radiology of chest 2

8/14/2019 Radiology of Chest 2

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X- RAY CHESTX- RAY CHEST

How To Read & InterpretHow To Read & Interpret


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Keep the patients age, sex & clinicalKeep the patients age, sex & clinical

information in mind.information in mind. Follow your own systematic approach &Follow your own systematic approach &

strict to it. You will never miss findings.strict to it. You will never miss findings.

See all four corners of the film.See all four corners of the film. Always compare both sides.Always compare both sides.


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See the IdentificationSee the Identification

number, name etc.number, name etc.

Observe right & leftObserve right & left

markers.markers.

See the date ofSee the date ofexamination.examination.


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See the Exposure.See the Exposure.

Optimal exposure is that in which vertebralOptimal exposure is that in which vertebralbodies & intervertebral discs are justbodies & intervertebral discs are just

visible behind the heart shadow.visible behind the heart shadow.

Avoid over or under exposed films.Avoid over or under exposed films.


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POSITIONPOSITION

Observe theObserve the

position of theposition of the

patient.patient. Medial ends of theMedial ends of the

clavicles should beclavicles should be

equidistant fromequidistant from

spinous processspinous process

of dorsal vertebrae-of dorsal vertebrae-

usually T4.usually T4.


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TRACHEATRACHEA

Observe the TracheaObserve the Tracheafor narrowing,for narrowing,

displacement &displacement &intraluminal lesions..intraluminal lesions.. It is usually central &It is usually central &

sometimes slightlysometimes slightly

shifted to right.shifted to right. Deviation suggestsDeviation suggests

pathology.pathology.


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TRACHEATRACHEA

Right Para Tracheal Stripe:Right Para Tracheal Stripe: Seen in 60% of chest x rays.Seen in 60% of chest x rays. Normally less than 5 mm.Normally less than 5 mm.Widening is caused by:Widening is caused by:

Mediastinal lymphadenopathy.Mediastinal lymphadenopathy.

Tracheal malignancy.Tracheal malignancy. Pleural effusion.Pleural effusion. MediastinitisMediastinitis..


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TRACHEATRACHEA

Carina is at T4 level.Carina is at T4 level.

Carinal Angle is normally 60-75Carinal Angle is normally 60-75degrees.degrees.

Widening occurs inWidening occurs in

Enlarged left atrium.Enlarged left atrium.

Enlarged carinal lymph nodes.Enlarged carinal lymph nodes.


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LUNG FIELDSLUNG FIELDS

Compare corresponding lung fields inCompare corresponding lung fields in

both lungsboth lungs ApicesApices

Upper zonesUpper zones

Mid zonesMid zones

Lower zonesLower zones


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LUNG FIELDSLUNG FIELDS

See for abnormal area of lucency.See for abnormal area of lucency.

Uneven distribution of lung markings.Uneven distribution of lung markings.

The size of upper & lower zone vessels.The size of upper & lower zone vessels. Look for any abnormal opacity.Look for any abnormal opacity.

Characterize the opacity by looking at location, extent,Characterize the opacity by looking at location, extent,

specific features such as calcification or cavitation etc.specific features such as calcification or cavitation etc.


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HIDDEN AREASHIDDEN AREAS

Look again at apices.Look again at apices.

Look again behind heart shadow.Look again behind heart shadow. Look bones esp at the overlappingLook bones esp at the overlapping

areas.areas.

Look the sharpness of cardiac,Look the sharpness of cardiac,mediastinal & diaphragmaticmediastinal & diaphragmatic borders.borders.


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COSTOPHERENIC ANGLESCOSTOPHERENIC ANGLES

Normally they are acute.Normally they are acute.

Blunting indicatesBlunting indicates EffusionEffusion

FibrosisFibrosis

Pad of fatPad of fat

Overinflated lungsOverinflated lungs


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PLEURA & DIAPHRAGMPLEURA & DIAPHRAGM

Right dome is usually higher than left.Right dome is usually higher than left.A difference of more than 3 cms isA difference of more than 3 cms is

significant.significant.

Raised dome indicate pathology.Raised dome indicate pathology.


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Diaphragmatic borderDiaphragmatic border Ill defined(Rt)Ill defined(Rt)

Ill defined(Lt)Ill defined(Lt)

Diaphragmatic positionDiaphragmatic position Abnormal(Rt)Abnormal(Rt)

Abnormal(Lt)Abnormal(Lt)

Free air under diaphragmFree air under diaphragm

Pleural borderPleural border Pneumothorax(Rt. or Lt)Pneumothorax(Rt. or Lt)

Pleural effusion(RT. or Lt)Pleural effusion(RT. or Lt)

Pleural thickeningPleural thickening


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THE HILUMTHE HILUM

Left hilum is 1-2 cms higher thanLeft hilum is 1-2 cms higher thanright.right.

The hila are composed ofThe hila are composed of Pulmonary artery and their mainPulmonary artery and their main

branches.branches.

Upper lobe pulmonary veins.Upper lobe pulmonary veins.

The major bronchi.The major bronchi. The lymph glands.The lymph glands.


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THE HILUMTHE HILUM

Compare position of right & left hilumCompare position of right & left hilum SizeSize

a. Enlargeda. Enlarged

b. Diminishedb. Diminished


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HEARTHEART Usually 2/3rd of heart shadow lies to theUsually 2/3rd of heart shadow lies to the

left of midline and 1/3rd to the right.left of midline and 1/3rd to the right.

Cardio-thoracic ratioCardio-thoracic ratio::

It is the ratio between maximumIt is the ratio between maximumtransverse cardiac diameter to thetransverse cardiac diameter to themaximum inner transverse diameter ofmaximum inner transverse diameter of

chest above CP angles.chest above CP angles. Normal C.T ratio is 0.5 or less. It is higherNormal C.T ratio is 0.5 or less. It is higher

in children.in children.


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RIGHT HEART BORDERRIGHT HEART BORDER

It is formed by:It is formed by:

Innominate vesselsInnominate vesselsSuperior vena cavaSuperior vena cava

Right atriumRight atrium

Small part of inferior vena cavaSmall part of inferior vena cava


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LEFT HEART BORDERLEFT HEART BORDER

It is formed by:It is formed by:

Subclavian arterySubclavian arteryAortic knuckleAortic knucklePulmonary bayPulmonary bay

Left arterial appendageLeft arterial appendage Left ventricleLeft ventricle


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SOFT TISSUESSOFT TISSUES Chest Wall soft tissue, breast shadow etc.Chest Wall soft tissue, breast shadow etc.

IncreaseIncrease DecreaseDecrease AbsenceAbsence

Soft tissue of NeckSoft tissue of Neck AsymmetryAsymmetry

Shoulder area soft tissueShoulder area soft tissue AsymmetryAsymmetry

CalcificationCalcification Upper abdomen soft tissueUpper abdomen soft tissue

CalcificationCalcification Abnormal air ( GI tract, or Outside)Abnormal air ( GI tract, or Outside)


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O S


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BONESBONES

RibsRibs Count pair of ribs( compare right to left)Count pair of ribs( compare right to left)

Missing ribMissing rib Asymmetric intercostals spacesAsymmetric intercostals spaces

Cervical ribsCervical ribs

Trace rib outlineTrace rib outline

FracturesFractures

MetastasisMetastasis


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BONES


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BONESBONES ClaviclesClavicles

FracturesFractures


JointsJoints ScapulaeScapulae

FracturesFractures


JointsJoints HumerusHumerus

FracturesFractures


Shoulder JointShoulder Joint CalcificationCalcification WideningWidening

NarrowingNarrowing

DislocationDislocation


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BONESBONES


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BONESBONES

Spine.Spine.

PA ViewPA View PediclesPedicles

ScoliosisScoliosis

Lat. ViewLat. View Vertebral heightVertebral height

KyphosisKyphosis


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radiology of chest 2

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