1. HOW READ CHEST XR -3
ANAS SAHLE ,MD

2. POSITION
PA AP
QUALITY
ROTATION PENETRATION INSPIRATION
LESION
Homo
Densityinfiltratio Heterogenous Centralperiph Silhouet
n
Wellill defined Zone eral
Necrotic sign
MEDIASTINAL
Central deviasionwided
COSTO-PHRENIC ANGEL
Freeoblitern
OTHER
Bone soft tissuediaphragm

3. Consolidation

4. Consolidation
Infection
causes Non-infection causes
Broncho-
WEGNER Cardiac
Pneumonia Lymphoma alveolar COP Sarcoid
disease failure
carcinoma

5. Case-1
A 35-year-old
male presented
with:
1. fever,
2. cough,
3. purulent
sputum
for one week.

6. POSITION •PA CXR
QUALITY •GOOD Technical Quality
Lower lobe
•Homogenous density in the right lower
LESION zone (with bronchogram) obscured
hemidiaphragm
•Central trachea? and mediasteinal.
MEDIASTINAL
•free left costo-phrenic angels
ANGELS
•NO
OTHER

7. Case-2
This 75-year-old
female presented
with:
acute respiratory
failure.
She had been
sick for two
weeks with:
1. fever,
2. cough,
3. purulent
sputum

8. POSITION •AP CXR
QUALITY •Poor Technical Quality
•(HIGH penetration).
•Tow homogenous opacification in both lung:
•in the left and right (middle,lower ) zone
LESION obscured aortic arc, and left border of heart
extend to chest wall,(air bronchodram)
•Central trachea and mediasteinal
MEDIASTINAL
•Free costo-phrenic angels
ANGELS
•NO
OTHER

9. Case-3
• A 30-year-old
male presented
with cough,
shortness of
breath
• and loss of
weight over four
months

10. POSITION •AP? CXR
QUALITY •Good Technical Quality
•Bilateral infiltrate at lower zone
LESION •(air bronchogram??)
•No kerley line.
•No upper zone venous diversion
•Central trachea and mediasteinal
MEDIASTINAL
•Free costo-phrenic angels
ANGELS
•NO
OTHER

11. disscusion
• The CXR shows bilateral infiltrates and air
bronchograms with a perihilar distribution.
• The heart size is normal.
• There are no Kerley B lines or evidence of
upper lobe venous diversion.
• All these are typical features of PCP

12. Case-4
• This middle-aged
male had low-
grade fever of one
month’s duration
• associated with
productive cough
and loss of weight.

13. POSITION •PA CXR
QUALITY •POOR Technical Quality
•rotation
•Hetero-genous density at right
lower zone (bronchogram) obscured
LESION hemidiaphragm
•Central trachea and mediasteinal
MEDIASTINAL
•Free left costo-phrenic angels
ANGELS
•NO
OTHER

14. Case-5
• This patient presented with stridor due to
thyroid goiter.
• was intubated (Fig. 1).
• Repeat CXR was done six hours later (Fig.2).
• What is the main radiological abnormality?

15. AFTER INTUBATED

16. POSITION •AP CXR
QUALITY •ACCEPT Technical Quality
•Bilateral perihilar patchy opaciteis
LESION •Diffused but Most in middle zone .
•Obscured aortic arc(bronchgram)
•Central trachea and mediasteinal
MEDIASTINAL
•Free left costo-phrenic angels
ANGELS
•NO
OTHER

17. AFTER SIX HOURS

18. discussion
• The first CXR shows a normal cardiac shadow
associated with bilateral perihilar alveolar
infiltrates suggestive of acute pulmonary edema.
• The development of pulmonary edema with a
normal heart size is indicative of an acute event.
• The rapid clearance of the pulmonary infiltrates
here indicates that the process is rapidly
corrected by positive pressure.
• In this patient, an important consideration is
negative pressure pulmonary edema due to
upper airway obstruction from the thyroid
Goiter