The document provides guidance for interpreting chest X-rays using an "in-to-out" approach and includes example cases to review. It begins with an overview of the approach and key factors like density and outlines areas to examine. Sample cases are then presented covering topics like collapse/consolidation, masses, pneumonia, pneumothorax, and emphysema. Lateral views and tricky cases are also mentioned. The goal is to work through example radiology cases using the described systematic method.

1. Med Home Unit
Chest 1: Respiratory Cases
RAH Radiology

2. Review: Chest Xray interpretation
“In-to-out” approach -
cardiomediastinum -> hilar -> lung fields -> pleura -> bones + soft tissues
Density of the abnormality -
air < fat < fluid/soft tissue < bone < metal
Increased density -
interstitial (lines) vs alveolar (clouds) vs mass lesion
Reduced density -
lung markings vs no lung markings
connective tissue boundary: mediastinum, diaphragm etc.

3. WARM UP CASES

4. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

5. Diagnosis: NGT coiled up in the mid to lower oesophagus.

6. Add in foreign body or gunshot etc

7. INCREASED DENSITY

8. Start with collapse/consolidation
Then do interstitial
Then do masses

9. Diagnosis: Right lower lobe collapse/consolidation

10. Diagnosis: Right middle lobe collapse/consolidation

11. Diagnosis: Right upper lobe collapse (volume loss, hilar elevation)

12. Diagnosis: Left lower lobe collapse (sail sign)

13. Diagnosis: Bilateral pneumonia (air bronchograms)

14. Diagnosis: Interstitial pulmonary oedema

15. Diagnosis: Alveolar (and insterstitial!) pulmonary oedema

16. Diagnosis: Upper lobe diversion (“pre-APO”, “fluid overload”)

17. Diagnosis: Fibrosis. Coarse interstitial opacity

18. Diagnosis: Large right hilar mass lesion with RUL collapse. Highly likely malignant.

19. Diagnosis: Left perihilar lung mass. Suspicious due to size. Malignant pathology.

20. Diagnosis: Left retrocardiac mass, suspicious due to size. Benign pathology.

21. Diagnosis: Cannonball mets. Malignant.

22. Diagnosis: Cavitating lesion with air-fluid level. Abscess vs malignancy.

23. LATERAL XRAYS
What will it look like on the frontal view?

24. Left lower lobe collapse

25. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

26. Diagnosis: misplaced ETT in right main bronchus. RUL collapse (veiling opacity)

27. Diagnosis: add in lateral cancer

28. Diagnosis: lateral effusion

29. DECREASED DENSITY

30. Diagnosis: Right sided pneumothorax with rib fractures and subcut emphysema

31. Diagnosis: Subtle left apical pneumothorax. No lung markings.

32. Diagnosis: Supine pneumothorax. Lucent right side with “deep sulcus”.

33. Diagnosis: Left sided tension pneumothorax.

34. Diagnosis: COPD. Hyper-expansion, coarsening of markings.

35. Diagnosis: Bullous emphysema. No lung markings right mid zone.

36. Diagnosis: Emphysema. Barrel chest, flattened diaphragm, enlarged clear space.

37. TRICKY CASES