basic approach for cxr interpretation
TRANSCRIPT
Basic approach to chest X-ray interpretation
Lecture 5 Dr. Kosar kamal ahmed
Basics First we should be familiar with normal CXR
Basics
Technical adequacy
• Rotation • Inspiration • Angulation • Penetration
Technical adequacy
• Rotation • Inspiration • Angulation • Penetration
Technical adequacy
• Rotation • Inspiration • Penetration • Angulation
Technical adequacy
• Rotation • Inspiration • Angulation • Penetration
Common normal variants
• Keat’s atlas of normal variants
• Azygos lobe fissure
Variants • Azygos lobe fissure
Variants
• An apparent nodule formed by joint between first rib and calcified cartilage
Variants
Pectus excavatum
How to interpret a CXR ?• Heart failure • Interstitial lung
disease • Pulmonary mass • Pulmonary abscess• Pleural effusion • Diaphragmatic hernia • Hilar pathology • LAP
A suggested form of ticsan inside-outside approach
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures
Inside to outside approach
• Technical adequacy
• Cardiothoracic ratio + CP
angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures Normal ( clear CP angles )
For pl. effusion click button
pleural fluid and effusion
pleural fluid and effusion
• Sub-pulmonic effusion
Is there any thing look like this ?
Eventration of the diaphragm or paralysis of hemidiaphragm
Eventration of the diaphragm and D. paralysis
pleural fluid and effusion
pleural fluid and effusion
Blunting of the costophrenic angle
pleural fluid and effusion
pleural fluid and effusion Meniscus sign
pleural fluid and effusion Meniscus sign
pleural fluid and effusion
• Layering effusion
• Lamellated effusion
• Loculated effusion ( vanishing
tumor )
What is the clue ? What to do next ?Take a lateral view
Lateral view CXR ( our best friend )
• On a normal lateral view the
contours of the heart are
visible and the IVC is seen
entering the right atrium.
• The retrosternal space should
be radiolucent, since it only
contains air. Any radiopacity in
this area is suspective of a
proces in the anterior
mediastinum or upper lobes of
the lung.
Lateral view CXR ( our best friend )
• As you go from superior to
inferior over the vertebral
bodies they should get darker,
because usually there will be
less soft tissue and more
radiolucent lung tissue (red
arrow).
• If this is not the case, look carefully for
pathology in the lower lobes.
Lateral view CXR ( our best friend )
What additional information can be obtained by lateral view ?
In our field lateral view is for localization
Lateral view CXR ( our best friend )
•The right diaphragm should be
visible all the way to the anterior
chest wall (red arrow).
•The left diaphragm can only be
seen to a point where it borders the
heart (blue arrow).
Lateral view CXR ( our best friend )
•From lateral view we can differentiate between hilar
masses ( LN or vascular lesions
Lateral view CXR ( our best friend )From lateral view we can differentiate between hilar masses ( LN or vascular
lesions
Hilar LAPPulm. HTN
Lateral view CXR ( our best friend )
• On the Paview the superior mediastinum is widened.
• The lateral view is helpful in this case because it demonstrates a density in the retrosternal
space.
• Now the differential diagnosis is limited to a mass in the anterior mediastinum (4 T's).
Lateral view CXR ( our best friend )
• 4 T s :
• Thymoma
• Teratoma
• Thyroid ( retrosternal )
• Terrible lymphoma
Let’s go back to where we skipped
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures
End of part one
Thank you for your attension