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Chest X Rays
1. B Y,
D R . S A I L I K I T H A K
H O U S E S U R G E O N
B A N G A L O R E M E D I C A L C O L L E G E A N D R E S E A R C H I N S T I T U T E
M O D E R AT O R ,
D R . J AV E R I YA
A S S I S TA N T P R O F E S S O R
D E P T O F P U L M O N A R Y M E D I C I N E
B A N G A L O R E M E D I C A L C O L L E G E A N D R E S E A R C H I N S T I T U T E
CHEST X RAYS
2. RELATIVE DENSITIES
Hierarchy of relative densities from LEAST dense to MOST dense :
Gas (air in the lungs)
Fat (fat layer in soft tissue)
Water (same density as heart and blood vessels)
Bone (the most dense of the tissues,
therefore appearing most opaque)
Metal (foreign bodies)
Air
Water
Bone
3. GENERAL PRINCIPLES & APPROACH
GENERAL PRINCIPLES:
Use a SYSTEMATIC APPROACH to interpret X Rays
Interpret the CXR in conjunction with the clinical findings
Always COMPARE with previous CXR if available to assess for change
APPROACH
Patient Identification Details
X Ray View
Breath : Inspiration or Expiration
Exposure
Rotation
Angulation
6. PA vs AP VIEW
PA VIEW AP VIEW
CLAVICLE Seen over the lung fields Seen above the apex of the lung
field
SCAPULA-MEDIAL BORDER Seen away from the lung fields Seen over the lung fields
RIBS Posterior ribs better visible Anterior ribs better visible
CARDIA Apparent cardiomegaly
18. INHALED FOREIGN BODY
Affected side(Right) more
inflated and radiolucent
compared to normal side. In expiration, normal lung will shrink and
become
more dense whereas abnormal areas stay
hyperinflated and lucent
Collapse of left lung due to inhaled foreign body
20. SOFT TISSUE
Areas:
Supraclavicular fossae
Axillae
Breast Shadows
Tissues along the sides of the breast
Under the diaphragm
L Mastectomy
Supclavicular masses
(enlarged nodes)
Axillary masses
Lateral chest wall
(surgical emphysema)
Look for:
Breast shadow
NIPPLE SHADOW
29. LUNG FIELDS
-For the purpose of description
the lungs are divided into zones:
upper, middle and lower.
-Each of these zones occupy
approx. 1/3RD of the height of the lungs.
-The lung zones do not equate to the lung lobes.
-Each zone is compared with its opposite side.
32. SILHOUETTE SIGN
An intrathoracic lesion touching the border of the heart,aorta or diaphragm will
obliterate that border.
An intrathoracic lesion not anatomically contiguous with a border of one of these
structures will not obliterate that border.
33. Sites of silhouette sign on the PA
chest radiograph include 3
right paratracheal stripe: right upper
lobe
right heart border: right middle lobe or
medial right lower lobe
right hemidiaphragm: right lower lobe
aortic knuckle: left upper lobe
left heart border: lingular segments of
the left upper lobe
left hemidiaphragm or descending
aorta: left lower lobe
Sites of silhouette sign on the
lateral chest radiograph include 3:
posterior border of the heart +/-
posterior left hemidiaphragm: left
lower lobe
anterior right hemidiaphragm: right
middle lobe
posterior right hemidiaphragm: right
lower lobe
RML Pneumonia
39. LUNG MASS
A pulmonary mass appears as an opacity >3cm in diameter,
Malignant lesions-SCC,small
cell Ca,AdenoCa,
Sarcoma,Pulmonary
lymphoma,Metastatic lung
lesions
Inefctions and infestations-
Pneumonia,Lung
Abcesses,Hydatid
cyst,Aspergilloma
Congenital-AV
Malformations,Bronchogenic
cyst
Other-Pumonary infart,Lung
contusion or hematoma,Roung
Atelectasis
40. PULMONARY NODULES
Nodules are rounded opacities of <3cm.
Macronodular
opacities
Nodules>
5mm in
diameter
Small nodular
opacities
Nodules 2-5mm
Micronodular
opacities/Miliar
y
Nodules 0.5-
1mm
Pulmonary Mets
CAUSES OF
MACRONODULAR
NODULES:
Metastases-Metastases
arising in the
breast,lung,kidney etc
Infections-
TB,Abscesses
Collagen Vascular
diseases-RA,Wegener
Granulomatosis
Pneumoconiosis-
Silicosis
42. CAVITY
A cavitation in the lung
is an area of
transradiancy
surrounded by
opacification or wall.
They are usually
associated with a
nodule,mass or area of
consolidation.
43. LUNG ABSCESS
Lung abcsess is the most
common cause of
cavitation with air-fluid
level.
Other causes are :
Malignancy
Tb cavities from rupture
of Rasmussen's
aneurysm.
A chest radiograph is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures.
It is the most commonly requested radiological investigation in medicine.