Post on 09-Apr-2018
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The Chest X-Ray
For: Nottingham SCRUBS 26thAugust 2006
Presented by: Matthew
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X-ray= radiolucent, absorbed less radiation
Radioopaque, absorbed moreradiation-appear white
CT = hyperdense, hypodense
MRI = hyperintense, hypointense
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Aims:
Basics
Best exam results
Appreciate the role radiology plays
? Instil an interest in radiology
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Contents:Densities
Techniques
AnatomyCXR Interpretation
Common Pathologies
Questions
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DensitiesThe big two densities are:
(1) WHITE - Bone
(2) BLACK - Air
The others are:
(3) DARK GREY- Fat(4) GREY- Soft tissue/water
And if anything Man-made is on the film,it is:
(5) BRIGHT WHITE - Man-made
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Mediastinum is a space between 2 lungs,
divided to sup & inf
Manubrium sterni =d2-d3
Angle of louis / Sternal angle = 2
nd
costaecartilage ( It marks the approximate level of the 2ndpair ofcostal cartilages and the level of the intervertebral
discbetween T4 and T5. It also marks approximately the
beginning and end of the aortic arch, and the bifurcation of
the trachea into the left and right mainbronchi.)
Xhyphoid =d9
t4t5
Angle of sterni
Ant mediastinum Post med
Middle med
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Techniques - Projection
P-A (relation of x-ray beam to patient)
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Techniques - Projection (continued)
A-P Supine/Erect
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Techniques - Projection (continued)Lateral
More lucent at the retrosternal
lower-lobe lung disease
pleural effusions
anterior mediastinal masses
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Techniques - Projection (continued)
Lateral Decubitus
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Techniques - Projection (continued)
Oblique
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Orientation
Orientation
R / L
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Rotation
1-7 =true ribs
8-10=vertebrochondral11-12=floating/false
Angle of carina=62-75
Lymphadenopathy > 75
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Rotation (continued)
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Penetration
Low kv film can see lung parenchime High kv film, lung darken
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Inspiration/Expiration
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Anatomy
R Brachiocephalic
L SubclavianL Internal carotid
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Anatomy
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Anatomy
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Lobes Right upper lobe:
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Lobes (continued) Right middle lobe:
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Lobes (continued) Right lower lobe:
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Lobes (continued) Left lower lobe:
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Lobes (continued) Left upper lobe with Lingula:
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Lobes (continued) Lingula:
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Lobes (continued) Left upper lobe - upper division:
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Pleura Layers: Viseral
Parietal
Pleural cavity 5-10ml
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Heart1. Right border: Edge of (r) Atrium
2. Left border: (l) Ventricle +Atrium
3. Posterior border: left Ventricle
4. Anterior border: Right Ventricle
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Heart (continued)
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Heart (continued)
Valves
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Mediastinum
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Hilum
Made of:
1. Pulmonary Art.+Veins
2. The Bronchi
Left Hilus higher (max 1-2,5 cm)
Identical: size, shape, density
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Hilum
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Ribs
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Soft tissue & bones
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Lateral CXR
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Lateral CXR (continued)
17 - Anterior border of lung
26 - Oblique fissure
18 - Cardiac notch
22- Lingula of left lung
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Lateral CXR (continued)
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Lateral CXR (continued)
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Lateral CXR (continued)
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CXR Interpretation
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Technical Details
Type
Orientation
RotationInspiration/expiration
Penetration
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Lungs:
Lungs
Density
Symmetry Lesions
H t
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Heart
Size: CTR
A
B
C
A+B
C
x 100=
H t
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Heart Size of heart
Size ofindividualchambers of heart
Size ofpulmonary
vessels
Evidence of stents,clips,
wires and valves
Outline of aorta and IVC
and SVC
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Mediastinum: Width
Contour
AP window
Hila: Size
Location
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Review areas:
Apices Behind the heart
CP angles
Below the diaphragm
Soft tissues ( breast, surgical emphysema)
Ribs & clavicle
Vertebrae
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Identify the lesion localise the lesion describe the lesion give DD
Never stop looking, carry on with your
systematic approach!!
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Pathology
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RUL pneumonia
-CXR PA projected
-In female pts
-properly centered
-inspiratory full
-showing opacity in RUL
-obliterating the R heart border
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RML pneumonia
-CXR PA projected
-In female pts
-properly centered
-inspiratory full
-showing opacity in RML
-obliterating the R heart border
-Kalau diaphrgm nmpk ok lg,
=ML problem
-Kalau diaphrgm nmpk x ok,
= LL yg problem
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RLL pneumonia
-CXR PA projected-In male pts
-properly centered
-inspiratory full
-showing opacity in RLL
-obliterating the R heart border
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LUL pneumonia
-CXR PA projected
-In male pts
-properly centered
-inspiratory full
-showing opacity in LUL-obliterating the L heart border
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LLL pneumonia
-CXR PA projected
-In female pts
-properly centered
-inspiratory full
-showing opacity in LLL
-obliterating the L heart border
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Consolidation on CT
Air bronchogram can
Found at consolidation
- edema
- carcinoma
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Hilar m l
-CXR frontal projected
-In male pts-properly centered
-inspiratory full
-showing well define opacity at the
level of left middle of hilar
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The Enlarged Hila
Causes:
1. Adenopathies (neoplasia, infection)
2. Primary Tumor
3. Vascular
4. Sarcoidosis
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Multiple Masses/
metastasis
-CXR frontal projected
-In female pts-properly centered
-inspiratory full
-showing multiple rounded opacity in bilateral lung
-mostly at the lower lung
Canon ball appearance/Spot film
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Hilar Lymphadenopathy
-CXR frontal projected
-In male pts-properly centered
-inspiratory full
-showing mass lymphadenopathy at
the level of left hilar
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Pleural Effusion
-CXR frontal projected
-In female pts
-properly centered
-inspiratory full
-showing opacity at the left middle zone- Left hemidiaphrgm and heart border
not seen
-there is a crescent margin at ULLobe
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Pulmonary Fibrosis
-CXR frontal projected
-In male pts
-properly centered
-inspiratory full
-showing scarring tissue at the both
lung
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Kerley lines, A= longer than B,oblique,hilum
B= shorter than A, horizontal, lung base
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Heart failure
-CXR frontal projected-In male pts
-properly centered
-inspiratory full
-showing the heart is larger
-the costophrenic angle is blunted
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Pneumothorax
-CXR frontal projected
-In male pts-properly centered
-inspiratory full
-showing
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RUL collapse
-CXR frontal projected
-In male pts-properly centered
-inspiratory full
-showing well define opacity at the
RUL due to lost air
-Changes to the normal anatomy &
asymmetrical density
-Mediastinal & trachea shift to the RUL
(the volume lost in the effected lungwill pull the mediastinum towards the
lesion)
-the borders of the heart & diaphrgm not
well seen
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LLL collapse
-CXR frontal projected
-In male pts
-properly centered
-inspiratory full-showing well define opacity at the
LLL due to lost air
-the LL borders of the heart &
diaphrgm not well seen
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Air under the diaphragm
-CXR frontal projected
-In male pts
-properly centered
-inspiratory full
-showing air under the diaphrgm
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Emphysema
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Cervical Rib
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Cavitating lesion
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Hiatus hernia
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Miliary shadowing
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Chest Tube, NG Tube, Pulm. artery cath
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