Reading the CXR
Frank Schembri
Pulmonary / Critical Care
Types of Densities
Basic Principles of the CXR
• Types of views– PA– Lateral– AP– Apical lordotic– Decubitus (R & L)
Apical Lordotic Chest
Decubitus Positioning
Approaching the CXR
• Name, date, type of film• Type of film• Patient positioning / rotation• Inspiration• Penetration
– White is underpenetrated– Black is overpenetrated
Approaching the CXR• The systematic approach
1. Tubes / Hardware2. Bones3. Soft tissues4.Pleura and diaphragm5. Trachea and mediastinum6. Lung parenchyma
Scanning the xray
Scanning the xray
2. Osseous Structures in the Chest
2. Osseous Structures of the Chest
4. Pleura and Diaphragm
5. Mediastinal Anatomy
5. Mediastinal Anatomy
5. Mediastinal Compartments
6. Parenchymal Anatomy
Anterior View
Lateral View
6. Parenchymal Anatomy
Left Lung Right Lung
Lobes• Right upper lobe:
Lobes (continued)
• Right middle lobe:
Lobes (continued)
• Right lower lobe:
Lobes (continued)
• Left lower lobe:
Lobes (continued)
• Left upper lobe with Lingula:
Lobes (continued)
• Lingula:
Lobes (continued)
• Left upper lobe - upper division:
Atelectasis
Elevation of diaphragm
mass
Minor fissure
Loss of volume
Minor fissue
Minor fissure
Major fissure
Pneumothorax
• Collection of air in pleural cavity• Primary and secondary causes• Upright position air rises and separates the lung
from the chest wall creating a line. Don’t be fooled by skin folds, clothing and bullae.
• In the supine position air moves anteriorly. The lung will not be clearly separated from the chest wall.
Pneumothorax in the Supine Patient
Deep sulcus sign
hyperlucent
Enlarged hemithorax
Mediastinal shift
Sharper cardiac border
Bat-winged appearance
Enlarged heart
CHF
Perihilar infiltrates/enlarge PA
Pleural effusions