Cx Xray Presentation

8/8/2019 Cx Xray Presentation

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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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Lateral Decubitus


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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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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


-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



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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


-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



-inspiratory full

-showing mass lymphadenopathy at

the level of left hilar


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Pleural Effusion


-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


-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



-inspiratory full

-showing


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RUL collapse



-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


-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


-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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Cx Xray Presentation

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