Chest X Ray- KABERA Rene

CHEST X RAY

KABERA René MD, M.Med CandidateResident PGY II, Family and Community Medicine Faculty of Medicine National University of Rwanda

• Differences between radiodence and radiolucent

objects on an x-ray film.

• Four most common x-ray view.

• Steps of reading a chest x-ray.

• Identify major landmarks on chest x-ray.

• Major syndromes on a CXR.

• References .

Objectives

Radiodence and radiolucent image

• The greater the density, the less penetration of x-ray through the object.

The film remains under exposed.

Color: white.

• The less dense object allows x-ray to penetrate it

The film is more exposed.

Color: black.

Radiodence and radiolucent image

• AIR

• FAT

• BLOOD

• MUSCLE

• BONE

FOUR X-RAY VIEW

• POSTEROANTERIAL [PA]

• ANTEROPOSTERIAL [AP]

• LATERAL [L]

• OBLIQUE [ 3/4 ]

FOUR X-RAY VIEW

• Typical CXR is a PA

• More views are better than one bcs

the body is 3 dimensional.

Read a CXR

• Check the name on the film

• Check the date of the film

• Chest anatomy

Quick look : BSO

Bones : Deformation or wrong place.

Soft tissue: is there air where it shouldn’t be?

Organs: are they all there ?

Symetrical ?

Read a CXR

• Chest anatomy

• Trachea

• Clavicle

• Spatula

• Lung field

• Mammal gland

• Heart

• Ribs

• Vertebrae

• Costo-diaphragmatic angle

• Gastric Air bubble

Read a CXR

• PA view

• Clavicles are straight ?

• How many ribs ?

�Count ante ribs.

�Count post ribs.

�Count spaces between post ribs.

�7-8 inspiration

�5-6 expiration

Read a CXR

• Ante ribs

• Spaces :ante / post

• Post ribs

Read a CXR

• Inspiration • Expiration

Read a CXR

• Standing • Lying

X

Read a CXR

• How big is the heart [ PA view only ]

• ID = Internal diameter of chest at level of right hemidiaphragm MRD = greatest perpendicular diameter from midline to right heart border MLD = greatest perpendicular diameter from midline to left heart border

• CT index = (MRD + MLD)/ID

• 0-3 wks: CT 0.55

• 4-7 wks: CT 0.58

• 2-11months: CT 0.57-0.54

• 1yr -6yrs: CT 0.53-.045

• >7 yrs :<0.50

Read a CXR

• Look at the lungs

�Are the diaphragmatic

borders clear and

sharp?

�Are the cardiac borders

clear and sharp?

Read a CXR

• THYMUS

--Thymus: visible till Thymus: visible till 2 2 years years

old.old.

--Anatomical confusions Anatomical confusions

with pathological image. with pathological image.

Read a CXR

• Lung field

Right :

• upper and middle

lobes are div. by

major fissure .

[PA, L]

• Middle and lower

lobes are div. by minor

fissure .

Left :

• upper and lower

lobes div. major fissure

Read a CXR

• Fissures seen on film x-

ray that may indicate a

pathology.

Read a CXR

• “Silhouette ”Sign

� Same plan

�Different plan

Read a CXR

• NORMAL CXR

Major landmarks on CXR

• Alveolar syndrome

• Interstitial syndrome

• Bronchial syndrome

• Pleural syndrome

• Cavity syndrome

• Vascular syndrome

• Parietal syndrome

• Mediastinum syndrome


• Alveolar syndrome:

-Opacities with out of focus borders, confluence

-Rapid onset.

-Aeric bronchogramm.

-Alveolar nodules.

�D’se involved:

Localised : pneumonia ,tbc, pulmonary oedema, broncho-alveolar cancer …

Diffuse : Viral dss, Inhalation, HMD …


• ALVEOLAR SD

1. PNEUMONIA

RUL RML


• ALVEOLAR SD

1.PNEUMONIA

[LUL]


• ALVEOLAR SD2.BRONCHOPNEUMONIA


• INTERSTITIAL SD

�Well limited opacities.

�Micronodular opacities.

�Not organised. No confluence.

�No air bronchogram.

� Slow evolution.

�Kerley ligns.

�D’se involved: TBC, bronchiolitis, inhalation

pneumonia, PCP, mucoviscidosis…


• INTERSTITIAL SD

�KERLEY LINES


• INTERSTITIAL SD

1.TBC [MILIAIRE]


• INTERSTITIAL SD

1.PULMONARY TBC


• INTERSTITIAL SD

2.PCP


• INTERSTITIAL SD

3.PULMONARY

FIBROSIS


• INTERSTITIAL SD

4.INHALATION

PNEUMONIA


• INTERSTITIAL SD

55.MUCOVISCIDOSE.MUCOVISCIDOSE


• BRONCHIAL SD

�Thickening of the bronchial wall .

�Dilatation of the bronchial lumen.

�Hypersecretion ,bronchial obstruction, …

�Obstruction of the bronchial lumen.

�Dse’s involved: chronic bronchitis.

atelectasis


• BRONCHIAL SD

�Atelectasis right lung


• BRONCHIAL SD

�Chronic bronchitis

Dilatation of bronchial

lumen


• PLEURAL

SYNDROM

1.Pleural effusion

Damoiseau curve


• PLEURAL SD

1.Pleural effusion

[ Lying position ]


• PLEURAL SD

2.Pneumothorax


• MEDIASTINUM SD

Air , liquid, lymphadenopathies, tumors in

mediastinum…


• MEDIASTINUM SD

1.Pneumopericardium


• MEDIASTINUM SD

2. LYMPHADENOPATHIES


• CAVITY SD

1.PULMONARY ABCESS


• CAVITY SD

2.KYSTE HYDATIQUE


• CAVITY SD

3.METASTASIS


Cavitating Metastasis

Multiple Thin Walled Cavities


��CAVITY SDCAVITY SD


• VASCULAR SD


• PARIETAL OR

EXTRAPLEURAL

SYNDROME

� concerning soft tissue and

bones .[deformation,

tumors…]

� Horizontal ribs


• PARIETAL OR

EXTRAPLEURAL

SYNDROME

�Breast cancer


� PARIETAL OR

EXTRAPLEURAL

SYNDROME

� Old fractured ribs

References

• www.uab.edu/pedradpath

• www.pediatricradiology.com

• www.spiral.univ-lyon1.fr/polycops/semeilogie-radiologique

• www.virtualpediatrichospital.org/providers

• Notes de cours “Imagerie médicale”.Doc III Prof SPEHL Marianne.NUR/FACMED

• Chest x-ray Atlas , http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/atlas/cxratlas_f.htm

THANK YOU

Murakoze

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Chest X Ray- KABERA Rene