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Lateral chest X-Ray.pptx
- 23. COMPARTMENT ANTERIORLY POSTERIORLY ANTERIOR STERNUM ANTERIOR ASPECT OF TRACHEA AND POSTERIOR MARGIN OF HEART MIDDLE ANTERIOR ASPECT OF TRACHEA AND POSTERIOR MARGIN OF HEART VERTICAL LINE ALONG THE THORASIC VERTEBRA 1 CM BEHIND THEIR ANTERIOR MARGINS POSTERIOR VERTICAL LINE ALONG THE THORASIC VERTEBRA 1 CM BEHIND THEIR ANTERIOR MARGINS COSTOVERTEBRAL JUNCTIONS
Editor's Notes
- Insufficient elevation of the arms will cause the soft tissues of the upper arms to obscure the lung apices and thoracic inlet, and even the retrosternal window, leading to masses or other lesions in these areas being missed. • Rotation will also partially obscure the retrosternal window, masking anterior mediastinal masses. It will also render the sternum less distinct, which may be important in the setting of trauma when sternal fracture may be overlooked
- Flattening of dome: < 1.5 cm height
- Important rule of thumb: On the lateral CXR there should not be any abrupt change in density across the shadow of the heart. If there is a change in density, you should suspect superimposed pulmonary pathology
- THE LATERAL CXR: A SIX-POINT CHECKLIST Are the vertebral bodies becoming blacker from above downwards (Fig. 2.35)? If not (i.e. they are becoming whiter), then suspect disease in a lower lobe (Figs 2.36 –2.38). Are both domes of the diaphragm well-deÄ ned and clearly seen? If either dome is obscured, suspect disease in the adjacent lower lobe (Figs 2.36–2.38). Remember — the right dome should be visible from front to back; normally the anterior aspect of the left dome disappears (Fig. 2.35). Are the hila normal (Fig. 2.35)? Two questions to ask: Does the overlapping / combination shadow of the two hila appear enlarged (Fig. 2.39)? Is the outline of the overlapping hila well-deÄ ned (i.e. normal vessels) or do the borders appear anarchic and irregular, or lumpy / bumpy? Is there any abrupt change in density across the cardiac shadow? This is likely to be a lung abnormality (Fig. 2.40). Are there any abnormal lung densities? Check: superimposed over the heart (Fig. 2.42) behind the heart posteriorly in a costophrenic recess Always, always correlate the Ä ndings with the frontal CXR
- SHADOW OF RIGHT DOME AND POSTERIOR HEART MARGINS OVERLAP CAUSINF TUBULAR OPACITY POSTERIORLY . The cardiac incisura. The anterior density (arrows) is caused by the normal cardiac apex and epicardial fat displacing the most infero-medial and anterior aspect of the left lung