Chest xray interpretation made easy basics

Cxr

1. Chest X-RAY interpretation

2. Before you interpret … check for the
following :
Name
Date
Orientation : Left, right
Position : erect , supine , PA or AP
Inspiration, expiration
Rotation : central or tilted
Distance from the medial end of each clavicle to the
spinousprocess of the vertebra at the same level
Exposure : You must barely see the thoracic vertebrae
behind the heart
Identify both costophrenicangles and lung apices

3. Name
Date Orientation
Adequate
inspiration
9 ribs
posteriourly
Exposure
Adequate tissue
penetration
Adequate anatomical exposure
Gastric air bubble
Rotation

6. Underpenetrated

7. Under-penetrated

8. Systematic Approach
Trachea and mediastinum
Heart and vessels
Hila
Diaphragm
Lung fields
Bones

9. PA Film

10. Trachea and Mediastinum
Ensure trachea is visible
If deviated to one side :
Pushed away by pleural effusion or tension pneumothorax
Pulled towards collapse
The carina, (60 –100 degrees)
Angle of the carina increases left atrial enlargement, lymph
node enlargement and left upper lobe collapse (left main
bronchus is pulled up)
Check for a widened mediastinum:
Mass lesions (egtumour, lymph nodes, aneurysm)

12. Heart and vessels
Heart size and heart borders
Check aorta : Widening, calcification
Check SVC, IVC, azygosvein widening

13. LV
Pulmonary
conus
Aortic
knuckle
RA
Rtand Lt
Pulmonary
arteires
SVC
IVC
Heart and vessels
Vascular pedicle

14. Hila
Note position and size bilaterally
Check for enlarged lymph nodes
Calcified nodes or nodules
Mass lesions
Pulmonary arteries (normally < 1.5cm )

15. Diaphragm
Right hemidiaphragmslightly higher than the
left
If right is much higher than the left : ? effusion,
lobar collapse, diaphragmatic paralysis
Haziness : consider lung infiltrate (eg
pneumonia) or effusion
Air under the diaphragm : perforated viscus

17. Lung fields
Parenchymal infiltrates :
1-Determine location :
Loss of heart borders or of the contour of the diaphragm
E.g. : Right middle lobe consolidation blurs the heart
border
The lingulablurs the left side border of the heart
2-Identify the pattern of infiltration :
Interstitial pattern → reticular
Alveolar → patchy or nodular pattern
Patchy infiltrates may be homogenous or heterogenous

18. Lung fields (cont’d)
Check also for :
Lobar collapse
Lobar consolidation : Look for air bronchograms
Pulmonary nodules
Apices
Effusions
KerleyB lines
Fissures : they become wide if there is fluid
collection
Costophrenicangle
The pleura : Thickening, loculations, calcifications
and pneumothorax

22. The minor fissure
which separates the
right upper lobe from
the right middle lobe.

23. Bone
Fractures, dislocation, subluxation, osteoblasticor
osteolyticlesions in clavicles, ribs, thoracic
Spine and humerusincluding osteoarthritic changes
soft tissues for subcutaneous air, foreign bodies

24. Lateral Film

30. Left LateralRight Lateral

32. Self Assessment

33. Right middle lobe infiltrates (or early consildation)

35. Hilarmass ( ? Enlarged ymphnode)

36. Pneumothorax

37. Left pleural effusion

38. Emphysema

39. Left pleural effusion

40. Left upper lobe mass

41. Air under diaphragm

42. Right upper lobe collapse
and consolidation . Lobar
density . Air bronchogram.
No loss of lung volume

43. RUL infiltration with air bronchogram +
atelectasis
Right upper lobe collapse .
Segmental or lobar density
Compensatory hyperinflation of
normal lung

44. Right middle lobe consolidation

45. LUL consolidation

46. Left lower lobe consolidation

47. pacemaker

48. Tension pneumothoraxTension pneumothorax (Left)

49. Pulmonary hypertension
Prominent pulmonary conusEnlarged pulmonary artery
Cardiomegaly

50. Pleural effusion
Enlarged pulmonary arteries
Pleural effusion
Prominent
transverse fissure

51. metastasis
Multiple round lesions ? Metastases

52. pneumothorax
Small Pneumothorax

53. Metastatic Ca colon

54. Infected hydatid cyst
Lung Abscess

55. Figure 7: Right middle lobe pneumonia
Right middle lobe pneumonia

56. KerleyB lines

57. Obvious !
Pulmonary edema

58. Obvious !
Pulmonary edema

59. Pulmonary fibrosis
Obvious !

60. Right upper lobe collapse

61. --------
Right upper lobe
collapse

62. Right middle lobe collapse

63. Cavitarytumourwith air-fluid level

64. Cavitarylesion

65. Pleural effusion
Obvious !

66. Pulmonary nodule

67. Obvious !
Metastases

68. Hilarlymph node

69. Any suggestion????
Large Hiatus hernia

70. Any suggestion????
Bilateral numerous small dots
MiliaryTuberculosis