Date post: | 26-May-2015 |
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Health & Medicine |
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CHEST RADIOLOGY
Prepared By :1.Belal Alrefaei2.Merry Admaso3.Bshara
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The 12-Step:
1: Name 2: Date 3: Old films 4: What type of view(s) 5: Penetration 6: Inspiration 7: Rotation 8: Angulation 9: Soft tissues / bony structures 10: Mediastinum 11: Diaphragms 12: Lung Fields
Quality Control
Findings
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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?
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 HEARTBORDERS
Note cardiac chambers that account for margins on the chest X-ray
6
7
1. R Atrium2. R Ventricle3. Apex of L Ventricle
4. Superior Vena Cava5. Inferior Vena Cava6. Tricuspid Valve
7. Pulmonary Valve8. Pulmonary Trunk9. R PA 10. L PA
LEFT 4TH RIB POSTERIOR AND ANTERIOR PORTIONS
POSTERIOR
ANTERIOR
4
A
P
AORTIC ARCH
LT. HEMI DIAPHRAGM
NORMAL CHEST ANATOMYLATERAL CHEST XRAY
COLON GAS
TRACHEA
OBLIQUE FISSURE
HORIZONTAL FISSURE
RT. HEMI DIAPHRAGM
Diaphragm-AP view
Diaphragm- Lateral view
LT.
LT.
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RT.
LT.
CARINA
LT. MAIN BRONCHUS
RT. MAIN BRONCHUS
TRACHEA
OBLIQUE FISSURE(major)
OBLIQUE FISSUREmajor
HORIZONTAL FISSUREminor
BRONCHOGRAM—CONTRAST OUTLINING AIRWAY
HORIZONTAL FISSURE
FISSURES DIVIDE
LUNGS INTO LOBES
RIGHT lung has:
UPPER
MIDDLE lobes
LOWER
LEFT lung has:
UPPER lobes
LOWER
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INTERESTING CASES
INFECTION
NEOPLASTIC
CARDIOVASCULAR
TRAUMA
13
15 RUL pneumonia
16 RML pneumonia
RLL pneumonia17
18 LUL pneumonia
19 LLL pneumonia
20
Pulmonary Fibrosis
21
Miliary TB Snow Storm Apperance
22
TB
23
24 Cavitating lesion
25
CaVity
26 Hilar Lymphadenopathy - BL
PNEUMOTHORAX
PLEURAL EFFUSION
PLEURAL EFFUSION
NORMAL
28
29
PLEURAL EFFUSION
30 Pleural Effusion
31
Bilateral pleural effusions
PNEUMOTHORAX
33 Pneumothorax
TENSION PNEUMOTHORAX
35
TENSION PNEUMOTHORAX
36Hyperinflation
37
Hemothorax
38
Aortic dissection with hemothorax
39 RUL collapse
40 LLL collapse
41
42
Chest mass, emphysema
Hilar mass
43 Emphysema
44
Subcutaneous emphysema
45
ARDS
Congestion Interstitial
and alveolar edema
Collapsed or distended alveoli
Bilateral
46
Bulla
47
SARCOIDOSIS Granulomatous
Inflammation Bilateral &
symmetrical hilar & mediastinal LAD
Generalized fibrosis
48
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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50
NORMAL HEART CARDIOMEGLY
52 Dextrocardia
53
54
Cardiomegaly
Cardiac silhouette
greater than 50% of width of
thorax
CARDIOMEGLY
CONGESTIVE HEART FAILURE
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Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
56
Congestive Heart Failure Increased heart size:
cardiothoracic ratio >0.5
Large hila with indistinct markings
Fluid in interlobar fissures
Pleural effusions, alveolar edema
57 Heart failure
58Pericardial effusion
59Pulmonary Edema
60Pulmonary Embolism
61Kerley B line
62VSD
63ASD
64
Tetrology Of Fallot(Boot Shaped)
65Aortic dissection
66
67 Multiple Masses
Free air beneath diaphragm
68
Free air
69 Air under the diaphragm
70
Empyema after trauma
Clavicle fracture
Cavitary lesion
Opacified hemithorax
71
Pneumonectomy
72
Entire mediastinum shifted left, indicating volume loss
Opacified left hemithorax
Trachea shifted left, indicating volume loss
Pneumonectomy
73 Hiatus hernia
PULMONARY METASTATIC NODULES
75
Clavicle dislocation
Medial clavicle is displaced inferiorly
76
Clavicle fracture, distal
LT.
Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
FRONTAL LATERAL
WHAT AND WHERE IS IT?
Air stripe
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.
79
Diaphragm rupture
80
Smoke inhalation, chronic changes
Right Lower Lobe
Pneumonia
Right side tension
pneumothorax
Fracture of posterior rib #7
Right Side
Pleural Effusio
n
Left Sided Pneumothorax