Chest X-ray Anna

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CHEST X-RAY

.Anna Ben Ely M.D

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Willhem Konrad Roentgen 1895

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Effective dose equivalent from diagnostic medical exposures

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Positioning The standard chest examination : PA (posterioranterior) + lateral chest x-ray.

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Positioning left chest against the cassette

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AP supine film

magnification of the heart and widening of the mediastinum A Free sample background from www.powerpointbackgrounds.com

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Lateral decubitus position

pleural effusion pneumothorax air trapping A Free sample background from www.powerpointbackgrounds.com

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Technically adequate 

Inspiration

– diaphragm at the level of the 8th - 10th posterior rib or 5th - 6th anterior rib

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Technically adequate  Penetration

PA : -thoracic spine disc spaces should be visible through the heart Lat: -“More black sign” -The sternum should be seen edge on posteriorly you should see two sets of ribs

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Technically adequate

underpenetrated normal PA film A Free sample background from www.powerpointbackgrounds.com

overpenetrated normal PA film

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Chest X-ray anatomy

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Bronchi

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Lobes and Fissures

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Lobes and Fissures

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Lobes and Fissures

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Diaphragm

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Mediastinum 1 Superior Vena Cava

2. Right Atrium 3. Aortic Arch 4. Edge of Main Pulmonary Artery 5. Left Atrial Appendage 6. Left Ventricle A Free sample background from www.powerpointbackgrounds.com

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Mediastinum 1. Trachea 2. Right Ventricle 3. Left Ventricle 4. Left Atrium 5. Right Pulmonary Artery A Free sample background from www.powerpointbackgrounds.com

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Pulmonary Vasculature A = Apical segmental bronchus B = Posterior segmental bronchus C = Anterior segmental bronchus D = Bronchus intermedius E = Truncus anterior F = Carina G = Right main pulmonary artery H = Left main pulmonary artery I = Right inferior pulmonary artery J = Right superior pulmonary vein K = Right middle lobe bronchus L = Right lower lobe bronchus M = Right inferior pulmonary vein N = Left Atrium O = Left superior pulmonary vein P = Apicoposterior segmental bronchus Q = Left upper lobe bronchus R = Lingular bronchus S = Left inferior pulmonary artery T = Left inferior pulmonary vein A Free sample background from www.powerpointbackgrounds.com

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Pulmonary Vasculature

left pulmonary artery passes over the left mainstem bronchus to descend behind it A Free sample background from www.powerpointbackgrounds.com

RPA passes behind the ascending aorta

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Mediastinum and Lungs

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Silhouette sign

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loss of lung/soft tissue interface

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mass or fluid in the normally air filled lung

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Air Bronchogram 

tubular outline of airway

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filling of surrounding alveoli by fluid

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causes : – lung consolidation – pulmonary edema – nonobstructive pulmonary atelectasis – severe interstitial disease – neoplasm – normal expiration

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Solitary Pulmonary Nodule 

compare with prior films if available

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nodule unchanged for two years - almost certainly benign

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completely calcifiedbenign

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Solitary Pulmonary Nodule

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Atelectasis  collapse or incomplete expansion of the lung

or part of the lung

– endobronchial lesion – extrinsic compression – cicatricial

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Atelectasis

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Atelectasis

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Pulmonary Edema

cephalization of pulmonary veins indistinctness of the vascular margins A Free sample background from www.powerpointbackgrounds.com

"bat wing" pattern

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Kerley B lines   

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horizontal lines less than 2cm long commonly found in the lower zone periphery thickened, edematous interlobular septa

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Pneumonia  Consolidation: air spaces filled with

bacteria or other microorganisms and pus  is NOT associated with volume loss  bacteria, viruses, mycoplasmae, fungi  x-ray findings : – airspace opacity, – lobar consolidation – interstitial opacities – may have an associated parapneumonic effusion.

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Pneumonia

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Pleural Effusion  CHF,

infection (parapneumonic), trauma, PE, tumor, autoimmune disease, renal failure

 200 ml of fluid - frontal film  75ml – lateral  Larger unilateral effusions are more likely

malignant

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Pleural Effusion

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Pneumothorax  air

inside the thoracic cavity but outside the lung

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spontaneous pneumothorax- without obvious inciting incident: idiopathic, asthma, COPD, pulmonary infection, neoplasm, Marfanâs syndrome, smoking cocaine most pneumothoraces are iatrogenic trauma tension PTX : air enters the pleural cavity and is trapped during expiration

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Pneumothorax

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Hydropneumothorax

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Emphysema

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Anterior Mediastinal Mass  4 "T's"

– Terrible lymphadenopathy – Thymic tumors – Teratoma – Thyroid mass  aortic aneurysm  pericardial cyst  epicardial fat pad

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Anterior Mediastinal Mass

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Middle Mediastinal Mass  The most common cause of a middle

mediastinal mass is lymphadenopathy

hiatial hernia  aortic aneurysm  thyroid mass  duplication cyst  bronchogenic cyst 

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Middle Mediastinal Mass

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Posterior Mediastinal Mass  Neoplasm  Lymphadenopathy  aortic aneurysm  adjacent pleural or lung mass  neurenteric cyst  lateral meningocele 

extramedullary hematopoiesis

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Posterior Mediastinal Mass

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Pericardial Effusion 

400-500 ml of fluid

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Pneumomediastinum

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Trauma - Rib fracture

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Thank you A Free sample background from www.powerpointbackgrounds.com