Sheetu Singh Assistant Professor Institute of respiratory disease SMS Medical college Jaipur Basics Chest Xray Dr Sheetu Singh Chest X Ray How will you evaluate a chest X ray Type of view ID: 930633
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Slide1
Basics of chest X ray
Dr Sheetu SinghAssistant ProfessorInstitute of respiratory disease, SMS Medical college, Jaipur
Basics Chest Xray: Dr Sheetu Singh
Slide2Chest X Ray
How will you evaluate a chest X ray?Type of viewExposureComplete vs Incomplete filmSoft tissueBony structuresTracheaHilum
Heart
Cardiophrenic
and Costophrenic anglesLung
Basics Chest Xray: Dr Sheetu Singh
Slide31. Type of viewPA view
AP viewLateral view (all fissures are seen on lateral film)Lateral decubitusLordotic viewBasics Chest Xray: Dr Sheetu Singh
Slide4PA view
1. Type of view
Basics Chest Xray: Dr Sheetu Singh
Slide5AP VIEW
1. Type of viewBasics Chest Xray: Dr Sheetu Singh
Slide6LATERAL VIEW
1. Type of viewBasics Chest Xray: Dr Sheetu Singh
Slide7LATERAL DECUBITUS
1. Type of viewBasics Chest Xray: Dr Sheetu Singh
Slide8LORDOTIC VIEW
1. Type of viewBasics Chest Xray: Dr Sheetu Singh
Slide9LORDOTIC VIEW
1. Type of viewBasics Chest Xray: Dr Sheetu Singh
Slide102. ExposureExposure made in full inspiration
Basics Chest Xray: Dr Sheetu Singh
Slide113. Complete vs Incomplete film
Despite best efforts only 60% of lungs are visualized on chest X ray as rest is hidden by other structures
Basics Chest Xray: Dr Sheetu Singh
Slide124. Soft tissue
Basics Chest Xray: Dr Sheetu Singh
Slide135. Bony structures
Basics Chest Xray: Dr Sheetu Singh
Slide146. Trachea
Basics Chest Xray: Dr Sheetu Singh
Slide157. Hilum
Pulmonary arteries and their main branchesUpper lobe pulmonary veinsMajor bronchiLymph nodesLeft hilum is higher than the right hilum.Basics Chest Xray: Dr Sheetu Singh
Slide167.
HilumBasics Chest Xray: Dr Sheetu Singh
Slide178. Heart
Basics Chest Xray: Dr Sheetu Singh
Slide189. DiaphragmLeft diaphragm is lower than the right because heart depresses the left diaphragm
Basics Chest Xray: Dr Sheetu Singh
Slide19Cardiophrenic and Costophrenic angles
Basics Chest Xray: Dr Sheetu Singh
Slide2010. LungBasics Chest Xray: Dr Sheetu Singh
Slide21Solitary pulmonary nodule A solitary pulmonary nodule is defined as a discrete, well-
marginated, rounded opacity less than or equal to 3 cm in diameter that is completely surrounded by lung parenchyma, does not touch the hilum or mediastinum, and is not associated with adenopathy, atelectasis or pleural effusion. Lesions larger than 3 cm are considered masses and are treated as malignancies until proven otherwise.
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide2210. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide23Solitary pulmonary noduleHamartoma
: popcorn calcification Non cavitating nodulesDiagnosis:CT chestCT guided FNAC/Biopsy
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide24Miliary shadows
SilicosisCoal workers pneumoconiosisLoeffler’s syndromeSarcoidosis / BerryliosisTuberculosis/Nocardia/BrucellaHistoplasmosisVaricellaMetastasisRheumatoid arthritis nodulesWegner’s
granulomatosis
Amyloidosis
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide2510. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide26Unilateral radiolucency on chest X ray
PneumothoraxEmphysemaResection of mammary glandPulmonary artery obstructionPatient rotation10. LungBasics Chest Xray: Dr Sheetu Singh
Slide27EmphysemaFlattened diaphragm (terrace pattern)
Tubular heartIncreased rib spacesIncreased retrosternal air spaces10. LungBasics Chest Xray: Dr Sheetu Singh
Slide2810. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide29Pleural effusionObtuse angle with chest wall
Not confined to bronchopulmonary segmentAir bronchogram not visualized (seen in Consolidation)Diagnostic modality –I/L Lateral decubitusUSG chestCT chest
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide3010. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide3110. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide32AsbestosisPleural plaques (primarily the diaphragmatic pleura)
Pulmonary fibrosisMesotheliomaLung cancer10. LungBasics Chest Xray: Dr Sheetu Singh
Slide33Pleural plaques
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide34Pleural fibrosis
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide35Mesothelioma
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide36Round atelectasis – comet tail sign
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide37Bulging of fissure seen in -Klebsiella
pneumonia10. LungBasics Chest Xray: Dr Sheetu Singh
Slide38Pneumatocele formation -
Staphylococcal pneumoniaPCP pneumonia10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide39Pulmonary edemaBat wing appearance on Chest X ray
Seen in –Congestive cardiac failureUremic lung10. LungBasics Chest Xray: Dr Sheetu Singh
Slide4010. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide41Bronchiectasis
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide42Bronchiectasis
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide43Bronchiectasis
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide44Massive hemoptysisBronchial artery
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide45Pulmonary embolismHampton’s hump
Westermark signPalla’s signGold standard investigationPulmonary angiographyVQ scan – perfusion defect with normal lung scan10. LungBasics Chest Xray: Dr Sheetu Singh
Slide4610. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide47TuberculosisUpper lobe predominance
Lower lobe involvement in immunocompromised host (DM, HIV)Cavitation, FibrosisMediastinal lymph node enlargement with necrosis10. LungBasics Chest Xray: Dr Sheetu Singh
Slide48Tuberculosis
10. LungBasics Chest Xray: Dr Sheetu Singh
Slide49HIVPCP –
perihilar bat wing appearance (GGO) AIDS defining illness Pentamidine increases risk of pneumothoraxTuberculosis – if CD4 count is low cavitation is less likely and chances of lymphadenopathyKaposi sarcoma – pulmonary, visceral and cutaneous involvement. (pleural and pericardial effusion common)
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide50Tree in bud appearance
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide51Tree in bud appearance
Infective bronchiolitisPulmonary tuberculosisMACViral pneumoniaFungal infection – aspergillusABPAPCPCongenitalCystic fibrosisBronchiolitisNeoplasticBronchioalveolar
carcinoma
10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide52Honeycombing of lung seen inInterstitial lung disease
IdiopathicSecondary to collagen vascular diseases (like RA, Scleroderma, Sjogren’s syndrome)Sarcoidosis10. Lung
Basics Chest Xray: Dr Sheetu Singh
Slide53Computed Tomography Tomography = sectional imaging / slice (transverse section view)
CT generates images in transaxial section (perpendicular to cranio-caudal axis)CT measures the degree of attenuation of X ray beams by various tissues in the body → called as HOUNSEFIELD unit (Godfrey Hounsefield)Ranges from -1000 HU (Black)→ 3000 HU (White) Air = -1000 HUWater = 0 HUBasics Chest Xray: Dr Sheetu Singh
Slide54Walls of CT scan room are coated with –Lead
GlassTungstenIronBasics Chest Xray: Dr Sheetu Singh
Slide55Role of CT chest in hemoptysisIn a patient with
hemoptysis and a normal chest X ray, the first investigation of choice CT chest → Bronchoscopy(this localization of the disease, improves the yield of bronchoscopy and also helpful in staging of tumor)Basics Chest Xray: Dr Sheetu Singh
Slide56HRCT chest
Characterized by Narrow beam collimationHigh spatial reconstruction algorithm / Bone algorithmSmall field of viewHRCT chest used to diagnose –Interstitial lung disease (ILD)Bronchiectasis
Basics Chest Xray: Dr Sheetu Singh