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Chest Xray
This document provides a 12-step process for analyzing chest x-rays and summarizes common findings seen on chest x-rays. It describes what to examine on a chest x-ray such as heart size and lung fields. It then reviews normal chest x-ray anatomy and presents examples of common abnormalities like pneumonia, tumors, fractures, and fluid buildup.
Chest Xray
- 1. CHEST RADIOLOGY PreparedBy : Belal Alrefaei Merry Admaso Bshara
- 2. The 12-Step: 1: Name 2: Date 3 : Old films 4 : What type of view(s) 5 : Penetration 6 : Inspiration 7 : Rotation 8 : Angulation 9 : Soft tissues / bony structures 10 : Mediastinum 11 : Diaphragms 12 : Lung Fields Quality Control Findings } } Pre-read }
- 3. Chest X-Ray FindingsIs heart enlarged or normal? Signs of heart failure and fluid overload? Does patient have pneumonia or collapsed lung? Is there evidence of emphysema? Are there findings of an aortic aneurysm? Is there fluid in the sac that surrounds the lung? Is there free air under the diaphragm? Is there a tumor in the lung that could represent cancer?
- 4. NORMAL CHEST X-RAYPA LATERAL Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2) Anterior or Posterior) or (3) Superior or Inferior.
- 5. NORMAL HEART BORDERSNote cardiac chambers that account for margins on the chest X-ray
- 7. R Atrium RVentricle 3. Apex of L Ventricle Superior Vena Cava Inferior Vena Cava 6. Tricuspid Valve Pulmonary Valve Pulmonary Trunk 9. R PA 10. L PA
- 8. LEFT 4 TH RIB POSTERIOR AND ANTERIOR PORTIONS POSTERIOR ANTERIOR 4 A P
- 9. AORTIC ARCH LT.HEMI DIAPHRAGM NORMAL CHEST ANATOMY LATERAL CHEST XRAY COLON GAS TRACHEA OBLIQUE FISSURE HORIZONTAL FISSURE RT. HEMI DIAPHRAGM Diaphragm-AP view Diaphragm- Lateral view LT. LT. RT. LT.
- 10. CARINA LT. MAINBRONCHUS RT. MAIN BRONCHUS TRACHEA OBLIQUE FISSURE (major) OBLIQUE FISSURE major HORIZONTAL FISSURE minor BRONCHOGRAM—CONTRAST OUTLINING AIRWAY
- 11. HORIZONTAL FISSURE FISSURESDIVIDE LUNGS INTO LOBES RIGHT lung has: UPPER MIDDLE lobes LOWER LEFT lung has: UPPER lobes LOWER
- 13. INTERESTING CASESINFECTION NEOPLASTIC CARDIOVASCULAR TRAUMA
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- 21. Miliary TB SnowStorm Apperance
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- 38. Aortic dissection withhemothorax
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- 42. Chest mass, emphysemaHilar mass
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- 45. ARDS Congestion Interstitialand alveolar edema Collapsed or distended alveoli Bilateral
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- 47. SARCOIDOSIS Granulomatous InflammationBilateral & symmetrical hilar & mediastinal LAD Generalized fibrosis
- 48. ATELECTASIS No ventilationto lobe beyond the obstruction Trapped air absorbed by pulmonary circulation Segmental/lobar density Compensatory hyper-inflation of normal lungs.
- 51. NORMAL HEART CARDIOMEGLY
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- 54. Cardiomegaly Cardiac silhouettegreater than 50% of width of thorax
- 55. CARDIOMEGLY CONGESTIVE HEART FAILURE Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
- 56. Congestive Heart FailureIncreased heart size: cardiothoracic ratio >0.5 Large hila with indistinct markings Fluid in interlobar fissures Pleural effusions, alveolar edema
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- 64. Tetrology Of Fallot(Boot Shaped)
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- 68. Free air Freeair beneath diaphragm
- 69. Air under thediaphragm
- 70. Empyema after traumaClavicle fracture Cavitary lesion Opacified hemithorax
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- 72. Pneumonectomy Entire mediastinumshifted left, indicating volume loss Opacified left hemithorax Trachea shifted left, indicating volume loss
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- 75. Clavicle dislocation Medialclavicle is displaced inferiorly
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- 77. LT. Rib fractureon the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
- 78. FRONTAL LATERAL WHATAND WHERE IS IT? Air stripe Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.
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- 80. Smoke inhalation, chronicchanges
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- 82. Right Lower LobePneumonia
- 83. Right side tensionpneumothorax
- 84. Fracture of posteriorrib #7
- 85. Right Side PleuralEffusion
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Editor's Notes
- #5Â Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2)Anterior or Posterior) or (3) Superior or Inferior.
- #6Â Note cardiac chambers that account for margins on the chest X-ray
- #11Â This exam shows barium contrast outlining the bronchial tree. This is an old exam not done now with CT imaging replacing it. It does demonstrate the anatomy of the hila which superimpose over the pulmonary arteries and veins. This is why anatomy here on the chest X-ray is difficult in this region.
- #12Â With heart failure edema builds up in lungs and edema along fissures allows them to be seen more easily on chest x-ray
- #29Â Pleural effusion developing on the left
- #33Â Air in the pleural space separates the visceral and parietal pleura. This limits effective ventilation of the lung.
- #35Â Here air has built up under pressure in the pleural space and collapsed the lung severely compromising ventilation. The pressure builds due to a ball valve type leak of air into the pleural space with air going into the space on each inspiration.
- #56 Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
- #75Â Multiple lesions in the chest are typical for metastatic disease since the pulmonary capillary bed is often the first site metastatic lesions appear as they spread and embolize the pulmonary capillaries and grow in the new location.
- #78Â Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
- #79Â Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.