AP)
• 2: SPECIAL VIEWS
A) Lordotic view
B) Inspiration and expiration views
C) Reverse Lordotic view
D) Oblique
E) Supine CXR
F) Lateral decubitus film

6. Interpretation Of Chest X-rays
The key to successfully interpretate any
radiograph is to be systematic
Identification: Correct patient, date, time, MR #
(if applicable), and examination
Side marker: Where is the side marker located
Technique: Concentrate on technical factors
such as:
• Is examination complete
• Requested views present or not
• Is the entire anatomical area included on the
films (projection, position, penetration,
rotation, and inspiration)

7. Systemic AnalysisSystemic Analysis
• Soft tissues, chest wall.
• Bones; shoulder girdle, spine rib cage.
• Diaphragm shape, position, sub-diaphragmatic
abnormalities.
• Review abdomen for bowel gas, organ size, abnormal
calcifications, and free air.
• Plastic; OETT, lines, and tubes.
• Pacemaker.
• Review mediastinum: size and shape; trachea (position,
carina, trachea should be central); margins (ascending
aorta, right atrium, left subclavian artery, aortic arch,
main pulmonary artery, left ventricle).
• Heart size and shape: width of heart should not be
greater than 50% of the width of the rib cage.
• Review hila: normal relationships of hila should be in
mind, size.
• Parenchyma: now the lungs; divide entire chest into three
parts, upper, middle, and lower thirds, then methodically
compare the right and left sides of each lung section
looking for asymmetry. Compare lung sizes, aeration,
vascular distinctness, and abnormal opacities.
• Pleura: costophrenic and cardiophrenic angles,
thickening fissures (if seen).

8. Normal Chest X-ray

9. COLLAPSE (ATLECTASIS)
Volume loss due to alveolar collapse or failure to expand causing
increased opacification of radiograph
Types
• Obstructive
• Compressive
• Cicatrization
• Adhesive
• Passive
Features of lobar collapse
• Shift of fissures
• Area of increased opacity
• Crowding of vessels
• Tracheal displacement towards the side of collapse
• Hilar shift
• Mediastinal shift towards the side of collapse
• Elevation of hemi-diaphragm
• Herniation of the opposite lung across midline

13. PLEURAL EFFUSION
• Defined as fluid in pleural space.
• Fluid can be transudative or exudative in
nature.
• Various types of effusions include:
1. Hydrothorax; transudative effusion i.e. CHF,
hypoalbuminemia
2. Pyothorax; pus in pleural space i.e.
empyema from pneumonia
3. Hemothorax; blood
4. Chylothorax; chyle

15. PNEUMOTHORAX
• Air enters pleural space
• Two types
1. Spontaneous pneumothoraces
2. Traumatic pneumothoraces

17. Differentiating Factors Between Atelectasis And
Pneumonia
• Atelectasis
1. Volume loss
2. Associated
ipsilateral shift
3. Linear, wedge-
shaped
4. Apex at hilum
• Pneumonia
1. Normal or
increased volume
2. No shift, or if
present then
contralateral
3. Consolidation, air
space process
4. Not centered at
hilum

18. Pneumonia Left lung collapse

19. Left Upper Lobe Collapse Pleural Effusion Pulmonary Edema

20. ARDS