This document provides an overview of interpreting chest x-rays. It discusses the basic principles including types of views, densities, and patient positioning. It then outlines a systematic approach to reading chest x-rays, covering hardware, bones, soft tissues, mediastinum, lungs, and common pathologies like pneumonia, atelectasis, and pneumothorax. Key signs for different conditions are highlighted, such as deep sulcus sign for pneumothorax or obliteration of the costophrenic angle by effusions. The document serves as a guide for radiologists to systematically analyze and identify findings on chest x-rays.
This document provides an overview of interpreting chest x-rays. It discusses the basic principles including types of views, densities, and patient positioning. It then outlines a systematic approach to reading chest x-rays, covering hardware, bones, soft tissues, mediastinum, lungs, and common pathologies like pneumonia, atelectasis, and pneumothorax. Key signs for different conditions are highlighted, such as deep sulcus sign for pneumothorax or obliteration of the costophrenic angle by effusions. The document serves as a guide for radiologists to systematically analyze and identify findings on chest x-rays.
This document provides an overview of interpreting chest x-rays. It discusses the basic principles including types of views, densities, and patient positioning. It then outlines a systematic approach to reading chest x-rays, covering hardware, bones, soft tissues, mediastinum, lungs, and common pathologies like pneumonia, atelectasis, and pneumothorax. Key signs for different conditions are highlighted, such as deep sulcus sign for pneumothorax or obliteration of the costophrenic angle by effusions. The document serves as a guide for radiologists to systematically analyze and identify findings on chest x-rays.
This document provides an overview of interpreting chest x-rays. It discusses the basic principles including types of views, densities, and patient positioning. It then outlines a systematic approach to reading chest x-rays, covering hardware, bones, soft tissues, mediastinum, lungs, and common pathologies like pneumonia, atelectasis, and pneumothorax. Key signs for different conditions are highlighted, such as deep sulcus sign for pneumothorax or obliteration of the costophrenic angle by effusions. The document serves as a guide for radiologists to systematically analyze and identify findings on chest x-rays.
respiratory system ASSIST PROF VALENTINA OPANCINA, MD, PHD Types of Densities Basic Principles of the CXR
Types of views PA Lateral AP Apical lordotic Decubitus (R & L) PA and LL
1. In PA, the patient stands with his/her chest against the film cassette and xrays go posterior to anterior 2. Asyou know, any area of film that is struck by xrays will be exposed and turn black. Any area that is blocked, will remain white 3. In Lateral x-rays, by convention patients stand with left side against the film 1. Minimizes magnification of heart AP 1. For AP, patient is in bed, sitting upright. Xrays coming from front, film is behind. Demonstrate the enlarging principles by putting hand in front of projector 5. Apical lordotic moves clavicles out of the way. Of note, in review of medicolegal cases, the most missed pathology occurs in the RUL 5. Generally 4 different densities: Air, fluid (soft tissue), fat, bone. Densities appear based on the abiliy of the substance to BLOCK the xray from hitting the film. If it blocks, film stays white. 6. Remember, we can only distinguish anatomical margins when 2 structures of DIFFERING densities abut each other! PA vs AP Lateral CXR Approaching the CXR
Name, date, type of film
Type of film Patient positioning / rotation Inspiration Penetration White is underpenetrated Black is overpenetrated Approaching the CXR The systematic approach 1. Tubes / Hardware 2. Bones 3. Soft tissues 4.Pleura and diaphragm 5. Trachea and mediastinum 6. Lung parenchyma Rotation Rotation Inspiration Penetration Scanning the xray # 1- Hardware #1- Hardware #1- Hardware #1- Hardware 2. Osseous Structures in the Chest 2. Osseous Structures of the Chest 3. Soft Tissues 4. Pleura and Diaphragm 5. Mediastinal Anatomy 5. Mediastinal Anatomy 5. Mediastinal Compartments 6. Parenchymal Anatomy
Right lung has 3 lobes, left lung has 2 lobes.
Lingula is considered part of the LUL. Lobes are separated by fissures, sometimes you can see them on xray (especially if they are thickened or fluid-filled) Lateral View
Anterior View 6. Parenchymal Anatomy 2 1 3
9 HOBP Hydropneumothorax Pneumonia Atelectasis
Loss of volume
mass Minor fissue
Minor fissure
Elevation of diaphragm Minor fissure
Major fissure Pneumothorax
Collection of air in pleural cavity
Primary and secondary causes Upright position air rises and separates the lung from the chest wall creating a line. Don’t be fooled by skin folds, clothing and bullae. In the supine position air moves anteriorly. The lung will not be clearly separated from the chest wall. PTX Pneumothorax in the Supine Patient Enlarged hemithorax
Mediastinal shift hyperlucent
Deep sulcus sign
Sharper cardiac border 1.Other signs: Kerly B lines (engorgement of the lymphatics in interlobular septa), vascular engorgement, small effusions Enlarged heart roughly estimated by heart size >50% thoracic cavity width Bat-winged appearance
Enlarged heart Kerley B lines 1.Fluid in between the parietal and viceral pleura. First collects in dependent spaces like costophrenic angle. Obliterates diaphragm. Minscus sign. Cannot determine nature of effusion based solely on the CXR. Effusions Normal Round Pneumonia Blastomycosis Segmental Pneumonia Aspiration Lung Abscess Plate like atelectasis Diffuse adhesive atelectasis ARDS Diffuse alveolar infiltrates Pulmonary edema Butterfly pattern Lobar Air bronchogram Pulmonary hemorrhage Chronic diffuse aleveolar Alveolar proteinosis Miliary nodules Interstitial disease Tuberculosis Unilateral haziness Left lung atelectasis Pleural effusion LUL cavity Tuberculosis Massive effusion Sub pulmonic Effusion
