Downloaded 682 times
Uploaded byNikhil Murkey
Normal Chest X-ray
This document provides guidelines for interpreting a chest x-ray, including structures to identify, technical aspects to evaluate, and what to examine in different areas of the image. It describes how to analyze the trachea, heart, diaphragms, lungs, hilum, and other areas. Key points covered are proper centering, penetration, inspiration, and angulation of the x-ray. Anatomical landmarks are identified for assessing abnormalities in each lung field.
More Related Content
Similar to Normal Chest X-ray
Normal Chest X-ray
- 1. CHEST X-RAY DR.NIKHIL MURKEY
- 3. STRUCTURES TO BEIDENTIFIED
- 4. • 1 SVC • 2 IVC • 3 RA • 4 RV • 5 LV
- 7. SCHEME • Patient demography • Technical aspect • Trachea • Heart and mediastinum • Diaphragms • Pleura • CP angles • Hilum • Lung field • Hidden areas • Below diaphragm • Soft tissue • Bones
- 8. TECHNICAL ASPECT • Centering • Penetration • Inspiration • Angulation
- 9. • Rotation •Medial ends of bilateral clavicles are equidistant from the midline or vertebral bodies
- 10. If spinous processappears closer to the right clavicle (red arrow), the patient is rotated toward their own left side If spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side
- 11. • Penetration •Should see ribs through the heart • Barely see the spine through the heart • Should see pulmonary vessels nearly to the edges of the lungs
- 12. Overpenetrated Film • Lungfields darker than normal—may obscure subtle pathologies • See spine well beyond the diaphragms • Inadequate lung detail
- 13. Underpenetrated Film •Hemidiaphragms areobscured •Pulmonary markings more prominent than they actually are
- 14. • Inspiration 1 2 • Should be able to 3 count 9-10 posterior 4 ribs 5 6 • Heart shadow should 7 not be hidden by the diaphragm 8 9 10
- 15. • Angulation 1 2 • Clavicle should lay over 3 3rd rib
- 16. Apical lordotic Same patient, not lordotic A film which is apical lordotic (beam is angled up toward head) will have an unusually shaped heart and the usually sharp border of the left hemidiaphragm will be absent
- 17. TRACHEA • 25 mmin males 21 mm in females. • Right paratracheal stripe • Widening occurs in Lymphadenopathy, tr acheal malignancy, mediasti nal tumours, mediastinitis, pleural effusion • Normal carinal angle 60-75 degees.
- 18. HEART & MEDIASTINUM •Cardio-thoracic ratio • Transverse cardiac diameter • Increase in transverse cardiac diameter by 1.5 cm in significant. • Normal in neonates and AP projection is 60 percent • Cardiac shadow measuring more than 5.5 cm to the right signifies right atrial enlargement
- 19. DIAPHRAGM • Position, sharpness of border • Difference should be less than 3 cm between both sides. • Subdiaphragmatic air
- 20. PLEURA • Pleural thickening • Calcification • Plaques • Pneumothorax • Effusion.
- 21. COSTOPHRENIC ANGLES • Acute •Well defined
- 22. LUNG FIELDS • Infiltrates •Increased interstitial markings • Masses • Absence of normal margins • Air bronchograms • Increased vascularity
- 23. LUNG FIELDS: USINGSTRUCTURES / SILHOUETTES Silhouette / Structure Contact with Lung 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)
- 24. LUNG FIELDS: USINGSTRUCTURES / SILHOUETTES Upper right heart border / Aortic knob ascending aorta (Apical (anterior RUL) portion of LUL ) Upper left Right heart border heart (medial RML) border (anterior LUL) Left heart border Anterior (lingula; hemidiaphrag anterior) ms (anterior lower lobes)
- 25. LUNG FIELDS: FISSURES •The fissures can also help you to determine the boundaries of pathology Major Oblique Fissure Separates the LUL from the LLL Separates the RUL/RML from Right Major Fissure the RLL Separates the RUL from the Right Minor Fissure RML
- 27. LUNG FIELDS: HIDDENAREAS • Apices • Mediastinum and hila • Behind the diaphragm
- 28. HILA • Position (left2.5 cm higher than right) • Equal density • Clearly defined lateral borders • Lower lobe pulmonary arteries and upper lobe pulmonary veins • Diameter of pulmonary arteries should measure 10-16 mm in males and 9 – 15 mm in females. • Upper lobe veins lie lateral to the arteries and lower lobe veins lie medial to the arteries.
- 29. BRONCHIAL ARTERIES • Usuallynot visualized • Branches of descending thoracic aorta at T5/6 level • 2 on left; 1 on right • When enlarged appear as multiple small nodules around hila • Enlarged in cyanotic heart disease like TOF, Pulmonary atresia • Other causes include bronchiectasis or bronchial carcinoma
- 30. SUBDIAPHRAGMATIC REGION • Freeair • Bowel (Chilaiditi syndrome) • Dilated bowel loops
- 31. SOFT TISSUE • Breast • Nipple • Skin folds especially in oblique and ill centered X-rays • Companion shadow – upper border of clavicle
- 32. BONES • Vertebrae • Clavicle • Ribs • Scapulae • Sternum*
- 33.