This document provides an overview of chest X-rays, including X-ray densities, common abnormal findings, technical aspects, different views used, and anatomy seen on chest X-rays. It then summarizes different pathologies visible on chest X-rays such as pleural effusions, pulmonary edema, cavities, masses, pneumothorax, and others. Key anatomical structures that can be seen as silhouettes on chest X-rays are also outlined.

1. Chest X-rays
S A Saleemi

2. X-ray DENSITIES
Blackest Air< fat< liver< blood< muscle< bone Whitest

3. Common Abnormal finding on Chest X-ray
Lucency
(lower density than surrounding tissue)
Opacity
(higher density than surrounding tissue)

4. Linear Reticular Reticulonodular
Alveolar

5. CYSTS and Cavities

6. Consolidation Collapse
Nodule Mass

7. M C Alraies 7
Technical Aspects
• Identification – name, file number, date & time
• Projection – PA or AP
• Position – Upright or Supine
• Inspiratory effort – ?poor inspiration
• Exposure - ?overexposed ?underexposed
– thoracic intervertebral disc space just visible
• Positioning/rotation
– medial clavicle heads equidistant to spinous process

8. Four major positions are utilized for
producing a chest radiograph:
• Posterior-anterior (PA)
• Anterior-posterior (AP)
• Lateral
• Lateral Decubitus

9. 9
AP (Antero-posterior)
(Portable)
FILM
FILM
X-ray Beam
PA ( Postero-anterior)
PA or AP view

10. PA
• Scapulae are visible over lung fields
• Heart appear larger
• Mediastinum widens
• Diaphragm are higher
• Pulmonary vascularity increase
AP

11. LATERAL view

12. Decubitus View
• "decubitus" means "lying down“
• To confirm free flowing effusion.

13. Three Main Factors Determine the
Technical Quality of the Radiograph
• Inspiration
• Exposure (Penetration)
• Rotation

14. Good inspiration film Poor inspiration film
9-10 post ribs
5-6 ant ribs

15. Good exposure Under-exposed
Over-exposed
Over-exposed Under-exposed

16. Is this film rotated? Is this film rotated?
Rotation

17. Extreme rotation

18. Cardiothoracic Ratio

19. Anatomical Structures in the Chest
• Mediastinum
• Hilum
• Lung Fields
• Diaphragmatic Domes
• Pleural Surfaces
• Bones
• Soft Tissue

20. Anatomy of Chest X-ray
scapula
Oblique
fissure
Oblique
fissure
horizontal
fissure

21. Upper lobe
Lower lobe
Left LUNG
Right Lung
Upper lobe
Lower
lobe
Middle
lobe
Right Lung
2 fissures (oblique and
horizontal).
3 lobes (upper,
middle, lower)
10 segments
Left Lung
1 fissure (oblique)
2 lobes (upper and
lower)
8 segments
Lingula

22. R
I
G
H
T
L
U
N
G
L
E
F
T
L
U
N
G

23. Silhoutte Adjacent lobe/segment
Right Diaphragm RLL/Basal segments
Right Heart margin RML/Medial segment
Ascending Aorta RUL/Anterior segment
Aortic knob LUL/Posterior segemnt
Left Heart margin Lingula/Inferior segment
Descending Aorta LLL/post segment
Left Diaphragm LLL/Basal segments
SILHOUETTE SIGN

24. Normal X-ray

25. Pleural effusion
Meniscus sign

26. Pulmonary edema

27. Bronchiectasis

28. Bronchiectasis
Varicose Cystic cylindrical

29. Cavities with air fluid level

30. Pulmonary infarction secondary to pulmonary embolism

32. ILD

34. COPD

35. RUL consolidation

36. Cardiomegaly

37. Right lung collapse Massive right pleural effusion

38. LLL pneumonia

39. Lingular Pneumonia

40. Lung mass

41. Right Pneumothorax

42. Tension Pneumothorax

43. Dextro-cardia/situs inverses

44. Bilateral hilar lymphadenopathy

45. 60 years old with gastric lymphoma
and acute abdominal pain

46. PH

47. Hiatus hernia

48. Right diaphragm paralysis

49. Tenting of right diaphragm due to right upper lobe
collapse

50. Klebsiella pneumoniae
(Friedlander pneumonia)

52. allergic bronchopulmonary aspergillosis.

53. Invasive aspergillus infection
Adenocarcinoma
Metastatic disease

54. NG tube right lung

55. Left lower lobe posterior segment consolidation

56. Hidden areas of Chest X-ray

57. Thanks