Interpretation of a few Common Diseases on the basis of Plain Chest X-Ray Radiograph

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Chest Radiogram
Technical quality:
1) Positioning:
2) Exposure:
 Structure seen :
1) Position of Trachea
2) Hilar position
3) Diaphragm position
4) Lung fissure & lobes
5) Zones of Lung field
6) Costophrenic angle
7) Cardiac shadow

5. 1)Tracheal position:
Trachea should be centrally placed . slightly deviated towards right side.
Trachea divided into bronchi at the lower border of 4th thoracic vertebrae
2) Hilar position:
Left hilum should be higher than the right hilum.
Normally they should be concave in shape & look similar to each other
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7. 3) Diaphragm position
Right diaphragm should be higher (1-1.2Inch) than the left because heart
pushing the left diaphragm down.
4) Lung’s fissure & lobe:
Oblique fissure: Pass obliquely downwards from the T4-5 vertebrae through
the hilum ending at anterior third of the diaphragm.
Horizontal fissure: In right lung the horizontal fissure runs horizontally at the
level of 4th costal cartilage to meet oblique fissure (at 5th rib in mid Axillary
line)
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8. 5) Zone of lungs field:
Upper Zone: Above the Rt. Anterior border of 2nd Rib
Middle Zone: Between Rt. Anterior border of 2nd & 4th Rib
Lower Zone: Between Rt. Anterior border of 4th Rib & diaphragm
6) Costophrenic angle
“Costophrenic angle should be well defined acute angles”
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9. 6) Cardiac shadow:
When trans cardiac diameter is less than half of trans-thoracic diameter.
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10. 1) Asthma
2) Bronchiolitis
3) Acute Bronchitis
4) Chronic Bronchitis
5) Emphysema
6) Bronchiectasis
7) Cystic fibrosis
Lung’s diseases affecting Airways:
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11. 1) Pneumonia
2) Tuberculosis
3) Emphysema
4) Pulmonary oedema
5) Pneumoconiosis
6) Lung’s cancer
7) ARDS
Lung’s diseases affecting Alveoli:
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12. Lung’s diseases affecting Interstitium:
Idiopathic Pulmonary
Fibrosis
Sarcoidosis
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13. Pleural Effusion
MesotheliomaPneumothorax
Lung’s diseases affecting Pleural cavity
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Hydropneumothorax

14. 1) Bronchitis
2) Bronchiectasis
3) Emphysema
4) Asthma
5) Pneumonia
6) Pneumothorax
7) Hydropneumothorax
8) Pleural Effusion
9) Tuberculosis
10) Lung’s collapse
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15. 11) Lung’s Abscess
12) Lung’s carcinoma
13) Haemosiderosis
14) Lung’s Fibrosis
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16. 1. A) Acute Bronchitis:
Acute Inflammation of bronchial mucous membrane
No parenchymal involvement.
No radiological finding may be seen on chest X Ray.
Chest X-Ray appears normal or Broncho-vascular markings may be
prominent.
Flattening of diaphragm.
Dilatation of bronchi
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17. 1. B)Chronic Bronchitis:
Productive cough for at least three consecutive months in
two successive years.
Hypertrophy of the mucous gland throughout the
bronchial tree.
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18. Chronic Bronchitis:
Radiologically Feature:
Chest X-Ray is normal in uncomplicated chronic bronchitis
Complication such as emphysema, pneumonia, cor
pulmonale may occurs with chronic bronchitis.
Contd…
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19. 2. Bronchiectasis:
Bronchiectasis is a irreversible dilatation of the bronchi,
often accompanied by impairment of drainage of
bronchial secretion leading to persistent infection
Condition that Causes Bronchiectasis:
1)Pulmonary infection in childhood
2)Cystic fibrosis
3)Long standing bronchial obstruction
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20. Bronchiectasis:
Permanent dilatation of parts of Lung airways
Radiological Feature:
1) Visibly dilated bronchi:
 If they contain air, the thickened wall of the dilated
bronchi may be seen as tubular or ring like structure.
 If filled with fluid, the dilated bronchi are either
opaque or contain air fluid levels.
2) Loss of volume of affected lobe or lobes is invariable.
Contd…
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Contd…
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22. 3. Emphysema:
Productive cough for at least three consecutive months in
two successive years.
An increase beyond the normal size of air spaces distal to
the terminal bronchiole with destructive changes in their wall.
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23. Emphysema:
Radiological Feature
Lungs increases in volume
•Diaphragm is pushed downwards & becomes flat.
•Heart is elongated & narrowed
•Ribs are widely spaced & more lungs lies in front of the heart & mediastinum
•Overinflation of the lung: when Rt hemi-diaphragm at their mid point are
below 7th rib anteriorly & 10th ribs posteriorly.
Attenuation of blood vessels
•The reduction in size & number of pulmonary blood vessels can be
generalised or localised. If severe, the involved area is called bulla.
•The edge of bulla is usually sharply demarcated.
•In some case the normal lungs adjacent to the bulla is compressed & appear
opaque.
Contd…
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24. Emphysema
 Increased Lung Volume
a) Low Diaphragms
b) Increase in Retrosternal
Airspace
c) Barrel chest
 Small Vessels
 Small, narrow cardiac
shadow
Contd…
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25. Emphysema
Contd…
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26. 4. Asthma:
Partially reversible inflammation of the airways and reversible airway
obstruction due to airway hyper-reactivity.
•wheeze,
•Shortness of breath,
•chest tightness or difficulty in breathing and cough
These symptoms are typically variable in intensity,
 Symptoms can be absent for long period of time..
Variable expiratory airflow limitation
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27. Asthma:
Radiological Feature:
The Radiological feature of Asthma is not specific
In absence of other concurrent illness , chest radiograph is almost
always normal or show only air trapping with fattening of
diaphragm.
Other radiological feature may include
1) Bronchial wall thickening
2) Peri-bronchial coughing (hazyness around a bronchus or large
bronchiole)
3) Hyperinflation (Uncommon in patient who don’t have
emphysema)
4) Pulmonary oedema may rarely be reported.
Contd…
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28. Contd…
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29. 5. Pneumonia:
An infection within the lung usually purulent, filling the alveoli”
Radiological findings:
1) Segmental or lobar consolidation & interstitial lung
disease
2) Consolidation may be accompanied by loss of volume
of affected lobe, (a common feature in children).
3) Dense consolidation of a considerable portion of one
lobe, usually without loss of volume-> Pneumococcal
Pneumonia, [there may be associated Pleural effusion].
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30. Pneumonia:
Radiological findings:
4) When consolidation is patchy, involving one or
more lobes: bronchopneumonia
5) Pneumonia may be secondary to obstruction of a
major bronchus .
 Bronchial obstruction should always be
considered in any patient presenting with
consolidation of one lobe or of two lobes supplied
by a common bronchus (Rt middle & lower lobe),
particularly if there is associated loss of volume.
Contd…
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31. LLL Pneumonia
NORMAL
LLL PNEUMONIA
Loss of diaphragm
Consolidation
Contd…
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32. Pneumonia:
Radiological findings:
Less common:
1)Mediastinal lymphadenopathy
2)Pleural effusion
3)Cavitation
4)Chest wall invasion
 Cavitation is a feature of infection with staphylococci, gram
negative & anaerobic bacteria & tuberculosis.
Contd…
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33. 6. Pneumothorax:
“ Abnormal presence of gas (air) in the pleural space”
It is useful to divide pneumothoraces into three categories 4:
1) Primary spontaneous: no underlying lung disease
2) Secondary spontaneous: underlying lung disease is present
3) Iatrogenic/ Traumatic
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34. Pneumothorax:
Radiological feature:
1) A visceral pleural line is seen without lung marking beyond it.
2) On standard lateral views, a visceral pleural line may be seen in
retrosternal position or overlying the vertebrae parallel to the
chest wall.
3) In case of clinically suspected Pneumothorax, Inspiratory
radiograph may look normal & expiratory radiograph may detect
small Pneumothorax.
Contd…
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35. Pneumothorax
Contd…
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36. 6. Tension Pneumothorax:
When the collection of gas in Pleural cavity is constantly
enlarging with resulting compression of Mediastinal
structures is known as a tension Pneumothorax.
May be presented with
1) Distended neck veins
2) Tracheal deviation,
3) Cardiac shadow deviation
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37. 6. Tension Pneumothorax:
Radiological feature:
1) Hemi thorax of affected side looks black due to air in
the pleura cavity.
2) Lung of affected side is completely compressed
3) The trachea is pushed to the opposite side.
4) The heart is shifted to the contralateral side.
5) Hemidiaphragm is depressed.
Contd…
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38. Tension Pneumothorax
INSPIRATORY VIEW EXPIRATORY VIEW
Contd…
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39. 7. Pneumohydrothorax:
“Abnormal collection of air & Fluid within pleural cavity”
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40. Contd…
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41. Radiological Feature:
On PA & AP Film:
1) Blunting of Costophrenic angle.
2) Blunting of Cardiophrenic angle
3) Fluid within horizontal & oblique fissure
4) Meniscus sign is seen:
5) With large volume effusion Mediastinal shift occur away from effusion.
6) If coexistent collapse dominate, Mediastinal shift may occur towards the
effusion
8. Pleural Effusion:
“Abnormal collection of any kind of fluid within the pleural space”
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42. Contd…
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43. 9. Tuberculosis:
Radiological Feature:
Primary TB
1) Consolidation (Ghones focus): (at periphery usually at mid/
upper zones of lung)
2) Lymphadenopathy (in hilar & Mediastinal lymph nodes)
 Primary Complex -->
Pulmonary consolidation + lymphadenopathy
 Primary complex may heal & calcified to remain through out
the life
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44. Contd…
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45. 9. Tuberculosis:
Contd…
Radiological Feature:
Primary TB
 Primary complex may spread via two routes-->
1) Bronchial tree: leading to bronchopneumonia Radiologically
appearing as->
Patchy or lobar consolidation
[which often involves more than one lobe]
 may be bilateral & frequently cavitates
2) The blood stream: resulting in Milliary TB Radiologically
appearing
As well defined innumerable small nodules of
same size & evenly distributed.
Pleural effusion may be present.
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46. Rt. Upper lobe is
consolidated & contains
large central cavity
Patchy consolidation from
tuberculous
bronchopneumonia seen
in rt. mid & lower zone
&
Left upper zone
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47. 9. Tuberculosis:
Radiological Feature:
Post Primary TB
 Usually confined to the apical & posterior segment of
upper lobe & apical segment of lower lobe.
 May also be present as a lower or middle lobe
bronchopneumonia
 May appears as-->
1) Consolidation
2) Pleural effusion
3) Mediastinal/ hilar lymphadenopathy
4) Cavitation ( appearing as rounded air space surrounded by
pulmonary opacification)
5) Tuberculomas:
 Tubercular granuloma in the form of spherical mass(<1-2 cm).
 The edge is sharply defined & lesion are partially calcified.
Contd…
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49. Tuberculosis:
Radiological Feature:
Post Primary TB
 With primary form post primary may spread to give
widespread bronchopneumonia/ milliary TB.
 May undergo healing at any stage by fibrosis often with
calcification
 Pleural effusion often leaves permanent pleural
thickening which may on occasion, calcify.
Contd…
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50. 9. Tuberculosis:
Contd…
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51. Contd…
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52. 10.(Atelectasis) Lung’s Collapse:
Loss of air in a lung or part of lung with subsequent
volume loss:
 Atelectasis: When there is a of loss of volume of a
lung lobe or part of lung’s lobe.
 Lung’s collapse: When there is entire loss of volume
of a lung (Right/ Left).
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53. (Atelectasis) Lung’s Collapse:
Morphologically Atelectasis can be sub categorised as:
1) Linear Atelectasis (Plate, Discoid, Band or Sub segmental
Atelectasis):
2) Lobar Atelectasis: Collapse of one or more lobes of a lung
3) Segmental Atelectasis (collapse of one or more individual
pulmonary segments)
4) Round Atelectasis (classically associated with asbestos
exposure)
Contd…
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55. (Atelectasis) Lung’s Collapse:
Radiographic features:
Obstructive Atelectasis:
1) Increased radio opacity of the atelectatic portion of lungs
2) Displacement of fissure towards the area of Atelectasis.
3) Crowding of pulmonary vessels & bronchi in the area of
Atelectasis.
4) Upwards displacement of hemidiaphragm ipsilateral to the
side of Atelectasis.
5) +/- compensatory Overinflation of unaffected lung.
6) +/- (If the Atelectasis is substantial) displacement of thoracic
structures
Contd…
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56. (Atelectasis) Lung’s Collapse:
Linear Atelectasis:
1) Relatively thin linear densities in the lung bases
parallel to the diaphragm (known as fleischner’s line).
Contd…
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58. • Wall thickness ,<4mm ->1 mmCyst
• Wall thickness >4 mmCavity
Bulla
• Wall thickness <1 mm; size >10mmblebs
• Wall thickness <4 mm; size <10 mm

59. Pulmonary Consolidation: Solid lung
[Replacement of air space within lung by fluid or other material (pus/blood)]
Characteristics:
Increased
density
Acinar
shadow:
Silhouette
sign
Air
bronchogra
m
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60. Consolidation Without Volume Loss
e.g.
1) Pneumonia
2) Pulmonary oedema
3) Haemorrhage
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61. Consolidation With Volume Loss
E.g.
1) Atelectasis
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62. Deep sulcus sign
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63. Simple Pneumothorax
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64. Simple Left Pneumothorax
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65. No mediastinal shift
Small pleural
effusion
(common
finding)
Visceral
pleural line
Simple Left Pneumothorax
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66. one-way valve  Intrapleural air accumulates  Mediastinal shift  structures
compressed  rapid onset hypotension, hypoxia, shock, acidosis
Tension Pneumothorax
Progressive build up of air in the pleural space, causing a shift of
the heart and Mediastinal structures away from side of
Pneumothorax
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68. Mediastinal shift to
left
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69. Open Pneumothorax
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70. • Pleural margin
• Deep sulcus
• Crisp cardiac silhouette
• Hyper lucent hemi thorax
• Double diaphragm
• Depressed diaphragm
• Apical pericardial fat
RARELY USED!
CXR Signs of Pneumothorax
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