This presentation based on basics on chest x rays and basic knowledge about few important lung pathologies.

1. Chest X-ray interpretation
Harindu Udapitiya,
Temporary Lecturer,
Division of Pharmacology.

2. Overview

3. Before interpreting……
1. Proper labelling
2. Proper positioning
3. Veiw-PA? AP? Lateral?
4. Exposure
5. Rotation
6. Adequacy of inspiratory effort

9. Normal Anatomy

11. Normal Chest X-ray
 Cardiac Structures
 Position
 More central in younger infants and children
 More on the L side in older infants and teens
 Size
 The cardiothoracic ratio should be less than 0.5
 A cardiothoracic ratio of greater than 0.5 (in a good
quality film) suggests cardiomegaly.

12. A/B<0.5

13. Cardiomegaly

14.  Trachea
 The trachea is placed usually just to the right of
the midline

16.  Mediastinum

17.  Lungs
 There are three lobes in the right lung and two in
the left.
 Right lung
1. Upper lobe
2. Middle lobe
3. Lower lobe.
 Left lung
1. Upper lobe; this contains the lingula
2. Lower lobe.

19.  Pleura
 There are two layers of pleura: the parietal
pleura and the visceral pleura.
 The parietal pleura lines the thoracic cage and
the visceral pleura surrounds the lung.

21.  Diaphragm
 Contour
 Rounded with sharp pointed costophrenic and
costocardiac angles. Blunting of costalphrenic or
costocardiac angles suggests plueral effusion.
 Right diaphragm is usually 1-2 cm higher

25. Abnormal Chest X-ray
 Radiopacity (whiteness) means increased
density
 Radiotranslucency (blackness) means
decreased density
 Radiopacity can be of 3 causes
 Alveolar pattern – fluffy, soft, poorly demarcated
opacifications < 1 cm in diameter
 Possible causes:
 Pulmonary edema
 Viral pneumonia
 Pneumocystis
 Alveolar cell carcinoma

26. Pneumonia

27. Abnormal Chest X-ray
 Interstitial pattern
 Consolidation of interstitial tissue (alveolar walls,
intralobular vessels, interlobar septa and
connective tissue)
 Looks like branching lines radiating toward the
periphery of the lung
 Possible causes:
 Interstitial pneumonitis
 Pulmonary fibrosis

28. Pulmonary
Fibrosis

29. Abnormal Chest X-ray
 Vascular pattern – assessment of the
pulmonary arteries and capillaries
 If there is an increase in the size of the
pulmonary arteries as they extend out into the
lung – pulmonary hypertension
 If there is a decrease in size, truncation, or
obliteration of a pulmonary artery – embolus
 Lack of vascular making in the periphery -
pneumothorax

30. Pulmonary Hypertension

31. Pulmonary
Embolism

32. Lung pathologies
White Lung field Black lung Field
Well defined Ill defined
 Collapse
 Pleural Effusion
 Consolidation
 Fifrosis
 Pulmonary Edema
 Infiltration

33. Pathological Conditions
1. Consolidation
2. Abscess
3. Bronchial Asthma
4. Bronchiectasis
5. COPD
6. Lung Collapse
7. Heart Failure
8. Pulmonary fibrosis

34. 9. Hiatus hernia
10. Pleural Effusion
11. Pneumothorax
12. TB
13. Carcinoma
14. Lymphoma
15. Pericardial Effusion
16. Mitral Stenosis

35.  17. ASD

36. 1.Consolidation
 Causes
 Pneumonia
 Bronchial carcinoma
 Lymphoma
 Inflammatory conditions

37.  Radiological features
 Airbronchogram
 Silhouette sign
 Lower border

39. R.Middle lobe
Pneumonia

40. R.Lower Lobe pneumonia

42. 2.Abscess

43. 3.Bronchial asthma
I. Hyperinflation
II. Diaphragmatic
flattening
III. Bronchial wall
thickening
IV. Hilar
enlargement

44. 4.Bronchiectasis
I. Tram line
opacification
II. “Bundle of graphes
appearance”

45. 5.COPD

48. 7.Lung Collapse

49.  DD
I. Lung collapse
II. Lower lobe consolidation
III. Pleural effusion
IV. Raised hemi diaphragm

51. 8.Pulmonary fibrosis

53. 9.Pleural Effusion

56. 10.Pneumothorax

60. 11.Hiatus hernia

62. 12.TB

65. Miliary
TB

66. 13.Bronchial carcinoma

69. 14.Lymphoma

71. 15.Pericardial effusion

73. 16.Mitral Stenosis

75. 17.ASD

78.  1.Basics on normal chest x ray
 2.Basics on Abnormal chest x ray
 3.Pathological conditions