x thorax beoordelen
DESCRIPTION
x Thorax BeoordelenTRANSCRIPT
![Page 1: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/1.jpg)
Basic Chest X-Ray Interpretation
R. Baak, acute zorg presentatie
![Page 2: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/2.jpg)
X-rays- describe radiation which is part of the
spectrum which includes visible light, gamma
rays and cosmic radiation.
Unlike visible light, radiation passes through
stuff.
When you shine a beam of X-Ray at a person
and put a film on the other side of them a
shadow is produced of the inside of their body.
![Page 3: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/3.jpg)
Different tissues in our body absorb X-rays at
different extents:
•Bone- high absorption (white)
•Tissue- somewhere in the middle absorption (grey)
•Air- low absorption (black)
![Page 4: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/4.jpg)
![Page 5: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/5.jpg)
Essentials Before Getting
Started• Exposure
– Overexposure
– Underexposure
• Sex of Patient
– Male
– Female
![Page 6: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/6.jpg)
Be
systematic
:
1) Check the quality of the film
![Page 7: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/7.jpg)
Systematic Approach
• Bony Fragments
– Ribs
– Sternum
– Spine
– Shoulder girdle
– Clavicles
![Page 8: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/8.jpg)
Film Quality
• First determine is the film a PA or AP view.
PA- the x-rays penetrate through the back of the patient
on to the film
AP-the x-rays penetrate through the front of the patient
on to the film.
All x-rays in the PICU are portable and are AP view
![Page 9: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/9.jpg)
Film Quality (cont)
• Was film taken under full inspiration?
-10 posterior ribs should be visible.
Why do I say posterior here?
When X-ray beams pass through the anterior chest on to the film
Under the patient, the ribs closer to the film (posterior) are most
apparent.
A really good film will show anterior ribs too, there should
Be 6 to qualify as a good inspiratory film.
![Page 10: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/10.jpg)
![Page 11: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/11.jpg)
Quality (cont.)
• Is the film over or
under penetrated if
under penetrated you
will not be able to see
the thoracic
vertebrae.
![Page 12: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/12.jpg)
Quality (cont)
• Check for rotation
– Does the thoracic
spine align in the
center of the sternum
and between the
clavicles?
– Are the clavicles level?
![Page 13: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/13.jpg)
Verify Right and Left sides
• Gastric bubble should be on the left
![Page 14: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/14.jpg)
![Page 15: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/15.jpg)
![Page 16: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/16.jpg)
Now you are ready
• Look at the diaphram:
for tenting
free air
abnormal elevation
• Margins should be
sharp
(the right hemidiaphram is
usually slightly higher than
the left)
![Page 17: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/17.jpg)
Pitfalls to Chest X-ray
Interpretation• Poor inspiration
• Over or under penetration
• Rotation
• Forgetting the path of the x-ray beam
![Page 18: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/18.jpg)
Check the Heart
• Size
• Shape
• Silhouette-margins should be sharp
• Diameter (>1/2 thoracic diameter is
enlarged heart)
Remember: AP views make heart appear larger than it
actually is.
![Page 19: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/19.jpg)
Cardiac Silhouette
1. R Atrium
2. R Ventricle
3. Apex of L Ventricle
4. Superior Vena Cava
5. Inferior Vena Cava
6. Tricuspid Valve
7. Pulmonary Valve
8. Pulmonary Trunk
9. R PA 10. L PA
![Page 20: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/20.jpg)
![Page 21: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/21.jpg)
![Page 22: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/22.jpg)
Check the costophrenic angles
Margins should
be sharp
![Page 23: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/23.jpg)
Loss of Sharp Costophrenic Angles
![Page 24: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/24.jpg)
Check the hilar region
• The hilar – the large
blood vessels going
to and from the lung
at the root of each
lung where it meets
the heart.
• Check for size and
shape of aorta,
nodes,enlarged
vessels
![Page 25: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/25.jpg)
![Page 26: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/26.jpg)
Finally, Check the Lung Fields
• Infiltrates
• Increased interstitial markings
• Masses
• Absence of normal margins
• Air bronchograms
• Increased vascularity
![Page 27: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/27.jpg)
Lung Anatomy on Chest X-ray
• PA View:
– Extensive overlap
– Lower lobes extend
high
• Lateral View:
– Extent of lower lobes
![Page 28: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/28.jpg)
Lung Anatomy on Chest X-ray
• The right upper lobe
(RUL) occupies the upper
1/3 of the right lung.
• Posteriorly, the RUL is
adjacent to the first three
to five ribs.
• Anteriorly, the RUL
extends inferiorly as far as
the 4th right anterior rib
![Page 29: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/29.jpg)
Lung Anatomy on Chest X-ray
• The right middle lobe
is typically the
smallest of the three,
and appears triangular
in shape, being
narrowest near the
hilum
![Page 30: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/30.jpg)
Lung Anatomy on Chest X-ray
• The right lower lobe is the largest of all three lobes, separated from the others by the major fissure.
• Posteriorly, the RLL extend as far superiorly as the 6th thoracic vertebral body, and extends inferiorly to the diaphragm.
• Review of the lateral plain film surprisingly shows the superior extent of the RLL.
![Page 31: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/31.jpg)
Lung Anatomy on Chest X-ray
• The lobar architecture
of the left lung is
slightly different than
the right.
• Because there is no
defined left minor
fissure, there are only
two lobes on the left;
the left upper
![Page 32: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/32.jpg)
Lung Anatomy on Chest X-ray
• Left lower lobes
![Page 33: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/33.jpg)
Lung Anatomy on Chest X-ray
• These two lobes are separated by a major fissure, identical to that seen on the right side, although often slightly more inferior in location.
• The portion of the left lung that corresponds anatomically to the right middle lobe is incorporated into the left upper lobe.
![Page 34: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/34.jpg)
Lung Anatomy on Chest X-ray
• These lobes can be separated from one another by two fissures.
• The minor fissure separates the RUL from the RML, and thus represents the visceral pleural surfaces of both of these lobes.
• Oriented obliquely, the major fissure extends posteriorly and superiorly approximately to the level of the fourth vertebral body.
![Page 35: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/35.jpg)
Describing Abnormal Findings on a
Chest Radiograph
• When addressing an abnormal finding on a chest radiograph, only a description of what is seen, rather than a diagnosis, should be presented (a chest radiograph alone is not diagnostic, but is only one piece of descriptive information used to formulate a diagnosis)
• Descriptive words such as shadows, density, or patchiness, should be used to discuss the findings
![Page 36: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/36.jpg)
Liquid Density
Liquid density Increased air density
Generalized Localized
Diffuse alveolar
Diffuse
interstitial
Mixed
Vascular
Infiltrate
Consolidatio
n
Cavitation
Mass
Congestion
Atelectasis
Localized airway
obstruction
Diffuse airway obstruction
Emphysema
Bulla
![Page 37: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/37.jpg)
Common Abnormal Findings
on Chest Radiographs
![Page 38: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/38.jpg)
Silhouette Sign
• The loss of the lung/soft tissue interface due to
the presence of fluid in the normally air-filled
lung
• If an intrathoracic opacity is in anatomic contact
with a border, then the opacity will obscure that
border
• Commonly seen with the borders of the heart,
aorta, chest wall, and diaphragm
![Page 39: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/39.jpg)
![Page 40: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/40.jpg)
Air Bronchogram
A tubular outline of an airway made visible due to the filling of the surrounding alveoli by fluid or inflammatory exudates
Conditions in which air bronchograms are seen:
• Lung consolidation
• Pulmonary edema
• Non-obstructive pulmonary atelectasis
• Interstitial disease
• Neoplasm
• Normal expiration
![Page 41: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/41.jpg)
![Page 42: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/42.jpg)
Consolidation
The lung is said to be consolidated when the alveoli and small airways are filled with dense material.
This dense material may consist of:
• Pus (pneumonia)
• Fluid (pulmonary edema)
• Blood (pulmonary hemorrhage)
• Cells (cancer)
![Page 43: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/43.jpg)
Consolidation
• Lobar consolidation:
– Alveolar space filled with inflammatory exudate
– Interstitium and architecture remain intact
– The airway is patent
– Radiologically:
• A density corresponding to a segment or lobe
• Airbronchogram, and
• No significant loss of lung volume
![Page 44: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/44.jpg)
![Page 45: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/45.jpg)
Atelectasis
• Almost always associated with a linear increased
density due to volume loss
• Indirect indications of volume loss include
vascular crowding or mediastinal shift toward
the collapse
• Possible observance of hilar elevation with an
upper lobe collapse, or a hilar depression with a
lower lobe collapse
![Page 46: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/46.jpg)
Atelectasis
• Loss of air
• Obstructive atelectasis:
– No ventilation to the lobe beyond obstruction
– Radiologically:
• Density corresponding to a segment or lobe
• Significant loss of volume
• Compensatory hyperinflation of normal lungs
![Page 47: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/47.jpg)
![Page 48: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/48.jpg)
![Page 49: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/49.jpg)
Pneumonia
Typical findings on the chest radiograph include:
• Airspace opacity
• Lobar consolidation
• Interstitial opacities
![Page 50: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/50.jpg)
![Page 51: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/51.jpg)
![Page 52: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/52.jpg)
![Page 53: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/53.jpg)
Pneumothorax
• Appears in the chest radiograph as air without
lung markings
• In a PA film it is usually seen in the apices since
the air rises to the least dependent part of the
chest
• The air is typically found peripheral to the white
line of the visceral pleura
• Best demonstrated by an expiration film
![Page 54: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/54.jpg)
![Page 55: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/55.jpg)
![Page 56: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/56.jpg)
![Page 57: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/57.jpg)
![Page 58: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/58.jpg)
![Page 59: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/59.jpg)
Pulmonary Edema
There are two basic types of pulmonary edema:
• Cardiogenic pulmonary edema caused by increased hydrostatic pulmonary capillary pressure
• Noncardiogenic pulmonary edema caused by either altered capillary membrane permeability or decreased plasma oncotic pressure
![Page 60: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/60.jpg)
![Page 61: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/61.jpg)
Congestive Heart Failure
Common features observed on the chest
radiograph of a CHF patient include:
• Cardiomegaly (cardiothoracic ratio > 50%)
• Cephalization of the pulmonary veins
• Appearance of Kerley B lines
• Alveolar edema often present in a classis
perihilar bat wing pattern of density
![Page 62: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/62.jpg)
![Page 63: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/63.jpg)
![Page 64: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/64.jpg)
![Page 65: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/65.jpg)
![Page 66: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/66.jpg)
Emphysema
Common features seen on the chest
radiograph include:
• Hyperinflation with flattening of the
diaphragms
• Increased retrosternal space
• Bullae
• Enlargement of PA/RV (cor pulmonale)
![Page 67: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/67.jpg)
![Page 68: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/68.jpg)
Lung Mass
A lung mass will typically present as a lesion with
sharp margins and a homogenous appearance, in
contrast to the diffuse appearance of an infiltrate.
![Page 69: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/69.jpg)
![Page 70: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/70.jpg)
Pleural Effusion
On an upright film, an effusion will cause blunting on the lateral costophrenic sulcus and, if large enough, on the posterior costophrenic sulcus.
• Approximately 200 ml of fluid are needed to detect an effusion in a PA film, while approximately 75 ml of fluid would be visible in the lateral view
In the AP film, an effusion will appear as a graded haze that is denser at the base
A lateral decubitus film is helpful in confirming an effusion as the fluid will collect on the dependent side
![Page 71: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/71.jpg)
![Page 72: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/72.jpg)
![Page 73: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/73.jpg)
Hemothorax
![Page 74: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/74.jpg)
Putting It Into Practice
![Page 75: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/75.jpg)
Case 1
![Page 76: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/76.jpg)
![Page 77: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/77.jpg)
A single, 3cm relatively thin-walled cavity is noted in the left
midlung. This finding is most typical of squamous cell
carcinoma (SCC). One-third of SCC masses show cavitation
![Page 78: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/78.jpg)
Case 2
![Page 79: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/79.jpg)
![Page 80: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/80.jpg)
LUL Atelectasis: Loss of heart borders/silhouetting. Notice
over inflation on unaffected lung
![Page 81: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/81.jpg)
Case 3
![Page 82: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/82.jpg)
![Page 83: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/83.jpg)
Right Middle and Left Upper Lobe Pneumonia
![Page 84: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/84.jpg)
Case 4
![Page 85: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/85.jpg)
![Page 86: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/86.jpg)
Cavitation:cystic changes in the area of consolidation due to the
bacterial destruction of lung tissue. Notice air fluid level.
![Page 87: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/87.jpg)
Cavitation
![Page 88: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/88.jpg)
Case 5
![Page 89: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/89.jpg)
![Page 90: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/90.jpg)
Tuberculosis
![Page 91: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/91.jpg)
Case 6
![Page 92: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/92.jpg)
![Page 93: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/93.jpg)
COPD: increase in heart diameter, flattening of the diaphragm, and
increase in the size of the retrosternal air space. In addition the
upper lobes will become hyperlucent due to destruction of the lung
tissue.
![Page 94: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/94.jpg)
Chronic emphysema effect on the lungs
![Page 95: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/95.jpg)
Case 7
![Page 96: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/96.jpg)
![Page 97: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/97.jpg)
Pseudotumor: fluid has filled the minor fissure creating a density that
resembles a tumor (arrow). Recall that fluid and soft tissue are
indistinguishable on plain film. Further analysis, however, reveals a
classic pleural effusion in the right pleura. Note the right lateral gutter
is blunted and the right diaphram is obscurred.
![Page 98: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/98.jpg)
Case 8
![Page 99: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/99.jpg)
![Page 100: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/100.jpg)
Pneumonia:a large pneumonia consolidation in the right lower
lobe. Knowledge of lobar and segmental anatomy is important in
identifying the location of the infection
![Page 101: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/101.jpg)
Case 9
![Page 102: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/102.jpg)
![Page 103: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/103.jpg)
CHF:a great deal of accentuated interstitial markings,
Curly lines, and an enlarged heart. Normally indistinct
upper lobe vessels are prominent but are also masked
by interstitial edema.
![Page 104: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/104.jpg)
24 hours after diuretic therapy
![Page 105: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/105.jpg)
Case 10
![Page 106: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/106.jpg)
![Page 107: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/107.jpg)
Chest wall lesion: arising off the chest wall and not the lung
![Page 108: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/108.jpg)
Case 11
![Page 109: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/109.jpg)
![Page 110: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/110.jpg)
Pleural effusion: Note loss of left hemidiaphragm. Fluid drained
via thoracentesis
![Page 111: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/111.jpg)
Case 12
![Page 112: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/112.jpg)
![Page 113: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/113.jpg)
Lung Mass
![Page 114: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/114.jpg)
Case 13
![Page 115: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/115.jpg)
![Page 116: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/116.jpg)
Small Pneumothorax: LUL
![Page 117: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/117.jpg)
Case 15
![Page 118: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/118.jpg)
![Page 119: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/119.jpg)
Right Middle Lobe Pneumothorax: complete lobar collapse
![Page 120: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/120.jpg)
Post chest tube insertion and re-expansion
![Page 121: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/121.jpg)
Case 16
![Page 122: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/122.jpg)
![Page 123: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/123.jpg)
Metastatic Lung Cancer: multiple nodules seen
![Page 124: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/124.jpg)
Case 17
![Page 125: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/125.jpg)
![Page 126: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/126.jpg)
Right upper lower lobe pulmonary nodule
![Page 127: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/127.jpg)
Case 18
![Page 128: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/128.jpg)
![Page 129: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/129.jpg)
Tuberculosis
![Page 130: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/130.jpg)
Case 19
![Page 131: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/131.jpg)
![Page 132: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/132.jpg)
Perihilar mass: Hodgkin’s disease
![Page 133: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/133.jpg)
Case 20
![Page 134: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/134.jpg)
![Page 135: x Thorax Beoordelen](https://reader030.vdocuments.site/reader030/viewer/2022020311/5695d04f1a28ab9b0291ed09/html5/thumbnails/135.jpg)
Widened Mediastinum: Aortic Dissection