![• Dilated right
pulmonary artery.
• Right ventricular
enlargement :
– Acute angle.
– Apex shifted
outward.
• Prominent upper
lobe veins.
[Cephalization]
Mitral Valve Disease.](https://image.slidesharecdn.com/xrays-130131232343-phpapp01/85/Medicine-Xrays-42-320.jpg)
Uploaded byPratik Kumar
Medicine- Xrays
1. Chest x-ray showed free gas under the right hemidiaphragm. 2. This finding suggests a hiatal hernia, where part of the stomach protrudes through the diaphragm into the chest. 3. The 67-year old patient presented with chronic cough and mild heartburn, consistent with symptoms of a hiatal hernia.
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Medicine- Xrays
- 1. 20 Important Xrays Neil Dominic Fernandes 080201054
- 4. • First look at the mediastinal contours—run your eye down the left side of the patient and then up the right. • The trachea should be central. • The aortic arch is the first structure on the left, followed by the left pulmonary artery; notice how you can trace the pulmonary artery branches fanning out through the lung • Two thirds of the heart lies on the left side of the chest, with one third on the right. The heart should take up no more than half of the thoracic cavity. • The left border of the heart is made up by the left atrium and left ventricle. • The right border is made up by the right atrium alone. Above the right heart border lies the edge of the superior vena cava. • The pulmonary arteries and main bronchi arise at the left and right hila. Enlarged lymph nodes can also occur here, as can primary tumours. These make the hilum seem bulky. • Now look at the lungs. • Apart from the pulmonary vessels (arteries and veins),they should be black (because they are full of air). • Scan both lungs, starting at the apices and working down, comparing left with right at the same level. The lungs extend behind the heart, so look here too. Force your eye to look at the periphery of the lungs—you should not see many lung markings here; if you do then there may be disease of the air spaces or interstitium. • Don’t forget to look for a pneumothorax. • Make sure you can see the surface of the hemidiaphragms curving downwards, and that the costophrenic and cardiophrenic angles are not blunted—suggesting an effusion. • Check there is no free air under the hemidiaphragm
- 5. The Normal CardiacBorders in the PA View: A) The left cardiac border is formed from above down by: 1. The aortic arch (= knob, knuckle). 2. The main pulmonary artery. 3. The left atrial appendage. 4. The left ventricle. B) The right border of the heart is formed by: 1. In the lower two thirds by the right atrium. 2. In the upper third by the superior vena cava.
- 8. How to read •This is a chest radiograph of a young male patient PA view. • The patient has taken a good inspiration and is not rotated; the film is well penetrated. • The trachea is central, the mediastinum is not displaced. • The mediastinal contours and hila seem normal. • The lungs seem clear, with no pneumothorax. • There is no free air under the diaphragm. • The bones and soft tissues seem normal
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- 14. Right upper lobecollapse
- 15. Features to lookfor Present features 1. Opacification Dense opacification of the right upper zone, V shaped 2. Horizontal fissure Has been displaced upwards from its original position 3. Hilum enlarged or elevated Right hilum is elevated than left hilum 4.Smaller lung, smaller hemithorax Not present 5. Compensatory hyperinflation and Present hyperlucency in other lobes 6. Tracheal deviation Absent 7. Elevated ipsilateral hemidiaphragm Present
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- 19. air crescent sign Fungalball - aspergilloma
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- 23. CHEST X-RAYS SITI ZAHIDA (O80201057)
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- 25. Pneumothorax Increased volume of the right hemithorax with tracheal shift to the OPPOSITE side- ”PUSH” effect Hyperlucency on the right side Absence of lung markings Presence of margin of collapsed lung at the hilum D/D:Unilateral emphysema
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- 27. Hydropneumothorax Horizontal fluid level with hyperlucent area above it Hyperlucent area with no lung markings Presence of air+fluid = Hydropneumothorax Trachea shifted to the SAME side-”PULL “ effect D/D:lung abscess
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- 29. Lung abscess Loculated cavity with thin wall(maybe post infective cyst, wall made up of a fibrous tissue) Presence of air fluid level Mild trachea shift to the left(probably due to rotation) Fundic air bubbles separately seen
- 30. Lung abscess VS Hydropneumothorax Feature Lung Abscess Hydropneumothorax Definition Intrapulmonary air- Intrapleural air- fluid collection fluid collection Shape of fluid Round, take up the Take up shape of the shape of cavity wall thoracic cavity & margin of collapsed lung Cavity Wall Clearly seen Not seen Margin of collapsed Not seen May be seen lung Length of air-fluid Equal regardless of Length varies with level radiographic radiographic projection projection
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- 32. Pleural effusion Homogenous opacity of right middle & lower zone = almost totally WHITE OUT LUNG Minimal tracheal shift to the left Cardiac shift to the opposite side with reduced left hemithorax size. Obliteration of right costophrenic & cardiophrenic angles D/D:consolidation, pleural thickening(heterogenous opacity), collapse.
- 33. Chest X-Ray Siti Hawa 080201059
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- 35. • Cardiothoracic ratiomore than 50%.
- 36. • Long diameter: – From junction of SVC and right atrium to apex of heart. – Normal : 10.0- 15.5cm.
- 37. • Left ventricular enlargement : – Rounding of the apex. – Obtuse angle. – Apex shifted inferiorly and outward.
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- 39. • Double aortic knuckle. • 3 sign at left margin of the aorta at the level of coarctation. Coarctation of Aorta.
- 40. Coarctation of Aorta. •Rib notching: – Due to pressure from tortuous intercostal arteries acting as collaterals. – Becomes evident after the age of 8 years. • Cardiomegaly.
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- 42. • Dilated right pulmonary artery. • Right ventricular enlargement : – Acute angle. – Apex shifted outward. • Prominent upper lobe veins. [Cephalization] Mitral Valve Disease.
- 43. • A: – Straightening of left cardiac border. – Notching at left cardiac border. • B: – Double atrial shadow. – LA shadow seen through the heart inside its right border.
- 45. CHEST X-RAY NOR FAZEHAN 080201061
- 46. Pulmonary Edema Bat wings/butterfly distribution Pleural effusion
- 47. Pulmonary Edema • Producesair space opacities with variable distribution. • Sparing of the apices and extreme lung bases. • “Butterfly” or “Bat wings” distribution – central lungs affected more. • With progression – opacities coalesce to form a “white-out” on chest radiograph. • Blurring of blood vessels occurs. • Air bronchogram – indicating intra alveolar edema.
- 48. Sequence of eventson CXR in acute pulmonary edema. Early changes. Late changes. 1. Prominent pulmonary artery. 7. Fluffy shadows. 2. Prominent pulmonary lobe 8. Air bronchogram. veins. 3. Interlobar fissure. 9. Bat’s wing appearance. 4. Perivascular cuffing. 10. Cardiomegaly . 5. Peribronchial cuffing. 11. Pleural effusion. 6. Kerley B lines.
- 50. Differences.. Criteria. Cardiogenic (LVH) Non cardiogenic(ARDS) 1. Cardiomegaly . Comman +++ Uncomman+ 2. Alveolar edema. +++ +++ 3. Appearance of Bat’s wing /butterfly More patchy shadow . appearance 4. Perivascular and More often seen Less likely peribronchial cuffing. 5. Tendency for Yes No gravitational distribution. 6. Pleural effusion. May be present Unlikely
- 51. Silhouette Sign • Onthe radiograph, loss of normal border of the heart, aorta, or diaphragm by intrathoracic lesions known as silhouette sign. Silhouete signs seen as Intrathoracic lesions Upper right heart Anterior segment of RUL border/ascending aorta Right heart border RML (medial) Upper left heart border Anterior segment of LUL Left heart border Lingula (anterior) Apical portion of LUL Aortic knob (posterior) Anterior hemidiaphragms Lower lobes (anterior)
- 53. Free Gas UnderDiaphragm
- 54. Hiatal Hernia. 67 years old patient complained of chronic cough and mild heartburn with no other symptoms.
Editor's Notes
- #10 most common symptoms being dyspnoea and / or a non-productive cough. In patients who are profoundly immunocompromised, onset may be more dramatic and resemble other pulmonary infectionsbilateral, diffuse, often perihilar, fine, reticular interstitial opacification, which may appear somewhat granularBat's wing or butterfly pulmonary opacities
- #11 Nodules are either sharply or poorly defined 1–4-mm in size Diffuse, random distributionImaging Findings Discrete Distinctive Pin-point opacities Nodule size 1 – 2 mm in diameter - SPHERICAL LESION IN Miliary ( millet seed ) Pattern INTERSTITIUM B/L even distribution - WELL CIRCUMSCRIBED Basal Predominance HOMOGENOUS PATTERN Rare or non-existent calcifications Upto 30 % no radiological signs Thickening of intralobar fissure / interlobular septa Nodular irregularity of vessels HRCT – more sensitiveAlveolar microlithiasisPNEUMOCONIOSIS - Coal Workers Pneumoconiosis - Silicosis - Siderosis - StannosisSARCOIDOSIS METASTATIC LUNG DISEASES NON TB INFECTIONS – Histoplasmosis - Blastomycosis - Cryptococcosis - Nocardiosis – Coccidiodomycosis BRONCHIOLITIS OBLITERANS
- #13 Many thoracic aneurysms are visible on chest x ray and are characterised by widening of the mediastinal silhouette, enlargement of the aortic knob or displacement of the trachea of the midline.
- #25 Tracheal shift to the left-PUSH effect, increased volume of the right hemithoraxHyperlucency of right hemithorax + absence of lung markings + margin of collapsed lung(compression collapsed) = pneumothoraxTotal collapse=collapse like a cricket ball towards the hilum
- #29 Loculated cavity with thin wall(myb post infective cyst, wall made upof a fibrous tissue)Presence of air fluid levelMild trachea shift to the left(probably due to rotation)Fundic air bubbles separately seend/d:lung abscess(unresolved pneumonia), primary tumor (?blood clot)
- #32 Trachea remains central-why?Cardiac shift to the opposite side ,lefthemithorax size reducedHomogenous opacity starts from right middle zone downwards +obliteration of right costophrenic & cardiophrenic angles = almost totally WHITE OUT LUNGNot WHITE OUT LUNG because,not involve entire lungd/d:consolidation, pleural effusion/thickening(heterogenous opacity), collapse, upward enlargement of the liver(r/o)Notes:left 4th rib…cavities???
- #33 Not WHITE OUT LUNG because,not involve entire lungWhy notConsolidation-no air bronchogramPleural thickening-heterogenous opacityCollapse-presence of lung markings
- #49 Changes of 1-6 indicates interstitial edema.7-9 indicates alveolar edema.10-11 likely present in the cardiogenic causes of pulmonary edema (LVH)
- #53 left border of heart obliterated:lesion in lingulaRight hemidiaphragmobliterated:lower lobe lesionParatracheal stripes obliteration :paratrachealdzIt can be either consolidation or superimposed mass lesion.p/s :tram track appearance near arrow 2?? : thickened bronchial wall..(d/d:bronchiectasis ,cystic fibrosis,allergicaspergillosis,recurrent asthma/bronchitis in child)Air under left diaphragm : colonic gas shadow overlapping fundic gas bubble…..you can see the haustration!! Volvulus??
- #54 Air under diaphragm:In normal x-ray :there will be a fundic bubble gas on right side.Presence of air under diaphragm here may be due to perforation of hollow viscus (stomach @ intestine) following procedures.examples following laparatomy.Laparoscopy??
- #55 As u can see a curved white line lying behind the heart.