NORMAL CHEST RADIOGRAPGH AND ANATOMY.pptx.pptx

NORMAL RADIOGRAPH OF CHEST

1. NORMAL CHEST RADIOGRAPH - Dr.SANDRA JOHNS 2nd YEAR RADIOLOGY RESIDENT Dr SMCSI MCH

2. Systematic approach to chest X-rays Patient details Projection Technical adequacy Systematic review of the X-ray Hidden areas

3. Posteroanterior view- Erect Anteroposterior view – Erect - Supine Additional views Lateral view lateral decubitus view Lordotic view Apical view PROJECTION

4. Technical Qualit y Check that the X-ray includes all of the thorax Both lung apices - First rib , Clavicle Lateral sides of the ribcage. Both costophrenic angles. It is important to assess RIP – Rotation, Inspiration, Penetration .

5. CHEST RADIOLOGY: THE BASIC ANATOMY

6. T r achea Narrowing Displacement Normal maximal c o r ona l diame t er: Males - 25mm Females - 21mm

7. Carina Normal angle – 60-75 Degree Widens in – Enlarged left atrium Enlarged carinal nodes

8. H E A R T 2/3 rd to the left 1/3 rd to the right Increased heart size : Short FFD Expiration Supine & AP view Elevated diaphragm

9. Cardiac Transverse Diameter (CTD) = a+b . < 15.5cm (males) < 15.0cm (females ) Cardiomegaly - >1.5cm on serial films Cardio-Thoracic Ratio (CTR) =a+b/c+d - < 0.5 (PA) - < 0.6 (AP) Cardia Size

10. SILHOUETTE SIGN Silhouette: the outline of a solid object. The term “silhouette sign” is a deliberate misnomer — refers to the loss of part of the silhouette.

11. Media s tinum

12. Mediastinum

13. Aortopulmonary window

14. Diaphragm Right higher than left anterior 6 th rib and posterior 9 th rib.

15. Lobes of Lung Three lobes of the right lung and the two lobes of the left lung . Clearly seen on lateral films

16. Fissures These fissures separate the lobes of the lung but are usually incomplete allowing collateral air drift to occur between adjacent l obes All fissures best seen on the lateral film. Horizontal fissure -4 th rib anteriorly Oblique fissures commence posteriorly at the level of T4 or T5, passing through the hilum. left is steeper and finishes 5 cm behind the anterior costophr e nic angle & right ends just behind the angle .

17. Fissures MAIN FISSURES: Right lung Horizontal fissure Obliqu e fissu r e Left lung Oblique fissure ACCESSORY FISSURES Azygous fissure Superio r a cc esso r y fissu r e In f erior a cc esso r y fissu r e Left horizontal fissure

18. Right Horizontal fissure

19. Accessory fissures Superior accessory fissure separates the superior from the basal segments of the lower lobes. Inferior accessory fissure appears as an oblique line from the cardio-phrenic angle toward the hilum and separating the medial basal from the other basal segments.

20. AZYGOUS FISSURE

21. The costophrenic angles

22. LUNG ZONES

23. Xray appearance of Hila

24. RIGHT HILUM LEFT HILUM

25. HILAR POINTS . Hilar point is formed by upper lobe pulmoary vein and lower lobe pulmonary artery. Left Hilar point is higher up than right ! Lateral border is concave

26. Pulmonary Arteries The right lower lobe pulmonary artery is clearly visible as a little finger”. The left lower lobe pulmonary artery shows the proximal part of a little finger. Max diameter of descending Pulmonary Artery is 16mm (Males) and 15 mm (Females).

27. BRONCHIAL VESSELS Generally not visualised on normal CXR. Anatomy is generally variable. Share a common origin which is intercostal arteries. Two on right and one on left. They accompany bronchi after entering hilum.

28. BELOW DIAPHRAGM Dilated bowel A ir under diaphragm Masses Displaced gastric bubble Calcified lesions

29. CHILAIDITI’S SYNDROME

30. SOFT TISSUE Chest wall Breast shadow Nipple shadow Companion shadows Shoulders Lower neck Sup r a cl a vicula r f ossa Sternoclavicular region Sternocleidomastoid muscl e Apical cap/ Apical pleural thickening

31. CLAVICLE Rhomboi d f ossa

32. SCAPULA

33. RIBS Companion shadows C osta l cartila g e calcifications

34. SPINE Bone & disc destruction Spinal deformity

35. The hidden areas Checking the four tricky areas :- Apices Retrocardiac Hilum Below the domes