Recommended
More Related Content
What's hot
What's hot (20)
Similar to Interpretation of Chest X-Ray PPT
Similar to Interpretation of Chest X-Ray PPT (20)
More from drmainuddin
Recently uploaded
Recently uploaded (20)
Interpretation of Chest X-Ray PPT
- 1. The Chest X-Ray Dr Md Main Uddin Assistant Professor (Medicine) Cox’s Bazar Medical College
- 2. Techniques - Projection •P-A (relation of x-ray beam to patient)
- 4. CXR Interpretation PA vs. AP views
- 5. Densities The big two densities are: (1) WHITE - Bone (2) BLACK - Air The others are: (3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the film, it is: (5) BRIGHT WHITE - Man-made
- 7. Techniques - Projection (continued) •Lateral
- 8. Techniques - Projection (continued) •Lateral Decubitus
- 9. Rotation
- 11. Rotation • Check for rotation – Does the thoracic spine align in the center of the sternum and between the clavicles? – Are the clavicles level?
- 12. Penetration • Is the film over or under penetrated • If under penetrated you will not be able to see the thoracic vertebrae.
- 13. Penetration
- 15. Now you are ready • Look at the diaphram: for tenting free air abnormal elevation • Margins should be sharp (the right hemidiaphram is usually slightly higher than the left)
- 16. Anatomy
- 17. Cardiac Silhouette . R Atrium . R Ventricle . Apex of L Ventricle 4. SVC 5. IVC 6. Tricuspid Valve 7. Pulmonary Valve 8. Pulmonary Trunk 9. R PA 10. L PA
- 18. Check the costophrenic angles Margins should be sharp
- 19. Check the hilar region • The hilar – the large blood vessels going to and from the lung at the root of each lung where it meets the heart. • Check for size and shape of aorta, nodes,enlarged vessels
- 20. Lobes • Right upper lobe:
- 21. Lobes (continued) • Right middle lobe:
- 22. Lobes (continued) • Right lower lobe:
- 23. Lobes (continued) • Left lower lobe:
- 24. Lobes (continued) • Left upper lobe with Lingula:
- 26. Lobes (continued) • Left upper lobe - upper division:
- 27. Heart Right border: Edge of (r) Atrium 3. Left border: (l) Ventricle + Atrium 4. Posterior border: Reft Ventricle 5. Anterior border: Right Ventricle
- 30. Mediastinum
- 31. Hilum Made of: 1. Pulmonary Art.+Veins 2. The Bronchi Left Hilus higher (max 1-2,5 cm) Identical: size, shape, density
- 32. Hilum
- 33. Ribs
- 38. Lungs: • Lungs • Density • Symmetry • Lesions
- 39. Heart •Size:
- 40. Heart •Size of heart •Size of individual chambers of heart •Size of pulmonary vessels •Evidence of stents, clips, wires and valves •Outline of aorta and IVC and SVC
- 41. Mediastinum: • Width • Contour • AP window Hila: • Size • Location
- 42. Review areas: • Apices • Behind the heart • CP angles • Below the diaphragm • Soft tissues ( breast, surgical emphysema) • Ribs & clavicle •Vertebrae
- 43. Identify the lesion → localise the lesion → describe the lesion → give DD Never stop looking, carry on with your systematic approach!!
- 44. RUL pneumonia
- 45. RML pneumonia
- 46. RLL pneumonia
- 47. LUL pneumonia
- 48. LLL pneumonia
- 49. Hilar m l
- 50. The Enlarged Hila Causes: 1. Adenopathies (neoplasia, infection) 2. Primary Tumor 3. Vascular 4. Sarcoidosis
- 51. Multiple Masses
- 52. Hilar Lymphadenopathy - BL
- 53. Pleural Effusion
- 55. ?
- 56. Heart failure
- 57. Pneumothorax
- 58. RUL collapse
- 59. LLL collapse
- 60. Air under the diaphragm
- 61. Emphysema
- 62. Cervical Rib
- 64. Hiatus hernia
- 66. Chest Tube, NG Tube, Pulm. artery cath
- 67. Dextrocardia
- 72. CXR Interpretation “Big Lungs” & “Little Lungs”
- 99. Hemothorax
- 103. Loss of Sharp Costophrenic Angles
- 104. 105 Presenting CXR
- 105. 106
- 107. 108154 slides Increased Cardiac Size: Can be Cardiac or Pericardial Pericardial EffusionDilated Cardiomyopathy What imaging would you use to differentiate between the two ? 108
- 108. 109154 slides Left Ventricular Enlargement Enlargement of Left Ventricle Left Ventricle IVC 109
- 110. Pulmonary embolism
- 111. Pulmonary embolism
- 112. 113 Normal lung Individual alveoli are too small to resolve, but together they appear radiolucent.
- 113. 114 Air-space Disease Filling of alveoli by: water, blood, pus, proteinaceous fluid, or cells -opacities -consolidation
- 114. Air-space pattern of lung disease 115
- 116. 119 CT Consolidation: Air Bronchograms
- 117. 120 Silhouette Sign • Definition: The effacement of a normal structure • Example: Airspace disease may silhouette: – right heart margin with right middle lobe pneumonia – diaphragm with lower lobe pneumonia
- 118. 121 Silhouette sign • sign describes the observation that an intrathoracic lesion will obliterate borders of shadows of similar radiodense structures that it contacts • example: right middle lobe pneumonia will obliterate apex of the right heart border
- 119. Silhouette sign Normal Pneumonia (-) silhouette sign (visible heart silhouette) Pneumonia (+) silhouette sign (no heart silhouette)122
- 120. Pulmonary edema + silhouette sign 123
- 121. 124 Pulmonary edema + silhouette sign
- 122. 125154 slides Where is the Pneumonia? 125
- 123. 126154 slides Left Lower Lobe Pneumonia 126
- 124. 127154 slides Where is the pneumonia? 127
- 125. 128
- 126. 129154 slides Right Middle Lobe Pneumonia 129
- 127. 130 • In a normal chest radiograph, the visible interstitium is the branching pulmonary vessels • The branching disappears peripherally because they are beyond resolution of the xray
- 128. 131 Interstitial pattern of lung disease
- 129. 132154 slides Interstitial Disease: Pulmonary Fibrosis 132
- 131. 134154 slides Honeycombing in patient with single lung transplant for pulmonary fibrosis Normal Transplanted LungHoneycomb Native Lung 134
- 132. 135154 slides Miliary Nodular Pattern: Miliary 135
- 134. 139154 slides Edema kerly A Pulmonary Edema Minor fissure 139
- 135. 140154 slides Alveolar Edema Alveolar Pulmonary Edema 140
- 136. 141Kerley A
- 137. 142 emphysema normal
- 138. 143 Emphysema
- 139. 144
- 140. 145154 slides Enlarged Retrosternal Air Space Flattened Diaphragms Bullous Emphysema 145
- 141. 146154 slides Diagnosis: LLL Collapse • Collapse secondary to central obstructing tumour 146
- 142. 147154 slides What Would You Do Next? 1) Compare with Any Available Previous 2) Computed Tomography 147
- 143. 148154 slides Solitary Pulmonary Nodule can be: Benign: Densely calcified noduleMalignant: Adenocarcinoma 148
- 144. 149154 slides Multiple Nodules: Diagnosis? Metastases 149
- 145. 150154 slides Small Pleural Effusion 150
- 146. 151154 slides Large Pleural Effusion 151
- 148. 154154 slides Pleural Effusion in Supine Patient • Pleural effusion layers posteriorly in a supine position • Cause diffuse increased density 154
- 149. 156
- 150. 158154 slides Inspiration Expiration 158
- 151. 159154 slides Collapsed Right Lung Tension Pneumothorax: Requires chest tube Tracheal Deviation What would you do with this patient? 159
- 152. 160154 slides Thyroid Goiter • Most common superior mediastinal mass extending to thoracic inlet Note Tracheal Deviation 160
- 154. 162154 slides Lateral CXR shows: mass is anterior NORMAL 162
- 155. 163154 slides Computed Tomography Thymoma Do you know any associated clinical syndrome? 163
- 158. 166 Small cell CA
- 159. 167154 slides Normal Hilar and Mediastinal Lymphadenopathy Diagnosis? 167
- 160. 168154 slides Hilar Lymphadenopathy on lateral Normal 168
Editor's Notes
- Normal CXR
- Normal CXR, Rotation
- .