chest radiology quiz
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Normal Chest Radiology Normal Chest Radiology A Quiz Based ReviewA Quiz Based Review
Ver. 1.0Ver. 1.0
For Undergraduate Medical For Undergraduate Medical StudentsStudents
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Radiological Anatomy Review
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• The TracheaThe Trachea
• Normally the upper part is Central in position then it becomes slightly deviated to the right.
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Check for:Check for:-Displacement (Mediastinal shift)-Narrowing-Intraluminal Lesions
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• The Heart & MediastinumThe Heart & Mediastinum
• Normal heart (refer to cardiac imaging section)
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Check for:Check for:- Cardiac size- Any abnormal densities- Fluid levels- Calcifications- Spinal Abnormalities
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• The Diaphragm:The Diaphragm:• Usually the right hemidiaphragm
is higher than the left.• On inspiration the level of the
diaphragm is at (6th Rib anteriorly or below the 10th posteriorly)
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Check for:Check for:-Loss of outline (adjacent pathology)-Look under the diaphragm (Intraperitoneal air)-Level of the diaphragm (Abnormal elevation or depression)
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• The Costophernic Angles:The Costophernic Angles:• Normally they are acute
and well defined.
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Check for:Check for:-Obliteration (Fluid accumulation)
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• The Lung Fields:The Lung Fields:• Both lung fields must be
examined and compared to each other.
• On PA views the lung fields could be divided in to 3 zones
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-Upper (Apex - 2nd rib) - Middle (2nd rib – 4th Rib)– Lower (4th Rib down) *(Mistake to define a lung lobes on basis of PA view only you must have a Lateral film)
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• The Lung Fields:The Lung Fields:• Check for:
– Abnormal Shadows or opacities.– Abnormal Areas of translucency.– Abnormal distribution of lung markings
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Upper Zone
Middle Zone
Lower Zone
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Diagram illustrating the approximate positions of the pulmonary segments as seen on the PA & Lateral radiographs
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• The Lung Apices:The Lung Apices:• The lung apices are
partially obscured on PA views by the ribs, costal cartilages, clavicles and soft tissues. (Considered one of the hidden areas in chest)
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Check for:Check for:-Apical Shadowing (Normal in 7% of patients due to pleural thickening)
-More Important: It’s the site for certain pathology:-T.B. -Fungal Infections-PANCOAST TUMOUR
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• The Lung Hila:The Lung Hila:• Normally the left is higher
than the right by 2.5 cm.• Both must be equal in
density and similar in size with clearly defined concave lateral borders.
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•(Considered one of the hidden areas in chest)
Check for:Check for:-Hilar position, Size and density
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• The Gastric Air bubble: The Gastric Air bubble: Checking the below the Checking the below the diaphragm areadiaphragm area
• (Considered one of the hidden areas in chest)
• Normally seen under the left hemidiaphragm
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Check for:Check for:-Any other abnormal gas shadow (Free intrperitoneal air – abcess – dilated bowel).-Displaced gastric bubble.-Calcified lesions.
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• The Breast Shadows: The Breast Shadows: Checking the soft tissue Checking the soft tissue shadows of the chestshadows of the chest
• Breast shadows may obscure the costophernic angles.
• Nipple shadows may be seen and resemble a pulmonary lesion.
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• Skin folds may overly the lung fields and resemble pathology.
Check for:Check for:-Absent breast shadow (Mastectomy)-Any normal skin shadow which may give impression of a pathology.
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• The Ribs: The Ribs: Bony ChestBony Chest
• Check for:Check for:-Extra Number
(Cervical rib)-Destruction.-Rib notching.
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How to count Ribs
1
2
3
4
5
6
7
Now you Now you try try
counting counting the rest of the rest of
them!!!them!!!
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• The Clavicles: The Clavicles: Bony Bony ChestChest
• Check for:Check for:-Destruction.-Erosion.
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• The Scapula and The Scapula and Humeral Heads:Humeral Heads:
• Both scapula must be projected away from the chest during taking the chest X-ray (Technical consideration)
• Check for:Check for:-Destruction.-Osteolytic lesions
(metastasis).
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