Chest X-ray interpretationChest X-ray interpretation

Harindu Udapitiya,Temporary Lecturer,Division of Pharmacology.

Overview

Before interpreting……

1. Proper labelling

2. Proper positioning

3. Veiw-PA? AP? Lateral?

4. Exposure

5. Rotation

6. Adequacy of inspiratory effort

Normal Anatomy

Normal Chest X-ray

Cardiac Structures Position

More central in younger infants and children More on the L side in older infants and teens

Size The cardiothoracic ratio should be less than 0.5 A cardiothoracic ratio of greater than 0.5 (in a good

quality film) suggests cardiomegaly.

A/B<0.5

Cardiomegaly

Trachea The trachea is placed usually just to the right of

the midline

Mediastinum

Lungs There are three lobes in the right lung and two in

the left. Right lung

1. Upper lobe

2. Middle lobe

3. Lower lobe.

Left lung1. Upper lobe; this contains the lingula

2. Lower lobe.

Pleura There are two layers of pleura: the parietal

pleura and the visceral pleura. The parietal pleura lines the thoracic cage and

the visceral pleura surrounds the lung.

Diaphragm Contour Rounded with sharp pointed costophrenic and

costocardiac angles. Blunting of costalphrenic or costocardiac angles suggests plueral effusion.

Right diaphragm is usually 1-2 cm higher

Abnormal Chest X-ray

Radiopacity (whiteness) means increased density

Radiotranslucency (blackness) means decreased density

Radiopacity can be of 3 causes Alveolar pattern – fluffy, soft, poorly demarcated

opacifications < 1 cm in diameter Possible causes:

Pulmonary edema Viral pneumonia Pneumocystis Alveolar cell carcinoma

Pneumonia

Abnormal Chest X-ray

Interstitial pattern Consolidation of interstitial tissue (alveolar walls,

intralobular vessels, interlobar septa and connective tissue)

Looks like branching lines radiating toward the periphery of the lung

Possible causes: Interstitial pneumonitis Pulmonary fibrosis

Pulmonary Fibrosis

Abnormal Chest X-ray

Vascular pattern – assessment of the pulmonary arteries and capillaries If there is an increase in the size of the

pulmonary arteries as they extend out into the lung – pulmonary hypertension

If there is a decrease in size, truncation, or obliteration of a pulmonary artery – embolus

Lack of vascular making in the periphery - pneumothorax

Pulmonary Hypertension

Pulmonary Embolism

Lung pathologies

White Lung field Black lung Field

Well defined

Ill defined

Collapse Pleural Effusion

Consolidation Fifrosis Pulmonary Edema Infiltration

Pathological Conditions

1. Consolidation

2. Abscess

3. Bronchial Asthma

4. Bronchiectasis

5. COPD

6. Lung Collapse

7. Heart Failure

8. Pulmonary fibrosis

9. Hiatus hernia

10. Pleural Effusion

11. Pneumothorax

12. TB

13. Carcinoma

14. Lymphoma

15. Pericardial Effusion

16. Mitral Stenosis

17. ASD

1.Consolidation

Causes Pneumonia Bronchial carcinoma Lymphoma Inflammatory conditions

Radiological features Airbronchogram Silhouette sign Lower border

R.Middle lobe Pneumonia

R.Lower Lobe pneumonia

2.Abscess

3.Bronchial asthma

I. HyperinflationII. Diaphragmatic

flatteningIII. Bronchial wall

thickeningIV. Hilar

enlargement

4.Bronchiectasis

I. Tram line opacification

II. “Bundle of graphes appearance”

5.COPD

7.Lung Collapse

DDI. Lung collapse

II. Lower lobe consolidation

III. Pleural effusion

IV. Raised hemi diaphragm

8.Pulmonary fibrosis

9.Pleural Effusion

10.Pneumothorax

11.Hiatus hernia

12.TB

Miliary TB

13.Bronchial carcinoma

14.Lymphoma

15.Pericardial effusion

16.Mitral Stenosis

17.ASD

1.Basics on normal chest x ray 2.Basics on Abnormal chest x ray 3.Pathological conditions