Chest xray
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This document provides a 12-step process for analyzing chest x-rays and summarizes common findings that may be observed. It describes what to examine on a chest x-ray such as heart size and lung fields. It then reviews normal anatomy and various pathologies that could appear as increased heart size, pneumonia, tumors, fractures, and fluid in the lungs or around the heart.
Chest xray
- 1. CHEST RADIOLOGY Prepared By : Belal Alrefaei Merry Admaso Bshara
- 2. The 12-Step: 1: Name 2: Date 3 : Old films 4 : What type of view(s) 5 : Penetration 6 : Inspiration 7 : Rotation 8 : Angulation 9 : Soft tissues / bony structures 10 : Mediastinum 11 : Diaphragms 12 : Lung Fields Quality Control Findings } } Pre-read }
- 3. Chest X-Ray Findings Is heart enlarged or normal? Signs of heart failure and fluid overload? Does patient have pneumonia or collapsed lung? Is there evidence of emphysema? Are there findings of an aortic aneurysm? Is there fluid in the sac that surrounds the lung? Is there free air under the diaphragm? Is there a tumor in the lung that could represent cancer?
- 4. NORMAL CHEST X-RAY PA LATERAL Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2) Anterior or Posterior) or (3) Superior or Inferior.
- 5. NORMAL HEART BORDERS Note cardiac chambers that account for margins on the chest X-ray
- 7. R Atrium R Ventricle 3. Apex of L Ventricle Superior Vena Cava Inferior Vena Cava 6. Tricuspid Valve Pulmonary Valve Pulmonary Trunk 9. R PA 10. L PA
- 8. LEFT 4 TH RIB POSTERIOR AND ANTERIOR PORTIONS POSTERIOR ANTERIOR 4 A P
- 9. AORTIC ARCH LT. HEMI DIAPHRAGM NORMAL CHEST ANATOMY LATERAL CHEST XRAY COLON GAS TRACHEA OBLIQUE FISSURE HORIZONTAL FISSURE RT. HEMI DIAPHRAGM Diaphragm-AP view Diaphragm- Lateral view LT. LT. RT. LT.
- 10. CARINA LT. MAIN BRONCHUS RT. MAIN BRONCHUS TRACHEA OBLIQUE FISSURE (major) OBLIQUE FISSURE major HORIZONTAL FISSURE minor BRONCHOGRAM—CONTRAST OUTLINING AIRWAY
- 11. HORIZONTAL FISSURE FISSURES DIVIDE LUNGS INTO LOBES RIGHT lung has: UPPER MIDDLE lobes LOWER LEFT lung has: UPPER lobes LOWER
- 13. INTERESTING CASES INFECTION NEOPLASTIC CARDIOVASCULAR TRAUMA
- 15. RUL pneumonia
- 16. RML pneumonia
- 17. RLL pneumonia
- 18. LUL pneumonia
- 19. LLL pneumonia
- 21. Miliary TB Snow Storm Apperance
- 22. TB
- 25. CaVity
- 26. Hilar Lymphadenopathy - BL
- 29. PLEURAL EFFUSION
- 30. Pleural Effusion
- 32. PNEUMOTHORAX
- 33. Pneumothorax
- 36. Hyperinflation
- 37. Hemothorax
- 38. Aortic dissection with hemothorax
- 39. RUL collapse
- 40. LLL collapse
- 42. Chest mass, emphysema Hilar mass
- 43. Emphysema
- 45. ARDS Congestion Interstitial and alveolar edema Collapsed or distended alveoli Bilateral
- 46. Bulla
- 47. SARCOIDOSIS Granulomatous Inflammation Bilateral & symmetrical hilar & mediastinal LAD Generalized fibrosis
- 48. ATELECTASIS No ventilation to lobe beyond the obstruction Trapped air absorbed by pulmonary circulation Segmental/lobar density Compensatory hyper-inflation of normal lungs.
- 51. NORMAL HEART CARDIOMEGLY
- 52. Dextrocardia
- 54. Cardiomegaly Cardiac silhouette greater than 50% of width of thorax
- 55. CARDIOMEGLY CONGESTIVE HEART FAILURE Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
- 56. Congestive Heart Failure Increased heart size: cardiothoracic ratio >0.5 Large hila with indistinct markings Fluid in interlobar fissures Pleural effusions, alveolar edema
- 57. Heart failure
- 59. Pulmonary Edema
- 61. Kerley B line
- 62. VSD
- 63. ASD
- 64. Tetrology Of Fallot (Boot Shaped)
- 67. Multiple Masses
- 68. Free air Free air beneath diaphragm
- 69. Air under the diaphragm
- 70. Empyema after trauma Clavicle fracture Cavitary lesion Opacified hemithorax
- 71. Pneumonectomy
- 72. Pneumonectomy Entire mediastinum shifted left, indicating volume loss Opacified left hemithorax Trachea shifted left, indicating volume loss
- 73. Hiatus hernia
- 75. Clavicle dislocation Medial clavicle is displaced inferiorly
- 77. LT. Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
- 78. FRONTAL LATERAL WHAT AND WHERE IS IT? Air stripe Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.
- 80. Smoke inhalation, chronic changes
- 82. Right Lower Lobe Pneumonia
- 83. Right side tension pneumothorax
- 84. Fracture of posterior rib #7
- 85. Right Side Pleural Effusion
Editor's Notes
- Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2)Anterior or Posterior) or (3) Superior or Inferior.
- Note cardiac chambers that account for margins on the chest X-ray
- This exam shows barium contrast outlining the bronchial tree. This is an old exam not done now with CT imaging replacing it. It does demonstrate the anatomy of the hila which superimpose over the pulmonary arteries and veins. This is why anatomy here on the chest X-ray is difficult in this region.
- With heart failure edema builds up in lungs and edema along fissures allows them to be seen more easily on chest x-ray
- Pleural effusion developing on the left
- Air in the pleural space separates the visceral and parietal pleura. This limits effective ventilation of the lung.
- Here air has built up under pressure in the pleural space and collapsed the lung severely compromising ventilation. The pressure builds due to a ball valve type leak of air into the pleural space with air going into the space on each inspiration.
- Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
- Multiple lesions in the chest are typical for metastatic disease since the pulmonary capillary bed is often the first site metastatic lesions appear as they spread and embolize the pulmonary capillaries and grow in the new location.
- Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
- Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.