Chest XRay interpretation INTERPRETATIONS Identifications: Name & Date Technical evaluation Basic Interpretations

Transcription

1 Chest XRay interpretation INTERPRETATIONS Identifications: Name & Date Technical evaluation Basic Interpretations TECHNICAL EVALUATION 1. Projection: AP/PA view To differentiate between AP & PA films, look at the clavicle if it is present below or nearby the anterior end of the first rib the film is PA. PA view LAT AP view 2. Penetration: hard/ soft The vertebral bodies and disc spaces should be just visible down to the 8/9 thoracic level through cardiac shadow (optimal penetrated) Soft too clearly visible the film is (over penetrated) Hard not visible is the film is (under penetrated) Centering: the medial ends of the clavicles are equidistant from vertebral spinous processes. 3. Rotation: centralized/ uncentralized centralized uncentralized

2 4. Orientation: Left/ Right (dextrocardia) The mark on the film. Provided that there is no dextrocardia notice the following: Aortic knuckle on the left side. Cardiac apex (the outermost dome of cardiac shadow) on the left side. Gastric air bubbles on the left side 5. Breathing: Insp/ Exp Degree of inspiration: Inspiration The anterior end of 6th rib or posterior ends of 10 th rib are above the right hemidiaphragm good inspiration film. If more ribs are visible the patient is hyperinflated. If fewer ribs are visible, the film is expiratory. Expiration Start report 1. Soft tissue. 2. Thoracic cage. 3. Diaphragm. 4. Pleural spaces. BASIC INTERPRETATIONS 5. Mediastinum. 6. Hilum. 7. Lung zones. 8. Review areas Soft tissues Thoracic cage Hilum Diaphragm The left hilum is usually higher than the right, rarely they are at the same level. should be of equal density, size with clearly defined concave lateral borders. The right hemidiaphragm is commonly higher than the left by 1-3 cm due to the heart depressing the left side and not to the liver pushing up the right hemidiaphragm. Rarely the left hemidiaphragm is at the level of the right or even higher if stomach or splenic flexure is distended.

3 The upper zone: one extend down to an imaginary line extending transversely from the point of the lower border of the second rib at its costochondral junction. Middle zone: a similar line extending from the point of the lower border of the 2 nd rib at its costo-chondral junction to the 4 th rib. Lower zone: below 4 th rib and downward. Lung Zones Mediastinum Hearts With good centering, the two thirds of the heart lie to the left and one third to the right of the midline. The cardiothoracic ratio is less than 50% on PA film (Normally, the transverse diameter of the heart that measured from the most convex point in each side to the line of the vertebral spine is < 50% of the transthoracic diameter). The costophrenic angles normal angles are acute and well defined. Review Areas

4 Normal 1. Bones 2. Muscles 3. Breast 4. Diaphragm 5. Heart 6. Hilum Normal Parenchyma trachea Fundus REPORTING ABNORMALITIES White (radiopaque) Abnormal Homogenous Heterogenous Shadow more/less white Combined black & white shadows Homogenous Milliary: 2-5mm nodule Tumour Nodular: 5-10 mm nodules Collapse Reticular: Linear interlacing streaks Effusion Reticulonodular: mix reticular & Consolidation military shadow Pure radiolucent Pneumothorax Emphysema Black (radiolucent) Abnormal Mixed Lucent and opaque Cavity Abscess. Cyst Bulla RADIOLOGICAL DIFFERENTIAL DIAGNOSIS Air bronchogram Cavitary lesion Shadowing is intrapulmonary, it is a hallmark for consolidation. 1. Consolidation. 2. Expiratory film. 3. Rarely lymphoma. 4. Alveolar cell carcinoma 5. Pulmonary infarction Lucency at least 1cm in diameter within an area of opacity with a wall thickness 3 mm. if it contains air fluid level it is called abscess. 1. Lung abscess 2. TB 3. Fungal infection 4. Bronchogenic carcinoma. 5. Metastatic tumors Nodules and Masses Nodule: any pulmonary lesion represented in a radiograph by a sharply defined, discrete, nearly circular opacity 2-30 mm in diameter Mass: larger than 3 cm single or multiple size border definition presence/absence of calcification location Solitary pulmonary nodule Tumor (bronchogenic carcinoma, metastases). Infection (TB, fungi, hydatid, round pneumonia) Pulmonary infarction. Collagen (rheumatoid arthritis). Skin and chest wall lesion. Multiple pulmonary nodules 1. Metastasis. 2. TB. 3. Fungi. 4. Hydated cysts. 5. Sarcoidosis. 6. Infarcts. 7. Arteriovenous malformation. 8. Hamartomas.

5 Milliary shadows 2-5mm nodule. TB Metastases. Sarcoidosis. Fungal infection. Pneumoconsiosis as silicosis, coal miner disease. Diffuse bilateral reticulonodular shadows Reticular: linear interlacing streaks Nodular: 5-10 mm nodules Collagen disease as SLE. Idiopathic interstitial fibrosis. Pulmonary oedema. Fungal infection. Pneumoconiosis as coal miner's, silicosis & asbestosis Unilateral TB. Malignancy (bronchial carcinoma) Pulmonary artery aneurysm. Fungi. Technical (rotation of the patient) Causes of hilar enlargement Bilateral Sarcoidosis TB Lymphoma Leukemia Pulmonary hypertension Expiratory film Opaque hemithorax Unilateral hypertranslucency Causes of apical shadow Pleural effusion, mesothelioma. Chest wall mastectomy. TB. Surgical pneumonectomy, thoracoplasty. Unilateral emphysema or bulla. Pancost tumor. Pulmonary collapse, consolidation, fibrosis. Pneumothorax. Pleural caps. Mediastinal huge mass. Obstructed pulmonary artery by Bullae. Diaphragm hernia. embolus. Pneumothorax. Pulmonary agenesis. Technical rotation. Technical (rotation of the patient). Fluid level in chest x-ray Intrapulmonary: lung abscess. Pleural: hydropenumothorax. Diaphragm: hernias, eventration, rupture. Oesophageal: achalasia, diverticulae. Calcification on chest x-ray * Intrapulmonary: Granuloma (TB, histoplasmosis). Tumor (hamartoma). Alveolar microlithiasis. Broncholith. * Pleural: TB, asbestosis.