Chest X-ray Anna
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Slide 1
© 2003 By Default!
CHEST X-RAY
.Anna Ben Ely M.D
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Slide 2
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Willhem Konrad Roentgen 1895
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Slide 3
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Effective dose equivalent from diagnostic medical exposures
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Slide 4
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© 2003 By Default!
Slide 5
© 2003 By Default!
Positioning The standard chest examination : PA (posterioranterior) + lateral chest x-ray.
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Slide 6
© 2003 By Default!
Positioning left chest against the cassette
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Slide 7
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AP supine film
magnification of the heart and widening of the mediastinum A Free sample background from www.powerpointbackgrounds.com
Slide 8
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Lateral decubitus position
pleural effusion pneumothorax air trapping A Free sample background from www.powerpointbackgrounds.com
Slide 9
© 2003 By Default!
Technically adequate
Inspiration
– diaphragm at the level of the 8th - 10th posterior rib or 5th - 6th anterior rib
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Slide 10
© 2003 By Default!
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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Slide 11
© 2003 By Default!
Technically adequate
underpenetrated normal PA film A Free sample background from www.powerpointbackgrounds.com
overpenetrated normal PA film
Slide 12
© 2003 By Default!
Chest X-ray anatomy
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Slide 13
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Bronchi
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Slide 14
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Lobes and Fissures
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Slide 15
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Lobes and Fissures
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Slide 16
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Lobes and Fissures
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Slide 17
© 2003 By Default!
Diaphragm
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Slide 18
© 2003 By Default!
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
Slide 19
© 2003 By Default!
Mediastinum 1. Trachea 2. Right Ventricle 3. Left Ventricle 4. Left Atrium 5. Right Pulmonary Artery A Free sample background from www.powerpointbackgrounds.com
Slide 20
© 2003 By Default!
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
Slide 21
© 2003 By Default!
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
Slide 22
© 2003 By Default!
Mediastinum and Lungs
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Slide 23
© 2003 By Default!
Silhouette sign
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loss of lung/soft tissue interface
mass or fluid in the normally air filled lung
Slide 24
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© 2003 By Default!
Slide 25
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© 2003 By Default!
Slide 26
© 2003 By Default!
Air Bronchogram
tubular outline of airway
filling of surrounding alveoli by fluid
causes : – lung consolidation – pulmonary edema – nonobstructive pulmonary atelectasis – severe interstitial disease – neoplasm – normal expiration
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Slide 27
© 2003 By Default!
Solitary Pulmonary Nodule
compare with prior films if available
nodule unchanged for two years - almost certainly benign
completely calcifiedbenign
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Slide 28
© 2003 By Default!
Solitary Pulmonary Nodule
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Slide 29
© 2003 By Default!
Atelectasis collapse or incomplete expansion of the lung
or part of the lung
– endobronchial lesion – extrinsic compression – cicatricial
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Slide 30
© 2003 By Default!
Atelectasis
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Slide 31
© 2003 By Default!
Atelectasis
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Slide 32
© 2003 By Default!
Pulmonary Edema
cephalization of pulmonary veins indistinctness of the vascular margins A Free sample background from www.powerpointbackgrounds.com
"bat wing" pattern
Slide 33
© 2003 By Default!
Kerley B lines
horizontal lines less than 2cm long commonly found in the lower zone periphery thickened, edematous interlobular septa
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Slide 34
© 2003 By Default!
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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Slide 35
© 2003 By Default!
Pneumonia
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Slide 36
© 2003 By Default!
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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Slide 37
© 2003 By Default!
Pleural Effusion
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Slide 38
© 2003 By Default!
Pneumothorax air
inside the thoracic cavity but outside the lung
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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Slide 39
© 2003 By Default!
Pneumothorax
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Slide 40
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Hydropneumothorax
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Slide 41
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Emphysema
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Slide 42
© 2003 By Default!
Anterior Mediastinal Mass 4 "T's"
– Terrible lymphadenopathy – Thymic tumors – Teratoma – Thyroid mass aortic aneurysm pericardial cyst epicardial fat pad
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Slide 43
© 2003 By Default!
Anterior Mediastinal Mass
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Slide 44
© 2003 By Default!
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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Slide 45
© 2003 By Default!
Middle Mediastinal Mass
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Slide 46
© 2003 By Default!
Posterior Mediastinal Mass Neoplasm Lymphadenopathy aortic aneurysm adjacent pleural or lung mass neurenteric cyst lateral meningocele
extramedullary hematopoiesis
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Slide 47
© 2003 By Default!
Posterior Mediastinal Mass
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Slide 48
© 2003 By Default!
Pericardial Effusion
400-500 ml of fluid
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Slide 49
© 2003 By Default!
Pneumomediastinum
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Slide 50
© 2003 By Default!
Trauma - Rib fracture
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Slide 51
© 2003 By Default!
Thank you A Free sample background from www.powerpointbackgrounds.com
© 2003 By Default!
CHEST X-RAY
.Anna Ben Ely M.D
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Slide 2
© 2003 By Default!
Willhem Konrad Roentgen 1895
A Free sample background from www.powerpointbackgrounds.com
Slide 3
© 2003 By Default!
Effective dose equivalent from diagnostic medical exposures
A Free sample background from www.powerpointbackgrounds.com
Slide 4
A Free sample background from www.powerpointbackgrounds.com
© 2003 By Default!
Slide 5
© 2003 By Default!
Positioning The standard chest examination : PA (posterioranterior) + lateral chest x-ray.
A Free sample background from www.powerpointbackgrounds.com
Slide 6
© 2003 By Default!
Positioning left chest against the cassette
A Free sample background from www.powerpointbackgrounds.com
Slide 7
© 2003 By Default!
AP supine film
magnification of the heart and widening of the mediastinum A Free sample background from www.powerpointbackgrounds.com
Slide 8
© 2003 By Default!
Lateral decubitus position
pleural effusion pneumothorax air trapping A Free sample background from www.powerpointbackgrounds.com
Slide 9
© 2003 By Default!
Technically adequate
Inspiration
– diaphragm at the level of the 8th - 10th posterior rib or 5th - 6th anterior rib
A Free sample background from www.powerpointbackgrounds.com
Slide 10
© 2003 By Default!
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
A Free sample background from www.powerpointbackgrounds.com
Slide 11
© 2003 By Default!
Technically adequate
underpenetrated normal PA film A Free sample background from www.powerpointbackgrounds.com
overpenetrated normal PA film
Slide 12
© 2003 By Default!
Chest X-ray anatomy
A Free sample background from www.powerpointbackgrounds.com
Slide 13
© 2003 By Default!
Bronchi
A Free sample background from www.powerpointbackgrounds.com
Slide 14
© 2003 By Default!
Lobes and Fissures
A Free sample background from www.powerpointbackgrounds.com
Slide 15
© 2003 By Default!
Lobes and Fissures
A Free sample background from www.powerpointbackgrounds.com
Slide 16
© 2003 By Default!
Lobes and Fissures
A Free sample background from www.powerpointbackgrounds.com
Slide 17
© 2003 By Default!
Diaphragm
A Free sample background from www.powerpointbackgrounds.com
Slide 18
© 2003 By Default!
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
Slide 19
© 2003 By Default!
Mediastinum 1. Trachea 2. Right Ventricle 3. Left Ventricle 4. Left Atrium 5. Right Pulmonary Artery A Free sample background from www.powerpointbackgrounds.com
Slide 20
© 2003 By Default!
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
Slide 21
© 2003 By Default!
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
Slide 22
© 2003 By Default!
Mediastinum and Lungs
A Free sample background from www.powerpointbackgrounds.com
Slide 23
© 2003 By Default!
Silhouette sign
A Free sample background from www.powerpointbackgrounds.com
loss of lung/soft tissue interface
mass or fluid in the normally air filled lung
Slide 24
A Free sample background from www.powerpointbackgrounds.com
© 2003 By Default!
Slide 25
A Free sample background from www.powerpointbackgrounds.com
© 2003 By Default!
Slide 26
© 2003 By Default!
Air Bronchogram
tubular outline of airway
filling of surrounding alveoli by fluid
causes : – lung consolidation – pulmonary edema – nonobstructive pulmonary atelectasis – severe interstitial disease – neoplasm – normal expiration
A Free sample background from www.powerpointbackgrounds.com
Slide 27
© 2003 By Default!
Solitary Pulmonary Nodule
compare with prior films if available
nodule unchanged for two years - almost certainly benign
completely calcifiedbenign
A Free sample background from www.powerpointbackgrounds.com
Slide 28
© 2003 By Default!
Solitary Pulmonary Nodule
A Free sample background from www.powerpointbackgrounds.com
Slide 29
© 2003 By Default!
Atelectasis collapse or incomplete expansion of the lung
or part of the lung
– endobronchial lesion – extrinsic compression – cicatricial
A Free sample background from www.powerpointbackgrounds.com
Slide 30
© 2003 By Default!
Atelectasis
A Free sample background from www.powerpointbackgrounds.com
Slide 31
© 2003 By Default!
Atelectasis
A Free sample background from www.powerpointbackgrounds.com
Slide 32
© 2003 By Default!
Pulmonary Edema
cephalization of pulmonary veins indistinctness of the vascular margins A Free sample background from www.powerpointbackgrounds.com
"bat wing" pattern
Slide 33
© 2003 By Default!
Kerley B lines
horizontal lines less than 2cm long commonly found in the lower zone periphery thickened, edematous interlobular septa
A Free sample background from www.powerpointbackgrounds.com
Slide 34
© 2003 By Default!
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.
A Free sample background from www.powerpointbackgrounds.com
Slide 35
© 2003 By Default!
Pneumonia
A Free sample background from www.powerpointbackgrounds.com
Slide 36
© 2003 By Default!
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
A Free sample background from www.powerpointbackgrounds.com
Slide 37
© 2003 By Default!
Pleural Effusion
A Free sample background from www.powerpointbackgrounds.com
Slide 38
© 2003 By Default!
Pneumothorax air
inside the thoracic cavity but outside the lung
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
A Free sample background from www.powerpointbackgrounds.com
Slide 39
© 2003 By Default!
Pneumothorax
A Free sample background from www.powerpointbackgrounds.com
Slide 40
© 2003 By Default!
Hydropneumothorax
A Free sample background from www.powerpointbackgrounds.com
Slide 41
© 2003 By Default!
Emphysema
A Free sample background from www.powerpointbackgrounds.com
Slide 42
© 2003 By Default!
Anterior Mediastinal Mass 4 "T's"
– Terrible lymphadenopathy – Thymic tumors – Teratoma – Thyroid mass aortic aneurysm pericardial cyst epicardial fat pad
A Free sample background from www.powerpointbackgrounds.com
Slide 43
© 2003 By Default!
Anterior Mediastinal Mass
A Free sample background from www.powerpointbackgrounds.com
Slide 44
© 2003 By Default!
Middle Mediastinal Mass The most common cause of a middle
mediastinal mass is lymphadenopathy
hiatial hernia aortic aneurysm thyroid mass duplication cyst bronchogenic cyst
A Free sample background from www.powerpointbackgrounds.com
Slide 45
© 2003 By Default!
Middle Mediastinal Mass
A Free sample background from www.powerpointbackgrounds.com
Slide 46
© 2003 By Default!
Posterior Mediastinal Mass Neoplasm Lymphadenopathy aortic aneurysm adjacent pleural or lung mass neurenteric cyst lateral meningocele
extramedullary hematopoiesis
A Free sample background from www.powerpointbackgrounds.com
Slide 47
© 2003 By Default!
Posterior Mediastinal Mass
A Free sample background from www.powerpointbackgrounds.com
Slide 48
© 2003 By Default!
Pericardial Effusion
400-500 ml of fluid
A Free sample background from www.powerpointbackgrounds.com
Slide 49
© 2003 By Default!
Pneumomediastinum
A Free sample background from www.powerpointbackgrounds.com
Slide 50
© 2003 By Default!
Trauma - Rib fracture
A Free sample background from www.powerpointbackgrounds.com
Slide 51
© 2003 By Default!
Thank you A Free sample background from www.powerpointbackgrounds.com
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