This document provides guidance on interpreting chest x-rays from Dr. Nazeer. It outlines common indications for chest x-rays such as evaluating chest symptoms or physical exam findings. It then describes how to analyze x-rays for abnormalities like consolidation, nodules, masses, cavities, and effusions. Specific pathological conditions are also discussed such as pneumonia, tuberculosis, lung cancer, and mediastinal lesions.

1. Interpretation of chest x-ray.
Dr/ ABD ALLAH NAZEER. MD.

2. Indication for a chest X-Ray.
1- Evaluation of chest symptoms(cough, chest pain,
shortness of breath, hemoptysis, fever, unexplained
weight loss.
2- Evaluation of physical sign(e.g. hypoxemia, abnormal
pulmonary examination.
3- Evaluation of nasogastric, endotracheal tubes and
central venous lines.
4-screening for pneumothorax after lung biopsy, central
line and pacemaker placement.
5- Evaluation of pacemaker lead fracture
6- Pre-employment and physical examination.

4. Distance 180 cm.

5. Distance 90 cm.

17. Penetration: Is the image over or under exposed? Under means the image is
too white (the radiation is not getting through adequately and more of the
X-ray is appearing white or similar to bone than it should be), and over
exposure is too dark. To tell which you have look for the intervertebral disks.

26. Right Lung lobe position.

27. Left Lung lobe position.

43. CR Interpretation:
Lung abnormalities:
Abnormal whiteness.
(increased density)
1-Consolidation.
2-Atelectasis.
3-Nodule or mass.
4-Inetrstitial.
Abnormal blackness
(decreased density):
1-cavitory lesion.
2-Cyst.
3-Emphysema.

46. Density in left lower lung field,
left heart silhouette intact, loss
of diaphragmatic silhouette
Right middle lobe consolidation
silhouette the right cardiac border
intact diaphragmatic silhouette .

47. Infiltrate is when your alveolar spaces are filled with
some sort of fluid, i.e. transudate, exudate. Consolidation is
more of a measure of the texture and hardening of the
lungs. But on a CXR you can't distinguish between the two.

48. Air bronchogram.

55. Nodules and Masses.
A solitary pulmonary nodule or SPN is defined as a discrete,
well marginated, rounded opacity less than or equal to 3 cm
in diameter.
It has to be completely surrounded by lung parenchyma,
does not touch the hilum or mediastinum and is not
associated with adenopathy, atelectasis or pleural effusion.
The differential diagnosis of SPN is basically the same as of
a mass except that the chance of malignancy increases with
the size of the lesion.
Lesions smaller than 3 cm, i.e. SPN's are most commonly
benign granulomas, while lesions larger than 3 cm are
treated as malignancies until proven otherwise and are
called masses.

56. Pulmonary nodule. Pulmonary mass.

57. Causes of cavitating lung lesions.
. Abscess.
. Neoplasm.
. Cavitating pneumonia.
. Cavitations in infarcts.
. Rheumatoid nodule(Rare).

58. Pneumonia with cavitation. Pneumonia with abscess formation.

59. Pathology.

124. Tension pneumothorax with tracheal deviation.

128. Lung nodules.

150. Cavitating Bronchogenic Carcinoma, Squamous Cell. There is a thick-walled cavity present
in the right lower lobe (white arrows) with a nodular inner margin to the cavity. An air-fluid
level is present. This was a squamous cell carcinoma, primary to the lung.

152. Non Small Cell Lung Cancer

154. Cavitory lesions of the lung.

161. Multiple abscesses.

162. Primary T.B with lymphadenopathy. T.B RUL infiltrate with 3 peri-hilar Cavitory lesions.
T.B disease.

163. T.B RUL infiltrate

165. Military T.B.

166. Mediastinal lesions.

188. Posterior mediastinal mass.

204. A subpulmonic effusion is excess fluid that collects at the base of the lung, in
the space between the pleura and diaphragm. The peak of the pseudo-diaphragm
will lie lateral to the normal position. When located on the left, an increased
distance may be seen between the pseudo-diaphragm and the gastric bubble.
Lateralization of the diaphragm apex at the right side
compatible with right sided subpulmonic effusion.
The left dome of diaphragm is higher than right with increased
distance of diaphragmatic outline to the fundal air bubble of
stomach, suggestive of a subpulmonic pleural effusion.

205. There is a moderate-sized right basal and right subpulmonic pleural effusion.
Sternotomy wires and loop recorder noted. Moderate cardiomegaly.

206. This is a PA chest image on the same patient taken after cardiac surgery. Note the
increased distance between the fundus of the stomach (black arrow) and what appears to
be the diaphragm (white arrow). The diaphragmatic plaque is marked by the grey arrow.