The Normal Chest X-ray

1. The Chest X-ray By Dr. Mehmet Kaphoury Residence of radio-diagnosis, ASU

2. Preliminary checklist Dose Centralization Patient’s data (name, age, sex, smoking, occupation, residence) Clinical history in brief

3. Centralized film

4. Mr. J is a 65-year-old male presents to the OPC complaining of cough & expectoration of bloody sputum 2 weeks ago. His smoking index is 1 pack/40 years. Past history is unremarkable except for frequent morning coughs with whitish sputum all through past 25 years almost everyday.. What is the best initial step in diagnosis? The answer is: a plain CXR

5. Bit-by-bit checklist Trachea Mediastinum Heart Cardio- phrenic angles Diaphragm Costo-phrenic angles Lungs Bony cage Lateral film, if present Other findings

6. Trachea Central at its upper part Deviates slightly to the right at its lower part Its lucency decreases caudally Comment on : Displacement Caliber Intraluminal ‘things’ Paratracheal stripe Carina

7. Mediastinum Central with aortic knuckle to the left and SVC to the right Smooth with no irregularities or festooning Thymus in children Comment on: Displacement Widening Fluid level, Air Spine

8. Thymus Mediastinum

9. Heart One third to the right, 2 thirds to the left Learn normal configuration Borders can be well defined Cardio-thoracic ratio is no more than 50% Comment on: Size & configuration Borders (well defined or not) Chambers size and effects of their enlargement Retro-cardiac shadows Pericardial calcification, cysts

10. Aortic knuckle Pulmonary trunk Left atrium Left ventricle apex SVC Right atrium

11. Cardio- phrenic angles Acute angles Mostly filled with fat pad Abnormalities known by blunting of these angles Comment on: Blunting of the angles Learn D.D of cardio- phrenic angles opacity

12. Diaphragm Dom shaped, right higher than left, left may be higher but not more than 3 cm than the right Can be traced all through Diaphragmatic hump may be normal Cut by the 6 th or 7 th rib in the mid- calv . line Comment on: Level (normal, depressed, elevated) Trace the contour Air under

13. Costo-phrenic angles Acute angles Lucent Comment on: Blunted angles

14. Lungs Airways Vessels Interstitium (fluid, fibrosis) Opacities (total, lobar, segmental, focal, miliary // homogenous, heterogenous ) Cavity Pleura (line, calcification) Apices Compare both sides for:

15. Bony Cage Cervical ribs Fractures Osteolytic lesions Inter-costal spaces