X RAY CHEST

1. Patient particulars2. View- PA / AP / LATERAL / OBLIQUE3. Exposure/penetration4. Centralisation5. Skeleton6. Lung fields7. Cardiovascular silhouette8. Mediastinum9. Costo phrenic & cardio phrenic angles10. Diaphragm11. Soft tissue abn.12. Conclusion

Radiologically, lung fields are divided into 3

ZONES……

UPPER ZONE - From above upto 2nd costal

cartilage

MIDDLE ZONE - 2ND TO 4TH Costal cartilage

LOWER ZONE - Below 4th costal cartilage

Patient particulars

View- Pa / AP / Lateral / Oblique

Should see ribs through the heart

Barely see the spine through the heart

Should see pulmonary vessels nearly to the edges of the lungs

OVERPENETRATED FILM

• Lung fields darker than normal—may obscure subtle pathologies

• See spine well beyond the diaphragms

• Inadequate lung detail

Underpenetrated Film

•Hemidiaphragms are obscured

•Pulmonary markings more prominent than they actually are

Should be able to count 9-10 posterior ribs

Heart shadow should not be hidden by the diaphragm

1

2

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5

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10

Medial ends of

bilateral clavicles

are equidistant from

the midline or

vertebral bodies

If spinous process appears closer to the right clavicle (red arrow), the patient is rotated toward their own left side

If spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side

Check for

Symmetry

Deformities

Fractures

Masses

Calcifications

Lytic lesions

Check for

Cardiomegaly

Mediastinal and Hilar

contours

Trachea- upper med.

Apex of heart- lower med.

Check sharpness of borders

Right is normally higher than left

Check for free air, gastric bubble, pleural effusions

>1.5 cm - normal < 1.0 cm- flat diaphragm

To help you determine abnormalities and their location…

Use silhouettes of other thoracic structures

This is chest radiograph, PA view with normal

exposure, no rotation and without any apparent

bony abnormality. Trachea is placed centrally & lung

fields are clear with normal broncho-vescicular

markings. Cardiovascular silhouette is within normal

limits with normal cardiothoracic ratio. Mediastinum,

costo-phrenic, cardio-phrenic angles, dome of

diaphragm & soft tissue shadow within normal limits.

Remember… be systematic!

Consolidation

a) PNEUMONIA

b) COLLAPSE

c) FIBROSIS

d) PULMONARY INFARCTION

e) CA LUNG

f) TUBERCULOSIS

Multiple bilateral cavitary lesions with air-fluid levels

1. LUNG ABSCESS

2. HYDROPNEUMOTHORAX

3. INFECTED LUNG CYST

PERICARDIAL EFFUSION

DCMP

RHD

IHD

ASD

VSD

SYST HTN

Non homogenious infiltrates

Non homogenious infiltrates

1. PULMONARY TB

2. RESOLVING BACTERIAL PNEUMONIA

3. ALVEOLAR CELL CA

4. PULMONARY EDEMA

5. FUNGAL INFECTION OF LUNG

Dextrocardia

Emphysema

emphysema

1) EMPHYSEMA

2) B/L PNEUMOTHORAX

3) LARGE MULTIPLE BULLAE

4) B. ASTHMA

5) OVER EXPOSED FILM

Normal broncho-vescicular markings

2/31/3

UPTO 2/3 – Normal

BEYOND 2/3 – Chronic bronchitis

Fibosis

Collapse

infiltration

Foreign body ? Trachea

? esophagus

Ans. Is…Lateral X-Ray Chest.

& Symptoms

pneumothorax

1) Pneumothorax

2) Bullae

3) Lung cyst

4) Obtructive emphysema

5) Mastectomy

6) Poor technique

Miliary tuberculosis

1. Miliary tb

2. Tropical eosinophilia

3. Pneumoconiosis

4. Lymphangitis carcinomatosa

5. Extrisic allergic alveolitis

6. Haemosiderosis

7. Sarcoidosis

8. Fungal ds

Homogeneous opacity

Homogenious opacity

Homogenious opacity

Homogenious opacity

Homogenious opacity

1) Pleural effusion

2) Empyema thorasis

3) Collapse

4) Consolidation

5) Thickened pleura

6) Pleural mesothelioma

7) Agenesis of lung

8) Surgical removal

9) Fibrosis

Right lung opacity

Left lung opacity

Ca lung

Loculated pleural effusion

Thank you All the best