2. Introduction
A chest radiograph, commonly called
a chest X-ray (CXR) or chest film, is a
projection radiograph of the chest
used to diagnose conditions affecting
the chest, its contents, and nearby
structures. Chest radiographs are
among the most common films taken,
being diagnostic of many conditions.
4. POSTERO-ANTERIOR (PA) VIEW
1. It is standard chest film taken in an x-ray.
2. PA position can be checked by observing
that the medial end of the clavicle overlies
the posterior end of the 4th rib.
3. Dorsal vertebrae are only visible.
4. Tip of blade of scapula presents a rounded
outline but should be recognized by its
continuity with medial border passing
upward and medially.
5. This view used to examine the lung border,
the diaphragm and other mediastinal
structures.
5.
6. ANTERO-POSTERIOR (AP) VIEW
1. In ICU or casualty department x-rays
may have to be exposed with the
patient supine.
2. Clavicles are projected above the
ribs, i.e above 1st rib.
3. In this type of x-rays, the diaphragm
is displaced upward by abdominal
contents.
4. Anterior structures such as heart
appear enlarged.
7.
8. LATERAL VIEW
1. Lateral film is usually extremely
helpful in deciding which lobe or
segment of lung involved in a
condition like consolidation.
2. Interpretation of anatomy is difficult
on lateral film as lungs are overlap
eachother.
9.
10. OBLIQUE VIEW
1. This film is most often used to
demonstrate the ribs, but may be also
used to assess the heart and aorta
and in bronchography.
15. MEDIASTINUM
1. It is space between two plural
cavities, extending from sternum to
the vertebral column.
2. The upper limit is thoracic inlet and
lower limit is diaphragm.
3. The space is divided into upper and
lower by an imaginary line.
4. Trachea is dominant mediastinal
structure shown in PA film, it usually
lies centrally or just to right of midline
and its walls are parallel to
eachother.
16. HILA
1. Opacity of each normal hilum is
caused by pulmonary arteries and
veins.
2. The centre of the right hilum appears
to lie 1-2 cm below left
3. The hilar shadows are approx. equal
in size but rotation of the patient will
make one appear larger than the
other.
4. The most common abnormality is
elevation of the hilum usually due to
fibrosis.
17. LUNGS
1.Lungs as a whole should be compared
particularly their translucency.
2. Upper, middle, lower third on each side
is compared with same area on the other
side.
3. On PA film, the fine white line of
horizontal fissure can be identified in
normal people, extending from hilum to
chest wall between anterior ends of 3rd
and 5th ribs.
4. As right lungs contains 3 lobes and left
lung contains 2 lobes, there is difference
18. HEART
1. Plain films shows abnormalities of
heart size and shape.
2. Simple method of assessing heart size
is the ratio between max. diameter of
heart and internal diameter of rib cage.
This is cardiothoracic ratio and its less
than 1:2.
3. In an adult, a cardiac diameter is
greater than 15.5 cm is always
abnormal.
19. DIAPHRAGM
1. In PA chest film is exposed in fully
expiration when, in slim individuals , right
diaphragm lies opposite to the posterior
end of right 10th rib.
2. Left diaphragm usually descends 1-2 cm
than right
3. Thickness of the diaphragm can be
measured when there is air in bowel
below diaphragm and air in the lung
above. Normal thickness of diaphragm is
5-8 mm.
4. The most common abnormality of
diaphragm on PA chest film is elevation.
20. THORACIC CAGE
1. In normal circumstances, ribs are
symmetrical in size and shape and in
spacing between them.
2. Posterior ends of the ribs are approx.
horizontal and anterior ends pass
inward and downward parellal to
other ribs on that side.
3. Costal cartilage which join the
anterior ends of ribs to the sternum
are only visible when calcified.
22. Pleural effusion
Texture of whiteness
at the base of the
lung.
Mediastenum is
shifted away from
effusion
Upper border of
shadowing- outer
border of effusion
will be concave.
Effusion will peak
much more
laterally.(difference
from
23. Pneumothorax
Able to see edge of
the lung which is
not seen normally
Hypertranslucency
between lung and
thoracic cage
Shift of the
mediastinum to the
opposite side.
24. Tension pneumothorax
• Black lung is
usually very large.
• Mediastinum is
shifted away from
affected lung.
• Shape of
mediastinum, at
the side of
blackness,
mediastinum is
concave.
25. Collapse
If right lung is smaller
than left lung suspect
an area of right sided
collapse.
Horizontal fissure of
the lung is displaced
above from its normal
position then collapse
is in upper lobe and is
displaced below then
collapse is in lower
lobe.
Heart shadow will
deviate to the side of
collapse.
Trachea will pull
towards area of
collapse.
26. Fibrosis
Shadowing that is
midzone or apical is
more likely to be fibrosis.
Fibrosis may cause
shrinkage of the lungs
which reduces the size
of the lung.
Mediastinum will pull
towards the side of
fibrosis.
It gives reticular nodular
shadowing which is
meshwork of lines.
Heart border and
diaphragm appear
blurred.
27. Hydropneumothorax
It shows fluid level,
fluid level is well
defined and
extends across the
hemithorax.
Costophrenic angle
can not see at the
side of
hydropneumothora
x
28. COPD
Diaphragm is flat or
even scallop shape
rather than
concave upwards
Elongated and
narrow heart.
Densely black
areas of lung
usually round,
surrounded by
hairline shadows
29. Pneumonectomy
Trachea is shifted
towards the
pneumonectomy
Opposite lung is
hyperinflated so it is
darker than normal
Can not see upper
border of diaphragm
at the side of
pneumonectomy
Usually 5th rib is
affected.
