DR.allam Alazhar univ

1. Part 1

2. Postero-anteriorPostero-anterior

3. Supine position (not ideal)Supine position (not ideal)

4. Chest & heartChest & heart
Vertebral columnVertebral column
SkullSkull
Hands & feetHands & feet
X-ray With contrastX-ray With contrast
• BariumBarium
• IVPIVP

5. A- Chest & heartA- Chest & heart
1.1. TypeType
2.2. ViewView
3.3. DoseDose
4.4. CentralizationCentralization
5.5. MediastinumMediastinum
6.6. Soft TissueSoft Tissue
7.7. BoneBone
8.8. DiaphragmDiaphragm
9.9. ChestChest
10.10.HeartHeart
Diagnosis

6. 1- Type1- Type
Plain With contrast

7. 2-2- ViewView
PosteroanteriorePosteroanteriore
(P.A.)(P.A.)
PosteroanteriorePosteroanteriore
(P.A.)(P.A.) LateralLateral

8. LateralLateral
PosteroanteriorePosteroanteriore
(P.A.)(P.A.)
(+ Ba Swallow)

9. 3 - Dose3 - Dose
• AverageAverage:- the vertebral bodies should just:- the vertebral bodies should just
be visible through the heart.be visible through the heart.
• SoftSoft:- the vertebral bodies are not visible,:- the vertebral bodies are not visible,
film will look ‘whiter’film will look ‘whiter’
• HardHard:- the vertebral bodies clearly identified:- the vertebral bodies clearly identified
and easly counted through the heart, the filmand easly counted through the heart, the film
appears too ‘black’appears too ‘black’

11. HardHardHardHard
AverageAverage

12. AverageAverage
SoftSoft

13. 4 - Centralization4 - Centralization
CentralizedCentralized:- Medial ends of clavicles are equidistant:- Medial ends of clavicles are equidistant
from the midline (spinous process)from the midline (spinous process)

14. 5- Mediastinum5- Mediastinum
Trachea (column ofTrachea (column of
air)air)
Heart (23 to the left)Heart (23 to the left)
Tracheal lower partTracheal lower part
is slightly shifted to theis slightly shifted to the
right because of aorticright because of aortic
arch.arch.

15. Mediastinal shiftMediastinal shift

16. Mediastinal shiftMediastinal shift

17. Mediastinal shiftMediastinal shift

18. Mediastinal shiftMediastinal shift

19. 6 - Soft Tissue6 - Soft Tissue
Female breastFemale breast

20. 7 - Bone7 - Bone
Ribs counting:-Ribs counting:-
The rib passes TV at the posterior aspect and oblique at theThe rib passes TV at the posterior aspect and oblique at the
anterior aspectanterior aspect

21. AnatomyAnatomy

22. Scoliosis

23. Notched ribsNotched ribs
caused by vascular collateralscaused by vascular collaterals

24. Post open heart surgeryPost open heart surgery

25. 8 - Diaphragm8 - Diaphragm
The right diaphragm is usually 1–1.5 cmThe right diaphragm is usually 1–1.5 cm
higher than the left.higher than the left.

26. The ‘curvature’:-The ‘curvature’:-
the highest point of a hemidiaphragm should be at least 1.5 cmthe highest point of a hemidiaphragm should be at least 1.5 cm
above a line drawn from the cardiophrenic to the costophrenicabove a line drawn from the cardiophrenic to the costophrenic
angleangle

27. DiaphragmaticDiaphragmatic
paralysisparalysis

28. Collapsed lung:-Collapsed lung:-
• Tented diaphragmTented diaphragm
• Mediastinal shift to the same sideMediastinal shift to the same side
• Overcrowded ribsOvercrowded ribs

29. CollapsCollaps
ee

30. CollapsCollaps
ee

31. Steps of chestXraySteps of chestXraySteps of chestXraySteps of chestXray
A)Costophrenic angleA)Costophrenic angleA)Costophrenic angleA)Costophrenic angle
B)LungopacityB)LungopacityB)LungopacityB)Lungopacity
C)HilarC)HilarC)HilarC)Hilar
D)HypertransleucencyD)HypertransleucencyD)HypertransleucencyD)Hypertransleucency

32. A) Costophrenic angleA) Costophrenic angleA) Costophrenic angleA) Costophrenic angle
Oblitrated by hommogenous opacity
Pleural effusion
Hydropneumothorax
Raising to the Axilla Horizontal level with
Mild===5th & 6th ribs Jet black above
Mod.=====2nd & 4th ribs Collspsed lung
Massive====above 2nd rib
In moderate or massive Pleural effusion the mediastinum
usually shifted to the opposite side.
But may not due to underlying Lung collapse or fibrosis as in
T.B. or malignancy
In moderate or massive Pleural effusion the mediastinum
usually shifted to the opposite side.
But may not due to underlying Lung collapse or fibrosis as in
T.B. or malignancy

33. Pleural effusion

51. A-A- Whole LungWhole Lung
B-B- Limited opacityLimited opacity
A- LobeA- Lobe
B- TriangularB- Triangular
C- CircleC- Circle
D- Multi-circleD- Multi-circle
E- OthersE- Others
B) Lung opacityB) Lung opacityB) Lung opacityB) Lung opacity

52. 1- Whole lung opacities
B) Lung opacityB) Lung opacityB) Lung opacityB) Lung opacity
Look to the mediastinum:-
A) Shifted to the
opposite side
B)Central
Massive pleural effusion Total lung
pneumonia (TLP)
C) Shifted to the same side
Lung fibrosis or collapse

57. Comment on any lesion
- No.
- Site.
- Size.
- Wall.
- Association.
Comment on any lesion
- No.
- Site.
- Size.
- Wall.
- Association.

58. (A) Lobe(A) Lobe (B)Triangular(B)Triangular
2- Limited Opacity
L. Pneumonia P. embolism
Homogenous opacity. Base of the triangle directed
At one lobe. Outside why?
Central Mediastinum.

60. DDDD Apical opacity:Apical opacity:--
– Apical pneumoniaApical pneumonia
– TBTB
– Pancoast tumourPancoast tumour
– Apical collapseApical collapse

67. B) Ring:- has a rim
– CavityCavity
– AbscessAbscess
– Lung cystLung cyst
C) Rounded OpacityC) Rounded Opacity
Solitary (or few countable)
A)Circle:-totally opaque
(Coin shadow )
• T.B.T.B.
• MalignancyMalignancy
• Infection (Pneumonic stage of Abscess).Infection (Pneumonic stage of Abscess).
• Calcified lung cyst (hydatid).Calcified lung cyst (hydatid).
• Foreign bodyForeign body
Comment on
- No.
- Site.
- Size.
- Wall.
-
Association.
Comment on
- No.
- Site.
- Size.
- Wall.
-
Association.

68. Coin shadow

69. Coin shadow

70. ‘Cannon ball’ metastases

72. CavityCavity

74. AbscessAbscess

79. D) Multi Circular opacitiesD) Multi Circular opacities
Honey coomb Soap bubble
Bronchectasis Polycystic Lung
N.B.: Hyper-trausleuceay of the apical part (jet black)
N.B.: The opacities may surrounded by Cosolidation

84. E) Other opacitiesE) Other opacities
1.Miliary Shadow:- Multiple pin point
2.Reticular or nodular:-
3.Un formed:- Fluffy cotton
DD:- Miliary Shadow
•Miliary T.B.
•Metastasis (Thyroid, Breast,
Prostate)
•Lymphangitis carcinomatosis
•Sarcaidosis
•Pneumoconiosis
•Haemosidrosis
DD Un-formed:-
Descriped as, Fluffy cottonDescriped as, Fluffy cotton
•Broncho pneumonia.
•T. B. pneumonia.
•Metastasis

88. C)HilarC)HilarC)HilarC)Hilar
Unilateral Bilateral
1- Tuberculosis
2- Neaplastic (1ry or 2nd
ry)
(May be festooned)
3- Infection.
Never unilateral 4- Sarcoidosis

91. D)HypertransleucencyD)HypertransleucencyD)HypertransleucencyD)Hypertransleucency
Emphysema (Hyper inflation)
Usually bilateral
Pneumothorax
Usually unilateral
Lung:-
Hyper-translucent
(COPD = Exaggerated broncho-
vascular marking).
Mediastinum
Heart :-Ribon-shape
Lung:- Collapsed Lung
Jet black (Absence of Broncho-
vascular marking)
Mediastinum:-
In tension pneumothorax
shifted to the opposite side
Rib:- Horizontal, wide & parallel
Diaphragm :- Low & Flat
NB:- Before diagnosis of hyper inflated lung observation of
the lung base is a must as it may show a honey coomb appearance