basic approach for cxr interpretation

Basic approach to chest X-ray interpretation

Lecture 5 Dr. Kosar kamal ahmed

Basics First we should be familiar with normal CXR

Basics

Technical adequacy

• Rotation • Inspiration • Angulation • Penetration

Technical adequacy

• Rotation • Inspiration • Angulation • Penetration

Technical adequacy

• Rotation • Inspiration • Penetration • Angulation

Technical adequacy

• Rotation • Inspiration • Angulation • Penetration

Common normal variants

• Keat’s atlas of normal variants

• Azygos lobe fissure

Variants • Azygos lobe fissure

Variants

• An apparent nodule formed by joint between first rib and calcified cartilage

Variants

Pectus excavatum

How to interpret a CXR ?• Heart failure • Interstitial lung

disease • Pulmonary mass • Pulmonary abscess• Pleural effusion • Diaphragmatic hernia • Hilar pathology • LAP

A suggested form of ticsan inside-outside approach

• Technical adequacy

• Cardiothoracic ratio + CP angles

• Mediastinal contour and para

vertebral lines

• Lung zones

• Hidden areas

• Bony stuctures

Inside to outside approach

• Technical adequacy

• Cardiothoracic ratio + CP

angles

• Mediastinal contour and para

vertebral lines

• Lung zones

• Hidden areas

• Bony stuctures Normal ( clear CP angles )

For pl. effusion click button

pleural fluid and effusion

pleural fluid and effusion

• Sub-pulmonic effusion

Is there any thing look like this ?

Eventration of the diaphragm or paralysis of hemidiaphragm

Eventration of the diaphragm and D. paralysis

pleural fluid and effusion

pleural fluid and effusion

Blunting of the costophrenic angle

pleural fluid and effusion

pleural fluid and effusion Meniscus sign

pleural fluid and effusion Meniscus sign

pleural fluid and effusion

• Layering effusion

• Lamellated effusion

• Loculated effusion ( vanishing

tumor )

What is the clue ? What to do next ?Take a lateral view

Lateral view CXR ( our best friend )

• On a normal lateral view the

contours of the heart are

visible and the IVC is seen

entering the right atrium.

• The retrosternal space should

be radiolucent, since it only

contains air. Any radiopacity in

this area is suspective of a

proces in the anterior

mediastinum or upper lobes of

the lung.

Lateral view CXR ( our best friend )

• As you go from superior to

inferior over the vertebral

bodies they should get darker,

because usually there will be

less soft tissue and more

radiolucent lung tissue (red

arrow).

• If this is not the case, look carefully for

pathology in the lower lobes.

Lateral view CXR ( our best friend )

What additional information can be obtained by lateral view ?

In our field lateral view is for localization

Lateral view CXR ( our best friend )

•The right diaphragm should be

visible all the way to the anterior

chest wall (red arrow).

•The left diaphragm can only be

seen to a point where it borders the

heart (blue arrow).

Lateral view CXR ( our best friend )

•From lateral view we can differentiate between hilar

masses ( LN or vascular lesions

Lateral view CXR ( our best friend )From lateral view we can differentiate between hilar masses ( LN or vascular

lesions

Hilar LAPPulm. HTN

Lateral view CXR ( our best friend )

• On the Paview the superior mediastinum is widened.

• The lateral view is helpful in this case because it demonstrates a density in the retrosternal

space.

• Now the differential diagnosis is limited to a mass in the anterior mediastinum (4 T's).

Lateral view CXR ( our best friend )

• 4 T s :

• Thymoma

• Teratoma

• Thyroid ( retrosternal )

• Terrible lymphoma

Let’s go back to where we skipped

• Technical adequacy

• Cardiothoracic ratio + CP angles

• Mediastinal contour and para

vertebral lines

• Lung zones

• Hidden areas

• Bony stuctures

End of part one

Thank you for your attension