INTERPRETITION OF CHEST XRAYS-2
BY
DR MUHAMMAD UBAID
ASSISTANT PROFESSOR OF MEDICINE
BEFORE WE START
• IDENTIFICATION
– Who’s Xray is this?
• PROJECTION
– What is the view (PA,AP, Lateral, any other)
• ORIENTATION
– Right is not always on Right
• ROTATION
– Tilt or no Tilt
• PENETRATION
– Too white or too black
• DEGREE OF INSPIRATION
– Full insipration or not
INTERPRETITION OF CHEST XRAYS
A SHORT TUTORIAL
BY
DR MUHAMMAD UBAID
ASSISTANT PROFESSOR OF MEDICINE
REFERENCE XRAY
REFERENCE XRAY
REFERENCE XRAY
(1)Trachea
(2) Carina
(3,4) Right and left main bronchi
(5,6) Right and left hilar structures
(7) Right horizontal fissure
(8) Right cardiac border formed by
right atrium
(9) Left cardiac border formed by
left ventricle
(10) Aortic knuckle
(11) Descending thoracic aorta
(12) Right paratracheal line
(13,14) Right and left
hemidiaphragms
(15,16) Costophrenic angles
(17) Gastric air bubble
(18) Gas in the colon
REFERENCE XRAY
(1,2) Right and left clavicles
(3,4) Right and left
sternoclavicular joints
(5,6) Right and left scapulae;
(7,8) Right and left humeral heads
(9) Spinous process of T1
(10,11) Right and left transverse
processes of T1;
Anterior ribs(AR) 1–6
Posterior ribs (PR) 1–10.
BEFORE WE START
• IDENTIFICATION
– Who’s Xray is this?
• PROJECTION
– What is the view (PA,AP, Lateral, any other)
• ORIENTATION
– Right is not always on Right
• ROTATION
– Tilt or no Tilt
• PENETRATION
– Too white or too black
• DEGREE OF INSPIRATION
– Full inspration or not
APPROACH TO CHEST RAY
HOW TO INTERPRET
Air, Airway, Apices
Bones
Cardiac shadow, cardiovascular system
Diaphragm
Edges, Effusions, Extrathoracic soft tissues
Field and Foreign bodies
Gastric bubble, Great vessels
Hilum
Impression
MNEMONIC - Alphabet (ABCDEFGHI)
TERMINOLOGIES
• PLEURAL EFFUSION
– FLUID IN THE PLEURAL CAVITY
• PNEUMOTHORAX
– AIR IN THE PLEURAL CAVITY FROM PUNCTURE
• HYDROPNEUMOTHORAX
– BOTH AIR AND FLUID IN THE PLEURAL CAVITY
• CONSOLIDATION / PNUEMONIA
– LOSS OF SPONGINESS AND HARDENING OF LUNG
PARENCHYMA
• HOMOGENOUS DENISTY
– SAME DENSITY WITHIN A ABNORMAL AREA
• HETEROGENOUS DENSITY
– DIFFERENT DENSITIES WITHIN AN ABNORMAL AREA
LETS PLAY!!!!!
AIRWAY
• Ensure trachea is visible and in midline
– Trachea gets pushed away from abnormality
• eg large pleural effusion or tension pneumothorax or mass
– Trachea gets pulled towards abnormality
• eg atelectasis or Fibrosis
– Check for tubes, pacemaker, wires, lines foreign bodies etc
– If an endotracheal tube is in place, check the positioning,
the distal tip of the tube should be 3-4cm above the carina
TRACHEAL DEVIATION- Push
TRACHEAL DEVIATION- Push
TRACHEAL DEVIATION- Pull
BONES
BONES
BONES
CARDIAC SHADOW
The Cardiac Diameter (Yellow & A) should not be more than
50% of the Thoracic Diameter (Blue & B)
CARDIOMEGALY
DIAPHRAGM
TENTING OF DIAPHARGM
Gas Under Right Diaphragm
EFFUSION (PLEURAL EFFUISON)
1- Loss of Costophrenic Angle
2- Meniscus Sign
= Pleural Effusion
MENISCUS SIGN
• Large free pleural effusion appears as a
dependent opacity with a meniscus-shaped
contour
EFFUSION (PLEURAL EFFUISON)
Mild Moderate Severe
PNEUMOTHORAX
A pneumothorax occurs when air leaks into the space between your lung
and chest wall. This air pushes on the outside of your lung and makes it
collapse.
A pneumothorax can be a complete lung collapse or a collapse of only a
portion of the lung
PNEUMOTHORAX
PNEUMOTHORAX
HYRDOPNEUMOTHORAX
Hydropneumothorax is defined as the presence of both air
and fluid within the pleural space. An upright chest x-ray will
show air fluid levels. The horizontal fluid level is usually well
defined and extends across the whole length of one of the
hemithorax
HYRDOPNEUMOTHORAX
LUNG ABSCESS
EXTRA THORACIC SOFT TISSUES
LOBES OF LUNG
LOBES OF LUNG
LOBES OF LUNG
LOBES OF LUNG
LOBES OF LUNG
ZONES OF LUNG (RADIOLOGICAL)
LUNG PARENCHYMAL ABNORMALITIES
• Lung abnormalities with an increased density -
also called opacities - are the most common.
A practical approach is to divide these into
four patterns:
• Consolidation
• Interstitial
• Nodules or masses
• Atelectasis
LUNG PARENCHYMAL ABNORMALITIES
AIR BRONCHOGRAM
Air bronchograms appear on a CXR when something other than
air is present in the alveoli adjacent to a bronchus or
bronchiole, making the air-filled bronchus more conspicuous
than normal
SILHOUETTE SIGN
On chest x-ray, four densities are visible: air, fat, water (fluid, or soft tissues), and metal (bone). When two immediately adjacent organs or tissues share the same density, they cannot be distinguished. In contrast, when a tissue abuts
another tissue of different density, it is silhouetted against the other tissue density. Loss of this normal silhouette, or the development of an unexpected silhouette at the interface of two tissues of similar density, is called the
silhouette sign and indicates a pathologic change in tissue density
SILHOUETTE SIGN
CONSOLIDATION
• OPACITY
• AIR BRONCHOGRAM
• SILHOUETTE SIGN
= CONSOLIDATION (PNEUMONIA)
LOBAR VS BRONCHOPNEUMONIA
DON’T FORGET- MASSES
DON’T FORGET- PULMONARY EDEMA
BAT WING APPEARANCE
DON’T FORGET- PULMONARY EDEMA
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY
INTERPRET THE CHEST XRAY