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CHEST RADIOLOGY

Prepared By : 1. Belal Alrefaei 2. Merry Admaso 3. Bshara

The 12-Step:

1: Name Pre-read 2: Date 3: Old films 4: What type of view(s) 5: Penetration 6: Inspiration Quality Control 7: Rotation 8: Angulation 9: Soft tissues / bony structures 10: Mediastinum Findings 11: Diaphragms 12: Lung Fields

Chest X-Ray Findings

Is heart enlarged or normal? Signs of heart failure and fluid overload? Does patient have pneumonia or collapsed lung? Is there evidence of emphysema? Are there findings of an aortic aneurysm? Is there fluid in the sac that surrounds the lung? Is there free air under the diaphragm? Is there a tumor in the lung that could represent cancer?
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NORMAL CHEST X-RAY

PA

LATERAL

Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2) Anterior or Posterior) or (3) Superior or Inferior.

NORMAL HEART BORDERS


Note cardiac chambers that account for margins on the chest X-ray

1. R Atrium 2. R Ventricle 3. Apex of L Ventricle

4. Superior Vena Cava 5. Inferior Vena Cava 6. Tricuspid Valve

7. Pulmonary Valve 8. Pulmonary Trunk 9. R PA 10. L PA

LEFT 4TH RIB


POSTERIOR AND ANTERIOR PORTIONS

POSTERIOR
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ANTERIOR

P A

NORMAL CHEST ANATOMY LATERAL CHEST XRAY


Diaphragm-AP view AORTIC ARCH
TRACHEA

LT.

HORIZONTAL FISSURE

Diaphragm- Lateral view


OBLIQUE FISSURE LT.

RT. HEMI DIAPHRAGM RT. LT. HEMI DIAPHRAGM COLON GAS LT.

BRONCHOGRAMCONTRAST OUTLINING AIRWAY

TRACHEA

LT. MAIN BRONCHUS

RT. MAIN BRONCHUS CARINA

OBLIQUE FISSURE major

OBLIQUE FISSURE (major)

FISSURES DIVIDE LUNGS INTO LOBES

RIGHT lung has:


UPPER
HORIZONTAL FISSURE

MIDDLE

lobes

LOWER

LEFT lung has: UPPER LOWER lobes

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INTERESTING CASES

INFECTION

NEOPLASTIC
CARDIOVASCULAR TRAUMA
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RUL pneumonia

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RML pneumonia

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RLL pneumonia

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LUL pneumonia

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LLL pneumonia

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Pulmonary Fibrosis
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Miliary TB

Snow Storm Apperance

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TB

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Cavitating lesion

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CaVity

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Hilar Lymphadenopathy - BL

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PNEUMOTHORAX

PLEURAL EFFUSION

PLEURAL EFFUSION

NORMAL

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PLEURAL EFFUSION

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Pleural Effusion

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Bilateral pleural effusions


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PNEUMOTHORAX

Pneumothorax

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TENSION PNEUMOTHORAX

TENSION PNEUMOTHORAX

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Hyperinflation

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Hemothorax

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Aortic dissection with hemothorax

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RUL collapse

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LLL collapse

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Chest mass, emphysema

Hilar mass

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Emphysema

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Subcutaneous emphysema

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ARDS
Congestion Interstitial and

alveolar edema Collapsed or distended alveoli Bilateral

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Bulla

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SARCOIDOSIS
Granulomatous Inflammation
Bilateral &

symmetrical hilar & mediastinal LAD Generalized fibrosis

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ATELECTASIS
No ventilation to lobe beyond the obstruction Trapped air absorbed by pulmonary circulation Segmental/lobar density

Compensatory hyper-inflation of normal lungs.

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NORMAL HEART

CARDIOMEGLY

Dextrocardia

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Cardiomegaly

Cardiac silhouette greater than 50% of width of thorax


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CARDIOMEGLY

CONGESTIVE HEART FAILURE


Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atriumthen to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)

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Congestive Heart Failure


Increased heart size:

cardiothoracic ratio >0.5

Large hila with indistinct markings Fluid in interlobar fissures Pleural effusions, alveolar edema
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Heart failure

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Pericardial effusion

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Pulmonary Edema

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Pulmonary Embolism

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Kerley B line

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VSD

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ASD

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Tetrology Of Fallot (Boot Shaped)

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Aortic dissection

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Multiple Masses

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Free air

Free air beneath diaphragm

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Air under the diaphragm

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Empyema after trauma


Clavicle fracture Cavitary lesion

Opacified hemithorax

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Pneumonectomy
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Trachea shifted left, indicating volume loss

Opacified left hemithorax

Entire mediastinum shifted left, indicating volume loss

Pneumonectomy
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Hiatus hernia

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PULMONARY METASTATIC NODULES

Clavicle dislocation

Medial clavicle is displaced inferiorly


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Clavicle fracture, distal

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LT.

Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.

FRONTAL

LATERAL

Air stripe

WHAT AND WHERE IS IT?


Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.

Diaphragm rupture

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Smoke inhalation, chronic changes

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LETS SEE HOW MUCH YOU PAID ATTENTION

Right Lower Lobe Pneumonia

Right side tension pneumothorax

Fracture of posterior rib #7

Right Side Pleural Effusion

Left Sided Pneumothorax

GOOD LUCK

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