Here are the points for describing a Chest X ray with some views of abnormal X rays related to specific conditions

1.  DEPARTMENT OF PT IN GENERAL MEDICAL AND
SURGICAL CONDITIONS

2. CHEST X RAYS
DR. SHIRIL. R. NAGARKAR
Professor and HOD

3. NORMAL CHEST X Ray

4. NORMAL X RAY

5. Patient Demographic data
- name
- Age
- Sex
Reading of X ray

6.  Postero-Anterior view [PA view]
 Antero-Posterior view [AP view]
 Lateral view
 Oblique view
 Apicogram
TYPES OF VIEWS

7. PA & AP View
Posterior – Anterior View
 X ray beam comes from behind
 Normal sized cardiac shadow
 Medial border of scapula
widely spaced
 Vertebral bodies shadow
appears blurred
 Done in stable patient
Antero – Posterior View
 X ray beam is from front
 Apparent cardiomegaly
 Medial border is closer
 Vertebral shadows can be clearly
seen
 Usually done in moriband or
seriously ill patients

8. Postero- Anterior view Antero-Posterior view

9.  Xray beam is from the lateral side of the patient
 Right or Left lateral view is decided by the level of
diaphragm
 Indications
- Visualisation of anterior and posterior
Costophrenic angle
- For localisation of lesion
- Segmental Collapse
- Mediastinal lesion
Lateral view

10. Left Lateral view

11.  Oblique View :
- Both lungs from the apices are included
- Maximum area of the lung is demonstrated
- Diaphragm and heart border appear sharp
- Heart and blood vessels appear magnified
 Apicogram :
For detailed evaluation of lung apex

12. Oblique radiograph

13.  Both CP angles should be clearly visible
 Both the lung apices should be clearly visible
 Bilateral chest wall soft tissue shadows clearly seen
Complete/ Incomplete

14.  A well exposed film, the spinous process of T4
vertebra should be clearly seen
 In an under exposed film the X ray film appears to be
more radio opaque (white) and in an over exposed
film the X ray film appears to be more radioluscent
(black)
Exposure

15.  Distance between medial border of clavicle and the
lateral border of the adjacent vertebra is noted
 In a centrally placed film this distance on both sides
should be equal
 Right rotation - Right distance increased
 Left rotation - Left distance increased
Rotation

16.  Soft tissue shadow
- Muscle (chest wall, neck , breast)
- abnormalities – Subcutaneous Emphysema
Soft tissue abcess ,tumour
Bony cage
- Ribs, Clavicles, Vertebraes, Scapula, Sternum
- abnormalities – Fractures, tumours, erosion,
other congenital anomalies

17.  Size
 Position : Tracheal shadow
Heart shadow
Central : Consolidation
Same side : Collapse, Fibrosis
Opposite side: Effusion, Hydropneumothorax,
Pneumothorax, Huge mass
Mediastinum

18.  Position
- Normally placed heart is 1/3 rd on the right and 2/3rd on the left
 Shape:
Water bottle shaped-Pericardial effusion
Tubular heart-Emphysema
Boot shaped heart-TOF
Box shaped heart-Tricuspid atresia
Upturned apex- ASD
 Size : Cardiothoracic ratio > 50% then Cardiomegaly
Heart

19.  Position
- at the level of 5th to 7th ribs space
- left diaphragm is 1 rib space below than the right
Elevated: collapse lower lobe,
Phrenic nerve palsy
Subpulmonic effusion
Subdiaphragmatic abscess
Hepatomegaly, Ascitis
Depressed: Emphysema, Chronic bronchitis
Diaphragm

20.  Curvature

21.  Curvature
-If the length of perpendicular <1 cm- flattening of Diaphragm
- Flattening of diaphragm is seen in Emphysema
 Margins
Normal – clear margins
Abnormal(blurred) - Lower lobe basal lesion
( consolidation, pulm. Oedema, tumour)

22. Normal Hila is formed by vessels, lymph nodes and bronchus
 Position
- Normally hila at the level of 3rd to 5th
rib
- right hila is normally at a higher level than left
Elevation : Upper lobe Collapse
Upper lobe Fibrosis
Depression: Lower lobe Collapse
Hila

23.  Hilar Prominence
-TB
- Fungal infection
- Malignancy
- Occupational lung disorders
- Sarcoidosis
- Pulmonary hypertension
- LVF

24.  Normally lung fields are Radiologically described in 3
Zones
Upper zone- Apex – lower margin of 2nd rib
Mid zone- lower margin of 2nd rib to lower margin of
4th rib
Lower zone- Lower margin of 4th rib to below
Lung feilds

25.  Radiological lung zones

26.  Luscency
normally luscency is equal in both lung
fields
Unilateral hyperluscency is seen in
- Rotated film
- Unilateral emphysema
- Unilateral Bullae
- Compensatory emphysema
- Poland’s syndrome(post viral unilateral bronchiolitis)
Bilateral hyperluscent lung
- Emphysema
- Bronchiolitis
Lung Fields

27. Bronchovascular markings
Prominence
- Bronchitis
- Pulmonary hypertension
- LVF (upper zone more prominent than
lower)
- Pulmonary arteriovenous malformations
Decreased
- Severe emphysema
- Pulmonary embolism
Lung fields contd…

28.  Costophrenic angle
- normally both CP angles are clear and acute
- Blunting seen in
- Pleural effusion
- Severe emphysema
- Basal consolidation
Lung fields contd…

29. Lung fields contd….
 Abnormal lung shadows
- Opacity with clear
margins
- Pleural effusion
- Loculated effusion
- Benign mass
- Collapse
- Cyst
- Opacity with irregular
margins
- Consolidation
- Malignant mass
- Lung infarction
- Nodular
- TB
- Fungal infection
- Pneumoconiosis
- Metastasis

30. Lung fields contd….
- Reticular/ Reticulonodular
-Interstitial lung disease
-Viral infections
-Occupational lung
disorders
- Sarcoidosis
- TB
- Alveolar
- Consolidation
- Pulmonary oedema
- Brochioalveolar
carcinonma
- Lymphoma
- Chronic sarcoidosis

31.  Cavity
- TB
- Fungal
- Lung Infarction
- Occupational lung disorders
- Vasculitis
- Malignancy
Lung fields contd…

32. Left side Pleural effusion

33. Lung cancer

34. Pulmonary Embolism

35. Pneumoconiosis

36. Bronchial cancer

37. Stage 4 Sarcoidosis

38. Tuberculosis

39. Pneumothorax

40. Emphysema

41. THANK YOU