interpretation of chest x ray

Interpretation of Chest X-Ray

WILHELM KONARD ROENTGEN

FATHER OF X-RAYWILHELM KONARD ROENTGEN (1845-

1923)German scientist Discovered X-rays on November 8th 1895Received 1st noble prize in physics in 1901 Refused to obtain patent right for his

discovery Died in poverty on February 10th 1923Despite poverty, donated entire nobel

prize money to the university of Wurtzberg

First X-ray Picture

•Air

•Fat

•Soft Tissue (Muscle Fluid)

•Metal (Bone)

Differential Absorption of Radiation

Normal X-ray ChestName AgeSexID No.L/R markingDate/Month/Year

Compare previous films if availableNormal X-ray chest does not exclude

pathology

Normal looking

Normal Looking Lat

RLL Consolidation

Are You Looking at Your Patients X-ray?

X-Ray Chest ViewsPA ViewAP ViewLateral ViewsLordotic ViewsLateral Decubitus ViewOblique View

Normal PA FilmFilm exposed keeping the subject at 6ft Full inspiration Rays coming from behindFilm cassette in front of chestScapula away

AP View

AP VIEW

Importance of lateral view

Exposure /PositioningExposureWhitish Photograph – under exposure, under

penetration, under developmentDark Photograph – over exposure, over

penetration, over development

Normally only upto 4th vertebral body is seen.

PositioningDistance between medial end of clavicle and the

vertebral spine must be equal

Technically Adequate Chest X-rayFactors to evaluate

PenetrationInspirationRotationAngulation

If the film is under penetrated the left hemi diaphragm will not be visible and the pulmonary markings will be appeared more prominent than they actually are.

Inspiration-about 10 posterior ribs visible in good inspiration

Under penetrated

Rotated Film

Rotated Film Cardio Megaly

Inspiration/ExpirationExposure must be in deep inspirationPoor inspiration – basal congestion, diaphragm

high, increased cardiac diameter, CP angle less acute, widened superior mediastinum.

Expiration FilmTo check air trapping. Unilateral wheeze – always

order expiratory film

Zones Upper – apex to horizontal line drawn at the

lower end of second rib anteriorly

Mid – below upper zone to horizontal line drawn at the lower end of fourth rib anteriorly

Lower – below mid zone to diaphragm

PA Normal

Upper

Mid

Lower

Acronym – Reading X-ray Chest

A. Airway

B. Bony Cage

C.Cardiac (central)

D. Diaphragm

E.External (soft tissue)

F. Fields (lung)

G. Gut (stomach, colon)

H. Hilam

A B

C

D

E

F

G

H

1

2 34

5

6

7

8

9

101

1

X ray Chest Reading SequenceA- Abdomen

T- Thorax

M- Mediastinum

L- Lung- Unilateral

L- Lung – Bilateral

X ray chest reading technique

Most lung disease result in increased radiodensity of the lung:

a. If the interstitial thickening is generalized - the

pattern is linear ( Reticular)

b. If the thickening is discrete - forms multiple

nodules.

c. If alveoli filled with fluid - becomes radiodense.

Insterstitium envoloped in the dense white lung

is not visible.

d. Air – Black Shadow

Most diffuse interstitial lung disease is chronic

and usually due to fibrosis

Acute diffuse interstitial lung disease is due to

Pulmonary Edema/ Viral or Mycoplasma

Pneumonia.

Most alveolar disease is acute – air spaces filled

with fluid , cells, blood, mucus, pus

PATHOLOGY

A. Airways

B. Bony Cage

Erosion Rib

Lytic lesion clavicle

Lytic Lesion Clavicle, Scapula

Rib Destruction

Kyphoscoliosis

Thoracoplasty

C. Cardiac (Central)

CardiomegalyCT ratio more than 50%-but heart is

normal1.Portable AP film2.Obesity 3.Pregnancy 4.Ascites5.Straight back syndrome6.Pectus excavatumIf the heart touches lateral wall,it is

enlarged

Dextrocardia

Unfolded Aorta

Pericardial Effusion

Dilated cardio myopathy

Kerly B Lines

Pneumomediastinum

D. Diaphragm

Check Diaphragm always

Air Under

Localised Eventration

Rt Dome High

ELEVATED RIGHT DOME

Emphysema

E. External (soft tissue)

Lt Breast

Rt Breast missing

Subcut. Emphysema

F. Fields (Lungs)

The Silhouette Sign

Two substances of same density, in direct contact, can not be differentiated from each other on an x-ray.This phenomenon, the loss of normal radiographic silhouette(contour), is called the silhouette sign.

Silhoutte signRight heart border Anterior

Descending aorta Posterior

Left heart border Anterior

Ascending aorta Anterior

Aortic knob Mid posterior

Silhoutte signSilhoutte Adjacent organ or

segmentDiaphragm LL basal segments

Right heart border RML Pathology

Ascending aorta RUL anterior segment

Aortic knob LUL apico posterior segment

Left heart border Lingular pathology

Descending aorta Left lower lobe apical

Lobar pneumonia

Segmental Pneumonia

S curve

LUL Pneumonia PA

Left Lower Lobe

Lingular pneumonia

Round Pneumonia

Atelectasis Left

Atelectasis Right

Atelectasis Left Lower Lobe

RLL Collapse

Atelectasis right upper lobe

Multiple Fluid Levels

The most frequent causes of acute diffuse alveolar

disease ( air space filling disease ) are bacterial

pneumonia and severe pulmonary edema.

The most frequent cause of focal alveolar

consolidation is also infection.

Sub acute alveolar consolidation is often

granulomatous infection ( Tuberculosis, Fungal)

Radiological signs of diffuse Interstitial lung disease:

1. “ Pulmonary markings” are _____ visible 1. more

2. The lung appears ______ 2. aerated

3. An air bronchogram is _____ visible 3. seldom

4. The silhouette sign ______ visible 4. is not

5. Two signs of chronic disease include ____and

______

5. distortion, honey

combing

Radiographic signs of alveolar filling disease or airspace

consolidation:

1. Vessels are _____ visible in the area of disease 1. less

2. The diseased lung appears ______ 2. not

aerated

3. An air bronchogram _____ visible 3. may be

4. A silhouette sign _______ visible 4. may be

Alveolar cell ca.

Bil. bronchiectasis

Miliary TB

Pulmonary Edema

Alveolar Protenosis

Cannon Ball

Cavitating carcinoma

Honeycombing

Fungal Ball

Lat decubitus fungal ball

Large Bullae

PLEURA

Loculated effusion

Sailsign

Pleural calcification

Pneumothorax COPD

G. Gut

Situs inversus

H. Hilam

Egg Shell

Hilar Nodes

Rt Hilam elevated

Rt Hilar adenopathy

Fleeting Shadows

Rib Notching

interpretation of chest x ray

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