Notes

Slide Show

Outline

1	Basic Chest X-Ray Interpretation Adam Guttentag, M.D.
2
3
4
5
6
7	The Lateral Chest Film Find abnormalities hidden on the frontal film Confirm abnormalities suspected from frontal film Don’t be afraid to look at it!
8	Looking at the lateral CXR
9
10
11
12	Technical Factors Positioning straight vs oblique
13	Effect of obliquity on heart size
14	Technical Factors Positioning straight vs oblique PA vs AP
15	Technical Factors Positioning straight vs oblique PA vs AP erect vs supine
16	Technical Factors Positioning straight vs oblique PA vs AP erect vs supine lordotic vs kyphotic
17	Technical Factors Positioning straight vs oblique PA vs AP erect vs supine lordotic vs kyphotic
18	Technical Factors Depth of inspiration Visualization of pathology depends on contrast provided by air in the lungs Count ribs!
19	Short of breath
20	Technical Factors Body habitus
21
22	Recognizing air space disease Alveolar spaces filled with…something. Radiologist's report: “consolidation” “air space opacity” “fluffy density” “infiltrate” Nonspecific: Atelectasis, pneumonia, bleeding, edema, tumor
23	The Silhouette Sign Indicates air space disease. Obscuration of a normally seen border, e.g. diaphragm or heart. Opacity with sharp edge along a fissure.
24	Localizing disease from the silhouette sign
25	Localizing disease from the silhouette sign
26
27	Lobar Atelectasis Best sign – shift of a fissure Rapid development and clearance Air bronchograms if non-obstructive Secondary signs: Mediastinal shift Elevated diaphragm Ribs closer together Vague increased density
28
29
30
31
32	Pneumonia Signs: Air bronchogram Silhouette - “positive” or “negative” Dense hilum “Spine” sign All are signs of any air space process Dx of pneumonia depends on appropriate clinical scenario.
33
34	Air bronchograms — CT
35	Right middle lobe
36	Right upper lobe
37	Right lower lobe
38
39
40
41	Final Exam
42	21 y.o. with fever and cough
43
44
45
46
47	Take home message #1 It’s a chest x-ray, not a lung x-ray.
48	6 cm lung mass missed. How?
49	Take home message #2 Old films are your friend!
50	Elderly man with hypotension
51	Suddenly septic
52	Pneumatosis of small bowel
53	Take home message #3 The patient pays for the whole film!
54	Review Questions
55	All are kinds of air space disease except: Hemorrhage Pneumonia Tumor Sarcoidosis Atelectasis
56	The most specific sign of atelectasis is: Obscuration of a diaphragm Shift of a fissure Air bronchograms Density over the spine Mediastinal shift
57	This can make the heart look larger than it is: Lordotic positioning AP positioning Expiratory film Supine positioning All of the above
58	Additional Reading Chest Roentgenology Felson, B W.B. Saunders Co, Philadelphia 1973 Chapter 2: Localization of Intrathoracic Disease. pp 22-70. Pare JAP and Fraser RG Synopsis of Diseases of the Chest W.B. Saunders Co, Philadelphia 1983. Chapter 4: Roentgenologic Signs in the diagnosis of Chest Disease. pp164-187.
59	The End