Cheat X-ray normal anatomy and patholgies For medical students

Chest xray

1. Chest X-Ray Dr.ASHIK JOSEPH PAUL

2. Introduction Most of the chest x-rays you will see will be normal In order to recognise abnormality, you need to know what a normal CXR looks like The CXR on the next slide is normal. How would you interpret it?

3. General Principles Interpret the CXR in conjunction with the clinical findings Always compare with previous CXR if available to assess for change

4. Name/marker/rotation/ penetration Lines/metal work Heart Mediastinum Lungs Zones (upper/middle/lower) Bones Diaphragm Soft Tissues Systematic Approach

5. Name/marker/rotation/ penetration clavicles equidistant from spinous processes of thoracic spine can just see lower thoracic spine

6. Lines/metal work Look for: Sternal wires (implies previous thoracic surgery) Tip of endotracheal tube (2cm above carina)

7. Lines/metal work Tip of central venous lines at origin of superior vena cava. See tubes and lines presentation.

8. Heart Occupies up to 50% of the maximum internal thoracic diameter on a standard PA erect view Cannot comment on heart size on AP view because of magnification of heart

9. Mediastinum Hilar vascular structures should be crisply defined No widening of mediastinum Trachea should be central

10. Lungs upper zone lower zone middle zone Compare upper, mid and lower zones Look between ribs for lung detail Remember to look “behind” the heart

11. Bones Look at each rib in turn Clavicles Scapulae and humeri if visible Lower cervical and thoracic spine

12. Diaphragm Both diaphragms should form a sharp margin with the lateral chest wall Both diaphragm contours should be clearly visible medially to the spine Position of stomach gas bubble (not present on this CXR)

13. Soft Tissues Supraclavicular fossae (enlarged nodes) Lateral chest wall (surgical emphysema) Under diaphragm (pneumoperitoneum)

14. How would you summarise this?

15. “This is an erect chest X-Ray of an adult male. The heart is not enlarged, the mediastinal contours are normal and the lungs are clear”

16. Take Home Points

17. Hidden areas

18. HEART

19. LA ENLARGEMENT

20. RV ENLARGEMENT

21. PACEMAKER