Download - Radiology of Chest 2
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X- RAY CHESTX- RAY CHEST
How To Read & InterpretHow To Read & Interpret
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X- RAY CHESTX- RAY CHEST
Keep the patients age, sex & clinicalKeep the patients age, sex & clinical
information in mind.information in mind. Follow your own systematic approach &Follow your own systematic approach &
strict to it. You will never miss findings.strict to it. You will never miss findings.
See all four corners of the film.See all four corners of the film. Always compare both sides.Always compare both sides.
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X- RAY CHESTX- RAY CHEST
See the IdentificationSee the Identification
number, name etc.number, name etc.
Observe right & leftObserve right & left
markers.markers.
See the date ofSee the date ofexamination.examination.
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X- RAY CHESTX- RAY CHEST
See the Exposure.See the Exposure.
Optimal exposure is that in which vertebralOptimal exposure is that in which vertebralbodies & intervertebral discs are justbodies & intervertebral discs are just
visible behind the heart shadow.visible behind the heart shadow.
Avoid over or under exposed films.Avoid over or under exposed films.
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POSITIONPOSITION
Observe theObserve the
position of theposition of the
patient.patient. Medial ends of theMedial ends of the
clavicles should beclavicles should be
equidistant fromequidistant from
spinous processspinous process
of dorsal vertebrae-of dorsal vertebrae-
usually T4.usually T4.
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TRACHEATRACHEA
Observe the TracheaObserve the Tracheafor narrowing,for narrowing,
displacement &displacement &intraluminal lesions..intraluminal lesions.. It is usually central &It is usually central &
sometimes slightlysometimes slightly
shifted to right.shifted to right. Deviation suggestsDeviation suggests
pathology.pathology.
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TRACHEATRACHEA
Right Para Tracheal Stripe:Right Para Tracheal Stripe: Seen in 60% of chest x rays.Seen in 60% of chest x rays. Normally less than 5 mm.Normally less than 5 mm.Widening is caused by:Widening is caused by:
Mediastinal lymphadenopathy.Mediastinal lymphadenopathy.
Tracheal malignancy.Tracheal malignancy. Pleural effusion.Pleural effusion. MediastinitisMediastinitis..
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TRACHEATRACHEA
Carina is at T4 level.Carina is at T4 level.
Carinal Angle is normally 60-75Carinal Angle is normally 60-75degrees.degrees.
Widening occurs inWidening occurs in
Enlarged left atrium.Enlarged left atrium.
Enlarged carinal lymph nodes.Enlarged carinal lymph nodes.
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LUNG FIELDSLUNG FIELDS
Compare corresponding lung fields inCompare corresponding lung fields in
both lungsboth lungs ApicesApices
Upper zonesUpper zones
Mid zonesMid zones
Lower zonesLower zones
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LUNG FIELDSLUNG FIELDS
See for abnormal area of lucency.See for abnormal area of lucency.
Uneven distribution of lung markings.Uneven distribution of lung markings.
The size of upper & lower zone vessels.The size of upper & lower zone vessels. Look for any abnormal opacity.Look for any abnormal opacity.
Characterize the opacity by looking at location, extent,Characterize the opacity by looking at location, extent,
specific features such as calcification or cavitation etc.specific features such as calcification or cavitation etc.
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HIDDEN AREASHIDDEN AREAS
Look again at apices.Look again at apices.
Look again behind heart shadow.Look again behind heart shadow. Look bones esp at the overlappingLook bones esp at the overlapping
areas.areas.
Look the sharpness of cardiac,Look the sharpness of cardiac,mediastinal & diaphragmaticmediastinal & diaphragmatic borders.borders.
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COSTOPHERENIC ANGLESCOSTOPHERENIC ANGLES
Normally they are acute.Normally they are acute.
Blunting indicatesBlunting indicates EffusionEffusion
FibrosisFibrosis
Pad of fatPad of fat
Overinflated lungsOverinflated lungs
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PLEURA & DIAPHRAGMPLEURA & DIAPHRAGM
Right dome is usually higher than left.Right dome is usually higher than left.A difference of more than 3 cms isA difference of more than 3 cms is
significant.significant.
Raised dome indicate pathology.Raised dome indicate pathology.
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PLEURA & DIAPHRAGMPLEURA & DIAPHRAGM
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PLEURA & DIAPHRAGMPLEURA & DIAPHRAGM
Diaphragmatic borderDiaphragmatic border Ill defined(Rt)Ill defined(Rt)
Ill defined(Lt)Ill defined(Lt)
Diaphragmatic positionDiaphragmatic position Abnormal(Rt)Abnormal(Rt)
Abnormal(Lt)Abnormal(Lt)
Free air under diaphragmFree air under diaphragm
Pleural borderPleural border Pneumothorax(Rt. or Lt)Pneumothorax(Rt. or Lt)
Pleural effusion(RT. or Lt)Pleural effusion(RT. or Lt)
Pleural thickeningPleural thickening
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THE HILUMTHE HILUM
Left hilum is 1-2 cms higher thanLeft hilum is 1-2 cms higher thanright.right.
The hila are composed ofThe hila are composed of Pulmonary artery and their mainPulmonary artery and their main
branches.branches.
Upper lobe pulmonary veins.Upper lobe pulmonary veins.
The major bronchi.The major bronchi. The lymph glands.The lymph glands.
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THE HILUMTHE HILUM
Compare position of right & left hilumCompare position of right & left hilum SizeSize
a. Enlargeda. Enlarged
b. Diminishedb. Diminished
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HEARTHEART Usually 2/3rd of heart shadow lies to theUsually 2/3rd of heart shadow lies to the
left of midline and 1/3rd to the right.left of midline and 1/3rd to the right.
Cardio-thoracic ratioCardio-thoracic ratio::
It is the ratio between maximumIt is the ratio between maximumtransverse cardiac diameter to thetransverse cardiac diameter to themaximum inner transverse diameter ofmaximum inner transverse diameter of
chest above CP angles.chest above CP angles. Normal C.T ratio is 0.5 or less. It is higherNormal C.T ratio is 0.5 or less. It is higher
in children.in children.
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RIGHT HEART BORDERRIGHT HEART BORDER
It is formed by:It is formed by:
Innominate vesselsInnominate vesselsSuperior vena cavaSuperior vena cava
Right atriumRight atrium
Small part of inferior vena cavaSmall part of inferior vena cava
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LEFT HEART BORDERLEFT HEART BORDER
It is formed by:It is formed by:
Subclavian arterySubclavian arteryAortic knuckleAortic knucklePulmonary bayPulmonary bay
Left arterial appendageLeft arterial appendage Left ventricleLeft ventricle
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SOFT TISSUESSOFT TISSUES Chest Wall soft tissue, breast shadow etc.Chest Wall soft tissue, breast shadow etc.
IncreaseIncrease DecreaseDecrease AbsenceAbsence
Soft tissue of NeckSoft tissue of Neck AsymmetryAsymmetry
Shoulder area soft tissueShoulder area soft tissue AsymmetryAsymmetry
CalcificationCalcification Upper abdomen soft tissueUpper abdomen soft tissue
CalcificationCalcification Abnormal air ( GI tract, or Outside)Abnormal air ( GI tract, or Outside)
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O S
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BONESBONES
RibsRibs Count pair of ribs( compare right to left)Count pair of ribs( compare right to left)
Missing ribMissing rib Asymmetric intercostals spacesAsymmetric intercostals spaces
Cervical ribsCervical ribs
Trace rib outlineTrace rib outline
FracturesFractures
MetastasisMetastasis
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BONES
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BONESBONES ClaviclesClavicles
FracturesFractures
MetastasisMetastasis
JointsJoints ScapulaeScapulae
FracturesFractures
MetastasisMetastasis
JointsJoints HumerusHumerus
FracturesFractures
MetastasisMetastasis
Shoulder JointShoulder Joint CalcificationCalcification WideningWidening
NarrowingNarrowing
DislocationDislocation
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BONESBONES
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BONESBONES
Spine.Spine.
PA ViewPA View PediclesPedicles
ScoliosisScoliosis
Lat. ViewLat. View Vertebral heightVertebral height
KyphosisKyphosis
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