Reading the CXR

Frank Schembri

Pulmonary / Critical Care

Types of Densities

Basic Principles of the CXR

• Types of views– PA– Lateral– AP– Apical lordotic– Decubitus (R & L)

PA vs AP

Lateral CXR

Apical Lordotic Chest

Decubitus Positioning

Approaching the CXR

• Name, date, type of film• Type of film• Patient positioning / rotation• Inspiration• Penetration

– White is underpenetrated– Black is overpenetrated

Approaching the CXR• The systematic approach

1. Tubes / Hardware2. Bones3. Soft tissues4.Pleura and diaphragm5. Trachea and mediastinum6. Lung parenchyma

Rotation

Rotation

Inspiration

Penetration

Scanning the xray

Scanning the xray

# 1- Hardware

#1- Hardware

#1- Hardware

#1- Hardware

2. Osseous Structures in the Chest

2. Osseous Structures of the Chest

3. Soft Tissues

4. Pleura and Diaphragm

5. Mediastinal Anatomy

5. Mediastinal Anatomy

5. Mediastinal Compartments

6. Parenchymal Anatomy

Anterior View

Lateral View

6. Parenchymal Anatomy

Left Lung Right Lung

Lobes• Right upper lobe:

Lobes (continued)

• Right middle lobe:

Lobes (continued)

• Right lower lobe:

Lobes (continued)

• Left lower lobe:

Lobes (continued)

• Left upper lobe with Lingula:

Lobes (continued)

• Lingula:

Lobes (continued)

• Left upper lobe - upper division:

Pneumonia

Atelectasis

Elevation of diaphragm

mass

Minor fissure

Loss of volume

Minor fissue

Minor fissure

Major fissure

Pneumothorax

• Collection of air in pleural cavity• Primary and secondary causes• Upright position air rises and separates the lung

from the chest wall creating a line. Don’t be fooled by skin folds, clothing and bullae.

• In the supine position air moves anteriorly. The lung will not be clearly separated from the chest wall.

PTX

Pneumothorax in the Supine Patient

Deep sulcus sign

hyperlucent

Enlarged hemithorax

Mediastinal shift

Sharper cardiac border

Tension

Pneumothorax

Bat-winged appearance

Enlarged heart

CHF

Perihilar infiltrates/enlarge PA

Pleural effusions

Kerley B lines

Effusions