LECTYRE OF THE CHEST X-RAY

A.WEISS M.DD.E.S ,Chirurgie Générale, Viscérale et LaparoscopiqueA.F.S/A.F.S.A/DU - FRANCE

Aims

• Basics .• Best exam results .• Appreciate the role radiology plays .• Instil an interest in radiology .

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Contents

• Densities• Techniques• Anatomy• CXR Interpretation• Common Pathologies• Questions

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Densities The big two densities are:

(1) WHITE - Bone (2) BLACK - Air

The others are:

(3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the

film, it is:

(5) BRIGHT WHITE - Man-made

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TECHNIQUEP-A ( relation of x-ray beam to patient )

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TECHNIQUELateral

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TECHNIQUELateral Decubitus

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I.D

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ORIENTATION - ROTATION

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PENETRATIONLOW HIGH

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INSPIRATION - EXPIRATION

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ORGANS

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LECTURE OF THE NORMAL CHEST X - RAY

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ANATOMY

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LOBES RIGHT UPPER LOBE

LOBES RIGHT MIDDLE LOBE

LOBES RIGHT LOWER LOBE

LOBES LEFT LOWER LOBE

• LOBES LEFT UPPER LOBE WITH LINGULA

LOBES LINGULA

LOBES LEFT UPPER LOBE – UPPER DIVISION

HEART

•- RIGHT BORDER : EDGE OF ( R ) ATRIUM

•- LEFT BORDER : ( L ) VENTRICLE + ATRIUM

•- POSTERIOR BORDER : REFT VENTRICLE

•- ANTERIOR BORDER : RIGHT VENTRICLE

HEART

HEART

HEART

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LECTURE OF THE NORMAL CHEST X - RAY

1. Superior vena cava

2. Inferior vena cava 3. Right atrium (blue) 4. Right ventricle

(blue) 5. Left ventricle (red) 6. Aorta 7. Pulmonary trunk

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MEDIASTINUM

HILUM

Made of :

1. Pulmonary Art.+Veins2. The Bronchi

Left Hilus higher (max 1-2,5 cm)

Identical : size, shape, density

HILUM

RIBS

LECTURE OF THE NORMAL CHEST X - RAY

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LATERAL CXR

LATERAL CXR

LATERAL CXR

LECTURE OF THE NORMAL CHEST X - RAY

POSTERIOR-ANTERIOR VIEW

LATERAL VIEW

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LECTURE OF THE NORMAL CHEST X - RAY

1. Rib 2. Sternum 3. Breast 4. Position of oblique fissure 5. Position of horizontal

fissure

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LECTURE OF THE NORMAL CHEST X - RAY

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LECTURE OF THE NORMAL CHEST X - RAY

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NORMAL POSITION OR NOT ?

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LECTURE OF THE NORMAL CHEST X - RAY

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CXR Interpretation

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TECHNICAL DETAILS

•Type•Orientation•Rotation •Penetration•Inspiration - expiration

LUNGS

•Lungs• Density• Symmetry• Lesions

HEARTSIZE

HEART •Size of heart •Size of individual chambers of heart

•Size of pulmonary vessels

•Evidence of stents, clips, wires and valves

•Outline of aorta and IVC and SVC

MEDIASTINUM:• Width • Contour• AP window

HILA• Size• Location

REVIEW AREAS• Apices• Behind the heart• CP angles• Below the diaphragm• Soft tissues ( breast, surgical emphysema) • Ribs & clavicle •Vertebrae

IDENTIFY THE LESION → LOCALISE THE LESION →

DESCRIBE THE LESION → GIVE DD

NEVER STOP LOOKING, CARRY ON WITH YOUR SYSTEMATIC

APPROACH!!

Pathology

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EMPHYSEMA

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EMPHYSEMA

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HYDROTHORAX - HEMOTHORAX

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HYDROTHORAX - HEMOTHORAX

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PLEURAL EFFUSION

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HYDROTHORAX - HEMOTHORAX

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PNEUMOTHORAX

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Pneumothorax

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PNEUMOTHORAX

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PNEUMOTHORAX

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CARDIAC TAMPONADE

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CARDIOMEGALY

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RUL PNEUMONIA

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RML PNEUMONIA

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RLL PNEUMONIA

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LLL PNEUMONIA

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HILAR M L

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HILAR LYMPHADENOPATHY

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THE ENLARGED HILA

Causes

1. Adenopathies (neoplasia, infection)

2. Primary Tumor

3. Vascular

4. Sarcoidosis

MULTIPLE MASSES

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tumor

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PNEUMONIA

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PNEUMOPERITOINE

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PNEUMOPERITOINE

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PNEUMOPERITOINE

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TUBERCULOSIS

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TUBERCULOSIS

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CERVICAL RIB

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THANK YOUAbdul.Kader WEISS 2009

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