how to read cxr edited
TRANSCRIPT
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INTERPRETATION OF
CHEST X-RAY
Adapted fromsource
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SYSTEMATIC
INTERPRET
ATION
Label
Orientation
Quality Skeletal structures
Soft tissue structures
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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 thefilm, it is:
(5) BRIGHT WHITE - Man-made
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Techniques - Projection (continued)
Lateral
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Techniques - Projection (continued)
Lateral Decubitus
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Rotation
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Rotation (continued)
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Penetration
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Inspiration/Expiration
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Lateral CXR (continued)
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Lateral CXR (continued)
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Soft
Tissue
Structures
Neck and Esophagus Symmetry, masses
Trachea Deviation, ID bifurcation, should not beable to ID airways further out becausethey are thin walled.
Breasts Symmetry, nipples may be visible
Diaphragm R ight usually higher
Costophrenic Angles Should be sharp and clear (no fluiddensity)
Cardiophrenic Angles Should be fairly clear
Vasculature Check for position and calcification
Hilum- L side generally higher and lookssmaller than R
Heart Size (1/2 width of thorax), Ventricles
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Skeletal
Structures
Skeletal Structures
Scapulae
Humeri & Shoulder
Joints
Clavicles
R ibs (9+ = goodinflation)
Spine
Assessment
Check forsymmetry, spacing,
and fractures. Check for linearity
of the spine.
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Ribs
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Lungs
Start at the top and compare the R and L
Trachea should be midline over thethoracic vertebrae and air filled
Lung parenchyma becomes lighter asyou go down the lung. If not, it may
indicate a lower lobe or pleural effusion
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Lobes
Right upper lobe:
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Lobes (continued)
Right middle lobe:
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Lobes (continued)
Right lower lobe:
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Lobes (continued)
Left lower lobe:
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Lobes (continued)
Left upper lobe with Lingula:
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Lobes (continued)
Lingula:
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Lobes (continued)
Left upper lobe - upper division:
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Heart Size
Cardio-ThoracicR atio
* Up to 50%- adults* Up to 55%- 1-24mths* Up to 60%- neonates
Cardiomegaly* Mild
* Moderate* Severe
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HeartSize of heart
Abnormal CTR > 0.55
Size of individual chambersof heart
Size of pulmonary vessels
Evidence of stents, clips,
wires and valves
Outline of aorta and IVC andSVC
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Heart
1.Right border: Edge of Rt. Atrium
2. Left border: Lt. Ventricle + Lt.Atrium
3. Posterior border: Left Ventricle
4. Anterior border: Right Ventricle
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RA ENLARGEMENT
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LA ENLARGEMENT
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LA & LAA enlargement
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LV enlargement
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RV enlargement
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Heart (continued)
Valves
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Hilum
Made of:
1. Pulmonary Art.+Veins
2. The Bronchi
Left Hilus higher (max 1-2,5 cm)
Identical: size, shape, density
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Hilum
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Mediastinum: Width
Contour
AP window
Hila: Size
Location
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ABNORMAL CHEST X R AY
R adiopacity (whiteness) means increaseddensity
R adiotranslucency (blackness) meansdecreased density
R adiopacity - Alveolar/Interstital Alveolar pattern ± fluffy, soft, poorly demarcated
opacifications < 1 cm in diameter Possible causes:
Pulmonary edema Viral pneumonia Pneumocystis Alveolar cell carcinoma
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Interstitial pattern
Consolidation of interstitial tissue(alveolar walls, intralobular vessels,interlobar septa and connective tissue)
Looks like branching lines radiatingtoward the periphery of the lung
Possible causes:
Interstitial pneumonitis
Pulmonary fibrosis
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R ules for detecting ConcealedConsolidation
Assess Heart borders and domes of diaphragm-Clearly visible/well defined
If Border is ill defined ± Precise site of Concealed consolidation can bededuced.
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Silhouette Sign: When a margin orstructure is masked by another density
Right Side of heart masked by a RML pneumonia
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RUL pneumonia
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RML pneumonia
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LLL pneumonia
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MultipleMasses
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Cephalisation
E l
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Enlargepulmonary
veins withperivascularfluidcollection
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Pleural Effusion
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ARD
S
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Pneumothorax
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RUL collapse
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Air under the diaphragm
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COPD
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Cervical Rib
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Cavitating lesion
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Miliary shadowing
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Chest Tube, NG Tube, Pulm. artery cath
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Hemothorax
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Mnemonic about the items you shouldlook at in a CXR :A: Airways
B: BonesC: Cardiac shadowD: DiaphragmE: Empty spaces
F: Fields of the lungG: Hilar regions
Wh t i th b lit i thi
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What is the abnormality seen in thispediatric AP chest x-ray?