Basic Chest X-Ray
Interpretation
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The Lateral Chest Film
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Find abnormalities hidden on
the frontal film |
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Confirm abnormalities suspected
from frontal film |
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Don’t be afraid to look at it! |
Looking at the lateral
CXR
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Technical Factors
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Positioning |
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straight vs oblique |
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Effect of obliquity on
heart size
Technical Factors
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Positioning |
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straight vs oblique |
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PA vs AP |
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Technical Factors
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Positioning |
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straight vs oblique |
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PA vs AP |
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erect vs supine |
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Technical Factors
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Positioning |
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straight vs oblique |
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PA vs AP |
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erect vs supine |
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lordotic vs kyphotic |
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Technical Factors
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Positioning |
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straight vs oblique |
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PA vs AP |
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erect vs supine |
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lordotic vs kyphotic |
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Technical Factors
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Depth of inspiration |
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Visualization of pathology
depends on contrast provided by air in the lungs |
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Count ribs! |
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Short of breath
Technical Factors
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Recognizing air space
disease
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Alveolar spaces filled
with…something. |
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Radiologist's report: |
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“consolidation” |
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“air space opacity” |
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“fluffy density” |
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“infiltrate” |
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Nonspecific: |
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Atelectasis, pneumonia,
bleeding, edema, tumor |
The Silhouette Sign
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Indicates air space disease. |
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Obscuration of a normally seen
border, e.g. diaphragm or heart. |
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Opacity with sharp edge along a
fissure. |
Localizing disease from
the silhouette sign
Localizing disease from
the silhouette sign
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Lobar Atelectasis
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Best sign – shift of a fissure |
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Rapid development and clearance |
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Air bronchograms if
non-obstructive |
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Secondary signs: |
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Mediastinal shift |
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Elevated diaphragm |
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Ribs closer together |
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Vague increased density |
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Pneumonia
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Signs: |
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Air bronchogram |
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Silhouette - “positive” or
“negative” |
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Dense hilum |
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“Spine” sign |
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All are signs of any air space
process |
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Dx of pneumonia depends on
appropriate clinical scenario. |
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Air bronchograms — CT
Right middle lobe
Right upper lobe
Right lower lobe
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Final Exam
21 y.o. with fever and
cough
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Take home message #1
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It’s a chest x-ray, |
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not a lung x-ray. |
6 cm lung mass missed.
How?
Take home message #2
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Old films are your friend! |
Elderly man with
hypotension
Suddenly septic
Pneumatosis of small
bowel
Take home message #3
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The patient pays for
the whole film! |
Review Questions
All are kinds of air
space disease except:
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Hemorrhage |
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Pneumonia |
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Tumor |
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Sarcoidosis |
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Atelectasis |
The most specific sign of
atelectasis is:
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Obscuration of a diaphragm |
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Shift of a fissure |
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Air bronchograms |
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Density over the spine |
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Mediastinal shift |
This can make the heart
look larger than it is:
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Lordotic positioning |
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AP positioning |
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Expiratory film |
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Supine positioning |
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All of the above |
Additional Reading
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Chest Roentgenology Felson, B W.B. Saunders Co, Philadelphia
1973 Chapter 2: Localization of Intrathoracic Disease. pp 22-70. |
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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. |
The End