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Imaging
Introduction
Indication :
• Screening.
• Preoperative underlying pulmonary and cardiovascular
diseases.
• Febrile patient pulmonary sources of fever
• Trauma patient.
Contraindication (relative):
• Pregnant women especially 1st & 2nd trimester.
• Neonates and children.
ANATOMY
Lung Anatomy
Lung Anatomy
Right Lung
o 3 lobes
• (divided by major fissure and minor
fissure)
o 10 segments
Left Lung :
o 2 lobes
• (divided by major fissure)
o 8 segments
o Lingula segments ~ medial lobe of
the right lung
Lung Anatomy
Trachea :
• Begins at the lower border of the cricroid
cartilage at the level of C6 vertebra.
• Extend to the carina at the level of the sternal
angle (T5 level)
• T4 level on expiration
• T6 level on inspiration
• The trachea is 15 cm and 2 cm in diameter.
RESPIRATORY TRACT ANATOMY
Trachea :
• The trachea in children is very pliable.
• It may be deviated to the right in normal expiratory
film.
• It only deviates to the left if the aortic arch is on the
right side.
RESPIRATORY TRACT ANATOMY
Primary lobule
• The smallest functional unit of the lung
• Comprises all the structures distal to a
respiratory bronchiole including 16-40 alveoli.
• Normal adult has approximately 23 million
primary lobules.
Acinus
• Consists of all structures distal to the terminal
bronchiole, including vessels, nerves, and
connective tissue.
• It has a diameter 4-8mm
• Contains approximately 10-20 primary lobules
Secondary Lobule
• The smallest structural unit of lung parenchyma
that is surrounded by a connective tissue
septum.
• Contains 3-12 acini and measures 1,0-2,5 cm in
diameter.
TRACHEOBRONCHIAL SYSTEM
19
Acinus
Lobulus primer
12/11/2018 www.brainybetty.com 20
Radioanatomi Posteroanterior Chest X Ray
CHEST X-RAY POSITION
POSTER0ANTERIOR
ANTEROPOSTERIOR
RIGHT/LEFT LATERAL
RIGHT ANTERIOR OBLIQUE
LEFT ANTERIOR OBLIQUE
RIGHT POSTERIOR OBLIQUE
LEFT POSTERIOR OBLIQUE
TOP LORDOTIC
RIGHT/LEFT LATERAL DECUBITUS
POSTEROANTERIOR
Indication:
Routine
Screening TB
Pre-operative
ANTEROPOSTERIOR
Indication:
(cannot be taken with PA )
• Severely ill patient
• Children
• Infant and neonates
• Obese
• Pregnant
• Ascites
• Intraabdominal tumor
Distortion in Anteroposterior chest x-ray
• Heart enlargement
• Mediastinal widening
• Crowded bronchovascular
marking at the basal zone.
How to differentiate PA & AP
PA AP
• V – shaped clavicles • Straight clavicles
• No lung superposition • Lung superposition with
with the scapula the scapula
• No mediastinal widening • Mediastinal widening
• Distinct anterior aspect • Distinct posterior aspect of
of the costa. the costa
• Less crowded
• Crowded bronchovascular
bronchovascular marking
marking especially at the
basal zone.
PA vs AP CXR
Lateral Chest X-Ray
Indication:
• Look at mediastinal
abnormalities.
• Look at anomalies that wasn’t
clear at posteroanterior
position.
• Heart assessment.
• To look for minimal fluid
collection in the pleural cavity
(75cc) that can not be seen in
the PA chest x-ray
R
L AORTIC ARCH
TRACHEA
OBLIQUE FISSURE
POSTERIOR RIBS
LT. HEMI
DIAPHRAGM
Indication:
To look at anomalies that were not clear at PA and lateral position.
Type:
Right anterior oblique (RAO)
Left anterior oblique (LAO)
Right posterior oblique (RPO)
Left posterior oblique (LPO)
The side that is mentioned is the side that was close to the film
RAO: The right side and the anterior side was close to the film
LPO: The left side and the posterior side was close to the film.
RAO LAO
Lateral Decubitus
Indication:
• To look for minimal fluid collection
in the pleural cavity (15-20cc) that
can not be seen in the PA chest x-
ray
LLD/RLD
Top Lordotic
Indication:
• To look for
anomalies at the
apex of the lung.
Inspiration
Level inspirasimaksimal
Apex of the diaphragm at the level 5th-6th
anterior ribs.
9th – 10th posterior ribs at the level of right
cardiophrenic sulcus.
Example of poor inspiration
AP PA
Distortion in AP Chest X-Ray
Trachea
• Lucent structure contain air.
• Centrally located.
• Normal diameter : 1,5 cm
• Look for deviation.
• Extend to the carina at the level of the sternal
angle (T5 level)
• T4 level on expiration
• T6 level on inspiration
• Tracheal bifurcation (carina) normal angle <900
• >900 in left atrial enlargement.
Sinuses or Sulci
Costophrenicus
Cardiophrenicus
Diaphragm
Right diaphragm is
higher than the left
diaphragm.
Normal : 2.5 cm
> 3 cm: abnormal
Shape :
Tenting
Scalloping
Lung
Apex
From the apex to the
clavicle
Upper lung field
From the clavicle to the
2nd anterior rib
Middle lung field
From the 2nd anterior rib
to the 4th anterior rib
Lower lung field
From the 4th anterior rib
to the diaphragm
Other Division of the Lung Zone
NORMAL Increased
LATERAL CHEST X RAY
How to read lateral chest x ray
• Quality
• Retrosternal space
• Retrocardiac space
• Posterior sinus
• Anterior sinus
• Diaphragm
• Hilar area
• Lung field
How to read lateral chest x ray
Quality
• From apex to the sinus.
• From sternum to the
posterior ribs.
• Chin and arms elevated
sufficiently
• No rotation
• No motion (sharp outlines)
• Visualize rib outlines and
lung marking through the
heart shadow
How to read lateral chest x ray
Retrosternal space
• Covered by heart
shadow < 1/3 bottom
• Abnormal > ½
Retrocardiac space
• Clear triangular shaped
How to read lateral chest x ray
Anterior sinus
• Sharp
• Sometimes covered by
mediastinal fat
• Depend on the
exposure of the film.
Posterior sinus
• Sharp
How to read lateral chest x ray
Lung field
• Clear lung at the
anterio and posterior
of the heart.
• Decrease density from
superio to inferior in
the posterior
mediastinum.
PATHOLOGIC FINDINGS IN CHEST X-RAY
Heart Failure and Pulmonary
Edema
Pleural Effusion
Pulmonary Contusion
Pulmonary Contusion with
Ribs Fracture
Atelectasis
Atelectasis
Tension Pneumothorax
Aspiration Pneumonia
Aspiration Pneumonia with
Thymic Shadow in an Infant
Thank You