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Chest xray interpretation made easy basics
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- 2. Before you interpret… check for the following : Name Date Orientation : Left, right Position : erect , supine , PA or AP Inspiration, expiration Rotation : central or tilted Distance from the medial end of each clavicle to the spinous process of the vertebra at the same level Exposure : You must barely see the thoracic vertebrae behind the heart Identify both costophrenic angles and lung apices
- 3. Name Date Orientation Adequate inspiration 9 ribs posteriourly Exposure Adequatetissue penetration Adequate anatomical exposure Gastric air bubble Rotation
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- 8. Systematic Approach Trachea andmediastinum Heart and vessels Hila Diaphragm Lung fields Bones
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- 10. Trachea and Mediastinum Ensuretrachea is visible If deviated to one side : Pushed away by pleural effusion or tension pneumothorax Pulled towards collapse The carina, (60 –100 degrees) Angle of the carina increases left atrial enlargement, lymph node enlargement and left upper lobe collapse (left main bronchus is pulled up) Check for a widened mediastinum : Mass lesions (eg tumour, lymph nodes, aneurysm)
- 12. Heart and vessels Heartsize and heart borders Check aorta : Widening, calcification Check SVC, IVC, azygos vein widening
- 13. LV Pulmonary conus Aortic knuckle RA Rt and Lt Pulmonary arteires SVC IVC Heartand vessels Vascular pedicle
- 14. Hila Note position andsize bilaterally Check for enlarged lymph nodes Calcified nodes or nodules Mass lesions Pulmonary arteries (normally < 1.5cm )
- 15. Diaphragm Right hemidiaphragm slightlyhigher than the left If right is much higher than the left : ? effusion, lobar collapse, diaphragmatic paralysis Haziness : consider lung infiltrate (eg pneumonia) or effusion Air under the diaphragm : perforated viscus
- 17. Lung fields Parenchymal infiltrates: 1- Determine location : Loss of heart borders or of the contour of the diaphragm E.g. : Right middle lobe consolidation blurs the heart border The lingula blurs the left side border of the heart 2- Identify the pattern of infiltration : Interstitial pattern → reticular Alveolar → patchy or nodular pattern Patchy infiltrates may be homogenous or heterogenous
- 18. Lung fields (cont’d) Checkalso for : Lobar collapse Lobar consolidation : Look for air bronchograms Pulmonary nodules Apices Effusions Kerley B lines Fissures : they become wide if there is fluid collection Costophrenic angle The pleura : Thickening, loculations, calcifications and pneumothorax
- 22. The minor fissure whichseparates the right upper lobe from the right middle lobe.
- 23. Bone Fractures, dislocation, subluxation,osteoblastic or osteolytic lesions in clavicles, ribs, thoracic Spine and humerus including osteoarthritic changes soft tissues for subcutaneous air, foreign bodies
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- 33. Right middle lobeinfiltrates (or early consildation)
- 35. Hilar mass (? Enlarged ymph node)
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- 40. Left upper lobemass
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- 42. Right upper lobecollapse and consolidation . Lobar density . Air bronchogram .
- 43. RUL infiltration withair bronchogram + atelectasis Right upper lobe collapse . Segmental or lobar density Compensatory hyperinflation of normal lung
- 44. Right middle lobeconsolidation
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- 46. Left lower lobeconsolidation
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- 49. Pulmonary hypertension Prominent pulmonaryconus Enlarged pulmonary artery Cardiomegaly
- 50. Pleural effusion Enlarged pulmonaryarteries Pleural effusion Prominent transverse fissure
- 51. metastasis Multiple round lesions? Metastases
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- 54. Infected hydatid cyst LungAbscess
- 55. Figure 7: Rightmiddle lobe pneumonia Right middle lobe pneumonia
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- 60. Right upper lobecollapse
- 61. - - -- - - - - Right upper lobe collapse
- 62. Right middle lobecollapse
- 63. Cavitary tumour withair-fluid level
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- 70. Any suggestion???? Bilateral numeroussmall dots Miliary Tuberculosis