Radiology for Undergraduate Part 1
46
Chest Roentgenogram DR. S. ASWINI KUMAR. MD Professor of Medicine Medical College Hospital Thiruvananthapuram
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Chest X-Rays How to interpret, description of commonly found X-Ray abnormalities in Medical Wards
Transcript of Radiology for Undergraduate Part 1
Chest Roentgenogram
DR. S. ASWINI KUMAR. MDProfessor of Medicine
Medical College HospitalThiruvananthapuram
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Chest Roentgenogram
4/15/2010
X-Ray machine
X-Rays produced by it
Pass through the human body
Black and white film
Placed on the opposite side
Chest X-Ray-Views
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PA view
Postero-anterior view
X-Rays-Posterior to anterior
Delineates the heart and lungs
Spine is not in focus
Chest X-Ray Views
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Lateral view
Lesions of lung and mediastinum
Right or left lateral view
Spine posteriorly - heart anteriorly
Useful in detecting the lobe of lung
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Densities
4/15/2010
The background - black
The soft tissues - light white
The bone - dense white
Fluid, blood - white as well
The air - black
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How do you read a Chest X-Ray PA
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Costo and cardiophrenic angles
Position of trachea and mediastinum
Soft tissue shadows
Study the lung parenchyma
Study the heart shadow
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The fissures and lobes of Lung
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Right Upper Lobe
4/15/2010
Right Upper Lobe in the lateral view
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Right Middle Lobe in the PA view
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Right lower lobe consolidation
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Right Middle Lobe Silhouette in Lateral View
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Extend of left upper lobe of lung
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Extend of left lower lobe of lung
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Consolidation of lung
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Pleural Effusion Left Side
4/15/2010
A higher level in axilla
Left lower zone outer aspect
Dense homogenous opacity
Obliteration of angles
No air bronchograms
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Massive Pleural Effusion Right Side
4/15/2010
No air bronchograms
Dense homogenous opacity
Obliteration of cardiophrenic
Obliteration of costophrenic
Tracheal shift to left side
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Bilateral pleural Effusion
4/15/2010
Higher levels in axillae
2 shadows both lower zones
Cardiophrenic angles obliteralted
Costophrenic angles obliteralted
Trachea & mediastinum central
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Encysted Pleural effusion
4/15/2010
One to horizontal fissure
Correspond to the fissures
The other oblique fissure
CP and CP angles are free
Rounded and oval shadows
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Cavity - Left Lung
4/15/2010
Homogenous opacity - lower part
Thin walled cavity - left middle
An air fluid level above opacity
CP and CP obliteralted
Right lung is normal
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Lung abscess - Right side
4/15/2010
Hhomogenous opacity lower part
A thick walled cavity Rt middle
An air fluid level above opacity
CP & CP angles not obliteralted
Left lung is normal
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Lung abscess - Left upper lobe
4/15/2010
A thick opacity - lower part
Thick walled cavity left upper
Air fluid level above the opacity
CP & CP angles not obliteralted
Right lung is normal
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Infilterative lesions of lung
4/15/2010
Thin walled cavities
Non-homogenous opacities
Minimal air fluid levels
early lesions of PTB
A close up of apex left lung
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Breaking down Consolidation
4/15/2010
Non-homogenous opacity
Involvement of Rt UZ
Breaking down of opacity
Formation of a cavity
left lung - few infiltrates
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Cavity - Right upper lobe
4/15/2010
Thin walled cavity
Disease of Rt upper zone/lobe
No air fluid levels inside
Cavity characteristic of PTB
The left lung is normal
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Fibrosis – Left Upper Lobe
4/15/2010
Mediastinum is shifted to left
The trachea is shifted to left
Intercostal spaces are narrowed
There are cavities inside
The right lung - few infiltrates
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Bilateral Upper lobe Fibrosis
4/15/2010
Both upper zones thin cavities
The mediastinum is central
Fibrotic bands
Compensatory emphysema
Trachea shifted to right
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Miliary Mottling
4/15/2010
Best seen in middle and lower
Multiple small 1-2 mm rounded
Miliary mottling
Hematogenous spread of TBB
All areas both the lung fields
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Reticulo-nodular Opacities
4/15/2010
Middle and lower zones
Multiple small 2-4 mm rounded
Reticulonodular shadows
Granulomatous spread of TB
All areas both the lung fields
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Bronchopneumonia
4/15/2010
Middle and lower zones
Both the lung fields are involved
Fluffy non-homogenous
opacitiesNo air bronchograms
Patient with acute dyspnoea
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Adult Respiratory Distress Syndrome
4/15/2010
Middle and lower zones
Both the lung fields are involved
Fluffy non-homogenous
opacitiesNo air bronchograms
Patient with acute dyspnoea
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Emphysema of lungs
4/15/2010
Ribs are horizontally placed
Diaphragm pushed down
Lung markings are reduced
Heart elongated and tubular
Chest is elongated
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Pneumothorax Right side
4/15/2010
Right side no lung markings
Minimal tracheal shift
Complete collapse compression
Air in the pleural cavity
The chest is emphysematous
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Hydro-Pneumothorax Right side
4/15/2010
Right lung-completely collapsed
Right lung has no lung markings
Compression by the air
Air-fluid level in pleural space
Left lung normal lung markings
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Massive Hydropneumothorax Left side
4/15/2010
No higher level in the axilla
Small air fluid level at the apex
Left heart border not visible
CP & CP angles obliteralted
Homogenous opacity left thorax
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Bronchiectasis in Plain X-Ray Chest
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No air bronchgrams
Nonhomogenous opacities
Bilateral and basal
Few cystic lesions also
Both the lung fields are affected
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Mass lesion in the lungs
4/15/2010
Central hyperdense lesion
A homogenous opacity
Peripheral streaks
No air bronchograms
Right lung parenchyma
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Lung mass with Collapse
4/15/2010
No air bronchgrams
Dense homogenous opacity
Tracheal shift to the right side
Collapsed right upper lobe
The right lung is involved
Solitary Nodule of Lung
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No air bronchgrams
Dense homogenous opacity RMZ
Round shadow & clear margins
Could be a mass lesion or an inter
lobar effusion
The right lung is involved
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Cannon Ball shadows
4/15/2010
Again there are no air bronchgrams
Dense homogenous opacities middle and
lower zones
Rounded shadow with not so clear
marginsCould be a
secondaries from any other primary
site
Both the lung fields are affected throughout
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Pleural Calcification
4/15/2010
It is dense and white with irregular
margins
Dense homogenous opacity lateral part
of middle zone
These are due to pleural thickening
May be there is additional
calcification of pleura
Both the lung fields are relatively clear
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Emphysematous Bulla
4/15/2010
There is a large air space in the left
middle zone laterally
There is an additional area of
hypertransleucencies
The wall of the lesion is very thin
There is no mediastinal shift to
suggest pneumothorax
The chest is emphysematous and
elongated
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Right Upper Lobe Collapse
4/15/2010
Absorption collapse of the lobe
There is a lower margin
Due to bronchial obstruction
Right Upper Lobe Atelectasis
A dense opacity in upper zone
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Right Middle lobe Collapse
4/15/2010
Seen in the right middle zone
A more diffuse type of shadow
a linear triangular shadow
in the lateral view suggestive
Right Middle Lobe Atelectasis
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Right Lower lobe Collapse
4/15/2010
A linear opacity
near the right diaphragm
shift of the right border of heart
Posterior triangular shadow in
Seen in a lateral view-
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