chest x ray in 10 seconds
TRANSCRIPT
1
Put the X-ray in the true position :
Any mark on the X-ray is the right side , except mark “L” is left .
If no mark look for the apex of the heart , aortic blub, gastric air buble … all are
left
2
Check the view : PA or AP :
In postero anterior view the shadow of the scapula is out-side the lung field , the
importance of that in anteroposterior view the heart appears larger so u cannot
evaluate cardiomegally in AP view .
3
Penetration :
normally the vertebral bodies are ( Just ) seen throught the lower part of the
heart .
Soft Hard
4
Rotation :
In rotated film the lung shadow may appear more dense than normal
5
Degree of inspiration :
10 posterior (or 6 anterior ribs) should be visible
If the film is taken while the patient not in full inspiration the lung bases will
appear whiter and the cardiac shadow will appear larger .
The mid point of RT hemi diaphragm should be between 5 – 7 rib anteriorly .
Know…… Lets search for the pathology :
6- Airway and mediastinum
7- Bone .
8- Cardiac shadow .
9- Diaphragm .
10- lung and Elsewhere soft tissue .
6
Air way
Normally the trachea is central or slightly deviated to right .
Mediastinum
Causes of widened mediastinum :
Lymphadenopathy / Pulmonary hypertension
7
Bone
8
Cardiac shadow:
Normally
1- the heart width = 50 % of thoracic width i.e. C/T ratio = 0.5 ( and up to 60% in
pediatric )
2- 2/3 of the heart to the left of the mid line & 1/3 to right .
Cardiac borders , if hazy indicate pathology in near by lung :
9
Diaphragm:
Elevated or depressed ?
Costophrenic angles , clear or hazy ?
Pleural effusion Encysted effusion
10
Lung , pleura , other soft tissue
Check for :
1- too white ?
2- too black ?
3- abnormal position ?
White area may be
1- Alveolar pattern : fluffy ill defined with air bronchogram e.g. pneumonia
.
Pneumonia
2- Interstitial pattern : reticular or military ( ground glass) e.g fibrosis.
3- Pleural : usually homogenous not respecting lung lobes and segments .
4- Increased broncho-vascular marking.
5- Coin shadow .
Collapse RUL collapse
Black lung :
Oligemia
Emphysema
Pneumo thorax
Pneumothorax Emphysema