How To Read A CXR

The Chest X-Ray Basics
How to read A CXR ?

NABIL PAKTIN, M.D.,F.A.C.C.
Trainer Specialist of Postgraduate Medial ducation
Afg!anistan " Ka#ul
$%&'%&&
Dr.Na#il Pa(tin,MD.FACC
Part &
Nor)al * #asics Concepts

+ densities of C!est ,-ra.
+ steps to C,/ interpretation
&- assess t!e lung e0pansion
1- assess t!e pleura
2- loo( for infiltrate
3- loo( at t!e )ediastinu)
+-Assess t!e a#do)en

Tec!ni4ues - Pro5ection 6continued7
Lateral Decu#itus
Tec!ni4ues
8olu)e of P and 9!et!er it:s

)o#ile or loculated.
Sensiti;e )et!od for detecting

s)all 4uantit. of PF6+'-
&'')l7.
Nondependent !e)it!ora0 to
confir) a pneu)ot!ora0 in a
patient 9!o could not #e
e0a)ined erect .
if t!e la.ering fluid is & c)

t!ic(, indicates an effusion of
greater t!an 1'' )L t!at is
a)ena#le to t!oracentesis
Tec!nical consideration
Inspiration
T!e patient s!ould #e

in full inspiration .
S!o9s #etter
intrapul)onar.
a#nor)alities
T!e diap!rag) fount

at a#out t!e le;el of
t!e $
t!
-&'
t!
posterior
ri#s or +
t!
-<
t!
anterior
ri# on good inspiration.
Penetration
=n a good PA fil) ,
t!e t!oracic spine
dis( spaces s!ould
#e #arel. ;isi#le
t!roug! t!e !eart
#ut #on. details of
t!e spine are not
usuall. #e seen
t!roug! t!e !eart .
=n t!e lateral ;ie9 ,

proper penetration
and inspiration is
seen t!roug! t!e
spine appears to
dar(en as .ou )o;e
caudall. . T!is is
due to )ore air in
lung in t!e lo9er
lo#es and less
c!est 9all .
Penetration cont>
?nderpenetrated
o;erpenetrated
T!ere is no
ade4uate
lung detail
A#sence of
perip!eral
;asculature
See
;erte#rae
e0tending
do9n into
t!e
a#do)inal
region.
/otation
T!e patient )ust

#e flat against t!e
cassette , if t!ere
is rotation of t!e
patient , t!e
)ediastinu) )a.
loo( ;er. unusual .
Cla;icular !eads
9!et!er t!e. are
in e4ual distance
fro) t!e spinous
process of t!e
t!oracic ;erte#ral
#odies .
/otation cont>
See t!e rotation !eads of t!e cla;icles

and t!e spinous processes .
/ecogni@ing a tec!nicall.
ade4uate C!est 0 ra.
Factors to e;aluate A
&- Penetration
1- Inspiration
2- /otation
3- Angulation
Penetration
Bou s!ould #e
a#le to 5ust see t!e
t!oracic spine
t!roug! t!e Ceart .
Pitfalls Due to o;er penetration
Inspiration
A#out &' posterior ri#s ;isi#le is an

e0cellent inspiration
In )an. Cospitali@ed patient D posterior

ri#s is an ade4uate Inspiration .
Anterior 8s. Posterior ri#s
Posterior
ri#s are
t!ose t!at
are )ost
apparent on
t!e c!est 0
ra. .t!e.
ru) )ore or
less
!ori@ontall..
Anterior ri#s
9ill #e
;isi#le #ut
are !arder
to see .
T!e. run
)ore or less
at a 3+
degree
angle
do9n9ard
to 9ard t!e
feet ,
Co9 to tell t!e difference #et9een t!e

anterior and posterior ri#s .
Ten posterior ri#s s!o9ing is an e0cellent inspiration

Pitfall due to poor inspiration
Poor inspiration 9ill cro9d lung )ar(ing and )a(e it

appear as t!oug! t!e patient !as airspace disease
Sa)e Patient
Better Inspiration and t!e disease at t!e lung #ases !as

cleared
/otation
If t!e spinous
process of
t!e ;erte#ral
#od. is
e4uidistant
fro) t!e
)edial ends
of eac!
cla;icle.
T!ere is no
rotation
Pitfall due to )ar(ed rotation
Se;ere rotation )a. )a(e t!e pul)onar. arteries

appear larger on t!e side fart!er fro) fil) .
Angulation
If t!e ,- ra. #ea) is angle to9ard t!e

!ead 6 )ostl. #ecause t!e patient is se)i-
recu)#ent 7 . T!e fils so o#tained is called
an E apical lordoticF ;ie9 .
Anterior structure 6 li(e t!e cla;icles7 9ill

#e pro5ected !ig!er on t!e fil) t!an
posterior structures .
Pitfall due to angulation
A fil) 9!ic! is apical lordotic 6 #ea) is angled up to9ard

!ead7 9ill !a;e an unusuall. s!aped !eart and t!e s!arp
#order of t!e left !e)idiap!rag) 9ill #e a#sent .
I)portant Points
T!e factors to e;aluate t!e 4ualit. of a

c!est 0-ra. are A
-
Penetration " see spine t!roug! t!e !eart
-
Inspiration " at least $-D posterior ri#s
-
/otation " spinous process #et9een
cla;icles
-
Angulation " cla;icle o;er 2
rd
ri#
G!at is )ost 9rong 9it! t!is i)age 6 clic( an.
t!at appl. 7H
Penetration
Inspiration
/otation
Angulation
Correct
T!e i)age is apical

lordotic loo( at t!e
!ig! position of t!e
cla;icles . It is also
underpenetrated .
Bou can:t tell if its
rotated and t!e
degree of
inspiration is
ade4uate
Grong
Can:t tell
Bou )a. #e rig!t #ut .ou can:t tell fro)

t!e i)age gi;en .
Correct
T!e i)age is apical

lordotic loo( at t!e
!ig! position of t!e
cla;icles . It is also
underpenetrated .
Bou can:t tell if its
rotated and t!e
degree of
inspiration is
ade4uate
G!at is )ost 9rong 9it! t!is
i)age 6 clic( an. t!at appl. 7H
Penetration
Inspiration
/otation
Angulation
Grong
Correct
T!e patient !as

ta(en a poor
inspiration . Ce
is also rotated
to9ard !is o9n
rig!t . Is
slig!tl.
underpenetrate
d and !e is not
angulated .
Correct
T!e patient !as

ta(en a poor
inspiration . Ce
is also rotated
to9ard !is o9n
rig!t . Is
slig!tl.
underpenetrate
d and !e is not
angulated .
Grong
Penetration
Inspiration
/otation
Angulation
Correct
T!e fil) is
underpenetrated ..ou
can:t see t!e !eart
t!roug! t!e spine .
T!e degree of
inspiration is
pro#a#l. ade4uate .
/otation can not #e
e;aluated and t!ere
is a slig!t a)ount of
Angulation
.incidentall. t!ere is
a large #rong!ogenic
ca in t!e left lung .
Grong
Can:t tell
Bou )a. #e rig!t #ut .ou can:t tell fro)

t!e i)age gi;en .
Penetration
Inspiration
/otation
Angulation
Correct
T!e pri)ar. tec!nical

pro#le) !ere is t!e
patient is rotated
considera#l. to9ard
!er o9n left side.
Notice !o9 t!e
!e)idiap!rag)
appears ele;ated on
t!e side to 9!ic! t!e
patient is rotated 6 red
arro9 7
Congratulation , .ou graduate
Anato).
Nor)al Anato).
nor)al frontal c!est ,-ra.A

&. trac!ea,
1. rig!t lung ape0,
2. cla;icle,
3. carina,
+. rig!t )ain #ronc!us,
<. rig!t lo9er lo#e pul)onar. arter.,
I. rig!t artiu),
$. rig!t cardiop!renic angle,
D. gastric air #u##le,
&'. costop!renic angle,
&&. left ;entricle,
&1. descending t!oracic aorta, &2. left
lo9er lo#e pul)onar. arter.,
&3. left !ilu),
&+. left upper lo#e pul)onar. ;ein,
&<. aortic arc!.
Nor)al
Anato).
&. Trac!ea
1. Lung ape0
2. /ig!t para-trac!eal
stripe
3. /ig!t !ilu)
+. /ig!t atriu) 6not

;entricleJ7
<. /ig!t costop!renic angle
I. /ig!t cardiop!renic angle
$. A@.go-oesop!ageal
stripe
D. Carina
&'. Descending t!oracic

aorta
&&. Kastric air #u##le
&1. Left ;entricle
&2. Left lo9er lo#e

pul)onar. arter.
&3. Left upper lo#e

pul)onar. ;ein
&+. Aortic arc!

Nor)al Anato).
nor)al lateral c!est
,-ra.A
&. ascending t!oracic aorta,
1. sternu),
2. rig!t ;entricle,
3. left ;entricle,
+. left atriu),
<. gastric air #u##le,
I. rig!t !e)idiap!rag),
$. left !e)idiap!rag),
D. rig!t upper lo#e #ronc!us,
&'. left upper lo#e #ronc!us,

&&. trac!ea.
Nor)al
Anato).
&. Trac!ea
1. Aortopul)onar. 9indo9
2. Sternu)
3. /ig!t ;entricle
+. /ig!t !e)idiap!rag)
<. Left !e)idiap!rag)
I. Left ;entricle
$. Posterior recess of lung
D. Left atriu)
&'. Scapula
&&. Lung ape0

Nor)al Anato).
Lateral C,/ 6continued7
Anato).
Lo#es
/ig!t upper lo#eA

Lo#es 6continued7
/ig!t )iddle lo#eA

Lo#es 6continued7
/ig!t lo9er lo#eA

Lo#es 6continued7
Left lo9er lo#eA

Lo#es 6continued7
Left upper lo#e 9it! LingulaA

Lo#es 6continued7
LingulaA
Lo#es 6continued7
Left upper lo#e - upper di;isionA

Pitfalls Due to ?nder Penetration
If t!e fil)s is
underpenetrated , t!e left
!e)idiap!rag) 7 and left
lung #ase 7 9ill not #e
;isi#le and t!e.
pul)onar. )ar(ing 9ill
appear )ore pro)inent
t!an t!e. actuall. are .
AP 8ersus PA
t!e effect of )agnification
In al PA fil) t!e !eart is closer to t!e fil)

and t!us less )agnified .
- t!e standard c!est ,-ra. is a PA fil) .
In a AP fil) , t!e !eart is fart!er fro) t!e

fil)s and is )ore )agnified .
- Porta#le c!est ,-ra. are al)ost al9a.s
done AP.
AP 8ersus PA
t!e effect of )agnification
AP porta#le fil) )a(e t!e

!eart loo( larger t!an it does .
=n t!is patient t!e PA fil)

is done one !our later .
Mediastinu) and Ceart
Structures for)ing t!e )ediastnal

)argins
Mediastinu) Cont>
Mediastinu) Cont>
T!e lo#es of
t!e lungs
for)ing t!e
)argins of
t!e lungs
along t!e
)ediastinu)
and c!est
9all .
Mediastinu) Cont>
Cila
Co)posed of
pul)onar. arter.
and it:s #ranc!es ,
and ad5acent and
pul)onar. ;eins .
T!e pul)onar.
arteries and upper
lo#e ;eins
significantl.
contri#ute to t!e
!ilar s!ado9 on
plain C!est ,-ra. .
Left !ilu) is slig!tl.

at a !ig!er position 6
'.+-1c)7 t!an t!e
rig!t !ilu).
Pul)onar. 8essels
T!e arteries and

;eins #ranc! out
fro) t!e Cila .
Beco)ing s)aller
to9ard t!e
perip!er. .
T!e larger central

;essels are #etter
seen . In t!e uprig!t
position , t!e lo9er
lung ;essels are
larger t!an t!e
upper lung ;essels
due to gra;itational
effects on flo9 . If
t!e patient is supine
, t!is called
Cep!ali@ation .
Diap!rag)

Angle of contact 9it!
t!e c!est 9all is
acute and s!arp.
Blunting of t!e angle

is so)eti)es
nor)all. seen in
at!letes.
Nor)all. rig!t
!e)idiap!rag) is
&.+-2.+c) !ig!er
t!an t!e left
difference of )ore
t!an 2 c) is
considered
a#nor)al .
In 2L of population .
Left !e)idiap!rag)
is at a !ig!er le;el
t!an t!e rig!t .
Diap!rag) cont>
C!ec( for do)ing of diap!rag) #. dra9ing a line prependicular fro) t!e )id
point of t!e do)e to a line 5oining costop!erenic and cardiop!renic angles .
T!e distance is AM&.+c) less t!an t!at consider flattened .

Diap!rag) cont>
6A7 ;entration of left !e)idiap!rag) 6B7 Air under t!e diap!rag)
Diap!rag) cont>
Nor)al 8ariant
&- scalloping
1- )uscle slips
2- diap!rag)
!u)p and
dro)edar.
diap!rag)
3-e;entration
+-accessor.
diap!rag).
Interpretation
Co9 to loo( at a c!est PA ;ie9
Co)parison 9it! pre;ious ,-ra.s

-
e;er. effort s!ould #e )ade to o#tain pre;ious fil)
for co)parison 9it! t!e current fil).
-
T!e easiest 9a. to identif. a ne9 a#nor)alit. is to
note its a#sence on a pre;ious fil)JJ
-
T!e (e. to successfull. interpreting an. radiograp!
is to #e s.ste)ic .
-
0a)ine all parts of t!e fil) in an orderl. )anner
and do t!is consistentl. .

Side )ar(er
T!e position of side )ar(er allo9s t!e

radiograp! to #e oriented correctl. for reading .
Tec!ni4ue
Ne0t concentrate on t!e tec!nical factors A

&- is t!e e0a)ination co)plete H
1- Are all t!e re4uested ;ie9s includedH
2- Is t!e entire anato)ical area included on t!e
fil) A
&- Positioning
1- Inspiration
2- E0posure
3- Rotation
S.ste)atic anal.sis
&- soft tissue including #reast , c!est 9all ,

co)panion s!ado9 .
1- #ones " s!oulder girdles , spine and ri#

cage .
2- diap!rag) position . S!ape ,

su#diap!rag)atic a#nor)alities .
3- re;ie9 a#do)en for #o9el gas , organ

si@e , a#nor)al calcification , free air .
+- plastic " TT . Lines , tu#es .

S.ste)atic anal.sis cont>
<- re;ie9 )ediastinu)A

-
=;eral si@e and s!ape
-
Trac!ea A position , carina , t!e trac!ea
s!ould #e central .
-
Margins AS8C ascending aorta , rig!t
atriu) , left su#cla;ian arter. , aortic arc! ,
)ain pul)onar. arter. , left ;entricle .
-
Lines and stripes A paratrac!eal ,
paraspinal , paraesop!ageal
6 a@.goesop!ageal7 , paraaortic .
-
/etrosternal clear space .
S.ste)atic anal.sis cont>
I- !eart si@e , s!ape A t!e 9idt! of t!e !eart s!ould #e no greater t!an +'L
of t!e 9idt! of t!e cage .
$-/e;ie9 !ila A
A- nor)al relations!ips
B- si@e
D- parenc!.)a A no9 finall. read. to e0a)ine t!e lungsJJ Mentall. di;ide t!e
entire c!est into upper , )iddle and lo9er t!irds . T!en , )et!odicall.
co)pare t!e rig!t and left sides of eac! lung section loo(ing for as.))etr. .
T!e easiest 9a. to identif. an a#nor)alit. is to confir) t!at it does not e0ist
on t!e ot!er side J .
Co)pare lung si@es , aeration , ;ascular distinctness and a#nor)al

opacities .
&'- pleura A costop!erenic and cardiop!renic angles , t!ic(ening fissures "

)a5or and )inor " if seen .
Mediastnal lines
Cidden Areas JJJ
&- supracla;icular regions
.
1- nds of ri#s
2- retrocla;icular regions
3-posterior )ediastnal
and para;erte#ral
regions .
Sil!ouette sign
=ne of t!e )ost useful sign in

c!est radiolog. is t!e
sil!ouette sign .
T!e sil!ouette sign is actuall.

eli)ination of t!e sil!ouette or
loss of lung%sot tissue interface
caused #. a )ass or fluid in
t!e nor)all. air filled lung .
For e0a)ple . If an
intrat!oracic opacit. is in
anato)ic contact 9it! t!e
!eart #order , t!en t!e opacit.
9ill o#scure t!at #order .
T!e sign is co))onl. applied

to t!e !eart , aorta , c!est
9all , and diap!rag) .
T!e location of t!is

a#nor)alit. can !elp to
deter)ine t!e location
anato)icall. .
T9o o#5ects of 9it! t!e sa)e

radiograp!ic densit. touc! eac!
ot!er , t!e #order #et9een t!e)
disappear .
Part 1
Disease Patterns
Air #ronc!ogra)
Air #ronc!ogra) is a
tu#ular outline of an
air9a. )ade ;isi#le #.
filling of t!e surrounding
al;eoli #. fluid or
infla))ator. e0udates .
Nor)al #ronc!i not

usuall. ;isuali@ed due to
t!in 9all and an air " air
interface .
Consolidation , pul.ede)a
, nono#strucuti;e
pul)onar. atelectasis ,
se;ere interstitial
disease , neoplas) and
nor)al e0piration .
Consolidation
Defined as a process
in 9!ic! air in t!e
al;eoli is replaced #.
products of disease .
T!e #ronc!i to t!e

consolidated area are
usuall. 9idel. patent .
In )ost instances ,
al;eolar filling is
patc!.,i.e. not all acini
are in;ol;ed .
T!e radiograp!ic
opacit. is t!erefore
non!o)ogeneous ,
so)eti)es 9it! are
#ronc!ogra) .
Collapse 6 atelectasis 7
Atelectasis is ;olu)e loss due to al;eolar

collapse or failure to e0pand causing increased
opacification of radiograp!.
Collapse )a. affect a 9!ole lung or a

su#di;ision 6 lo#e , seg)ent 7 .
T.pes
-
=#structi;e
-
Co)pressi;e
-
Cicatri@ation
-
Ad!esi;e
-
Passi;e
Keneral features of lo#ar collapse
S!ift of fissures
Area of increased opacit.
Cro9ding of ;essels
Trac!eal displace)ent
to9ard t!e side of t!e
collapse
Cilar s!ift
Mediastnal s!ift to9ard

t!e side of t!e collapse
le;ation of t!e
!e)idiap!rag)
Cerniation of t!e opposite

lung across t!e )idline
=t!er signs A
A !ilar )ass , 9!ic! also

suggest carcino)a as t!e
cause .
T!e presence of a foreign

#od.
T!e presence of an
endotrac!eal tu#e , is it
sited too lo9 H
=t!er e;idence of
)alignant disease 6 e.g.
ri# )etastases , effusion 7
.
Collapse of indi;idual lo#es
/ig!t upper lo#e collapse

Signs of rig!t upper lo#e
collapse
Minor fissures )o;e up9ard 9it! conca;it. inferiorl.

.
An area of opacit. t!at lies against ape0 of

)ediastinu)
Trac!eal s!ift to t!e rig!t
/i!gt !ilu) is ele;ated and t!e inter)ediate

#ronc!us assu)es !ori@ontal position .
Loss of rig!t paratrac!eal stripe 6 sil!ouette sign 7 .

/ig!t )iddle lo#e collapse
Signs of rig!t )iddle lo#e collapse
T!is is often not i))ediatel. o#;ious on t!e

frontal fil) .
Ill defined s!ado9ing is e;ident ad5acent to t!e

rig!t !eart #order , 9!ic! #eco)es indistinct .
/ig!t !eart #order is sil!ouetted .
Minor fissure )o;es do9n9ard .
Collapse of rig!t )iddle lo#e )ore o#;ious on

lateral ;ie9
In lateral ;ie9 , collapsed lo#e !as triangular

s!ape 9it! ape0 at t!e !ilu)
Also #est seen in lordotic ;ie9 .

/ig!t lo9er lo#e collapse
/ig!t lo9er lo#e @one s!ado9ing is co)#ined 9it! o#literation

of t!e !e)idiap!rag) 6 sil!ouette sign 7 .
T!e rig!t !eart #order , 9!ic! is anterior is usuall. still clearl.

seen 6 sil!ouette sign again 7 .
T!e o#li4ue fissure lies )ore !ori@ontall. and )a. #eco)e

;isi#le , gi;ing a s!arp upper )argin to t!e s!ado9ing .
If t!e lo#e is collapsed co)pletel. it )a. appear as a

triangular opacit. #eing anterior 9ill still #e clearl. seen .
=n lateral ,A#nor)all. increased densit. o;er t!e lo9er

t!oracic spine due to t!e triangular opacit. of t!e collapsed
lo#e.
/ig!t lo9er
lo#e collapse.
Loss of ;olu)e
in t!e rig!t
lung, t!e rig!t
!e)it!ora0 is
!.per
translucent.
Left upper lo#e collapse
T!e left lung lac(s a )iddle lo#e and t!ere fore a )inor fissure ,
so left upper lo#e atelectasis presents a different picture fro)
t!at of t!e rig!t upper lo#e collapse .
T!e result is predo)inantl. anterior s!ift of t!e upper lo#e in

t!e left upper lo#e collapse , 9it! loss of t!e left upper cardiac
#order .
It casts a ;eil li(e opacit. o;er t!e left !e)it!ora0 nor)all.

)ore dense to9ard t!e ape0 .
T!e e0panded lo9er lo#e 9ill )igrate to a location #ot!

superior and posterior to t!e upper lo#e in order to occup. t!e
;acated space and so t!e aortic (nuc(le c!aracteristicall.
re)ains clearl. ;isi#le .
Left lo9er lo#e collapse
T!e left lo9er lo#e collapse )ediall. and posteriorl. to

lie #e!ind t!e !eart .
It classicall. displa.s a triangular opacit. 9!ic! )a. #e

;isi#le t!roug! t!e cardiac s!ado9 or )a. o;erlie it ,
gi;ing t!e !eart an unusuall. straig!t lateral #order .

T!e !e)idiap!rag) )a. #e o#scured 9!ere t!e opacit.

lies against it .
In t!e lateral fil) t!ere is a#nor)all. increased densit.

o;er t!e lo9er t!oracic spine due to t!e triangular
opacit. of t!e collapse lo#e .
Total collapse to t!e lung
G!en t!e o#struction

9it!in t!e )ain ste)
#ronc!us .
T!e appearance is one of

total opacification of t!e
affected !e)it!ora0 .
T!e ;olu)e loss causes

de;iation of t!e trac!ea
and s!ift of t!e
)ediastinu) to t!e
affected side .
An effusion 9ill produce

)idline s!ift in t!e
opposite direction ,
!o9e;er , collapse and
effusion often coe0ist in
9!ic! case t!ere )a. #e
)ini)al s!ift .
Seg)ental atelectasis
/ounded atelectasis
Pleural effusion
Loculated effusion Vs La!ellar effusion
Pneu)ot!ora0
Ty"ical sin#s of "neu!othora$ on an erect X-ray
C.dropneu)ot!ora0
Pleural calcification
Pleural t!ic(ening
Diap!rag)atic Cernia
Diap!rag)atic Cernia
Morgagni Cernia
Boc!dale( Cernia
Ciatal !ernia
Diap!rag)atic in5ur.
Diap!rag)
;entration
it:s caused due to a#sence of a
part of )uscle in t!e
diap!rag) 9!ic! is replaced
#. a t!in la.er of connecti;e
tissue .
It is usuall. associated 9it!
triso)ies &2,&$, pul)onar.
!.poplasia , congenital
CM8 .
;entration is )ore co))on on
t!e left side .
/adiological features includeA
-
Ce)idiap!rag) not
;isuali@ed .
-
Multic.stic )ass in t!e
c!est .
-
Mediastnal s!ift to opposite .
H
Medicine is notorious for t!ro9ing surprises especiall. for non curious and not
e0perienced doctors JJJ
Pneu)o)ediastinu)
Basics of cardiac dia#nosis fro! chest X-ray
T!e first o#ser;ation usuall. )ade is t!at of

t!e !eart si@e A t!e CARDIOTHORACIC RATIO
HEART SIZE
The cardiothoracic ratio is the maximum transverse

diameter of the heart divided by the greatest
interna diameter of the thoracic cage ! from inside
of rib to inside of rib " #
In norma $eo$e % the cardiothoracic ration is

usuay ess than &'( # Therefore % the
cardiothoracic ratio is a handy )ay of se$arating
most norma hearts from most abnorma hearts #
Pitfalls for Cardio)egal. JJJ
0tra cardiac cause of

cardiac enlarge)ent include
A
-
Ina#ilit. to ta(e a deep
#reat! #ecause of
=#esit.
Pregnanc. or
Ascites
=r a#nor)alities of t!e
c!est t!at co)press t!e
!eart suc! as
Pectus e0ca;atu) defor)it.

or
Straig!t #ac( s.ndro)e

Cardiac contours
Ascending aorta
Dou#le densit. of
left atrial
enlarge)ent
/ig!t atriu)
Aortic (no#
Main or undi;ided
seg)ent of t!e
pul)onar. arter.
Left ;entricle

nlarge /A seen in #steins

If t!e !eart is enlarged and t!e )ain pul)onar. arter. is large 6 stic(
out #e.ond t!e tangent line 7 t!en t!e Cardio)egal. is )ade up of at
least rig!t ;entricular enlarge)ent .
If t!e !eart is enlarged and t!e aorta is pro)inent 6 ascending , (no# ,
descending 7 , t!en t!e Cardio)egal. is )ade up of at least Left
;entricular enlarge)ent .
Pul)onar. ;asculature
C,/ s!o9ing enlarged left pul.arter.
C,/ s!o9ing enlarge)ent of /PDA and left pul.arter.
C,/ s!o9ing left apical arc li(e calcification of t!e left ;entricle aneur.s)
Plain fil) approac! to critical care patient 9it! C,/ findings of pul)onar. congestion
Pericardial ffusion
,-ra. signs of pericardial

effusion A
Distinctness of t!e epicedial

fat planes .
Nor)al pul)onar. ;asculature

despite Cardio)egal.
=#literation of retrosternal
space .
Gater #ottle appearance of t!e

enlarged cardiac sil!ouette .
Bilateral !ilar o;erla. .

Pericardial Calcification
Disease Pattern
A s!ado9
rese)#ling a line N
!ence an.
elongated opacit.
of appro0i)atel.
unifor)- linear
atelectasis
Tu#ular opacit. "pul)onar. A8M

/ound opacit. " pul)onar. )ass
Irregular opacit. ")etastasis

Large rig!t paratrac!eal node

/ig!t !ilar node
Masses situated predo)inantl. in anterior )ediastnal co)part)ent
C,/ s!o9ing large 9ell )arginated opacit. t!roug! 9!ic! t!e
rig!t !ilu) is 9ee seen 6 case of anterior )ediastnal c.st 7
Lateral 0-ra. s!o9ing a 9ell )arginated calcified )ass in
t!e anterior )ediastinu)
C,/ and a0ial CT section s!o9ing a large

!eterogeneous )ass in t!e superior and anterior
)ediastinu) case of large retrosternal goiter .
Masses situated predo)inantl. in )iddle and posterior
co)part)ent
C,/ s!o9ing a rig!t cardiop!renic angle opacit.

" case of pericardial c.st .
C,/ s!o9ing a loculated opacit. 6 arro9 7 causing

9idening of )ediastinu) " case of aortic arc! aneur.s)
C,/ s!o9ing a 9ell )arginated rig!t upper @one opacit.

6 cause of neural tu)or 7
Masses situated in t!e para;erte#ral region
Locali@ed pleural #ased%c!est 9all opacit.
C,/ s!o9ing rig!t upper @one pleural #ased soft tissue )ass Dr.Na#il Pa(tin,MD.FACC
Diffuse pleural t!ic(ening
C,/ s!o9ing left lateral and #asal pleural t!ic(ening
Digital scanogra) s!o9ing left pleural diffuse t!ic(ening
9it! calcification
Pleural effusion with lar#e cardiac silhouette
C,/ s!o9ing enlarge !eart 9it! #ilateral

pleural effusion )ore e;ident on t!e left side .
Pleural effusion 9it!out pul)onar. disease
Pleural effusion )ore e;ident on t!e rig!t side

Pleural effusion 9it! pul)onar. disease
/ig!t lo9er @one pneu)onitis 9it! pleural effusion . Note

t!e left upper lo#e fungal #all.
/ig!t lo9er lo#e a#scess 9it! pleural effusion . Note air fluid le;el 6 arro9 7 .
Locali@ed opacit. 9it! seg)ental distri#ution
/ig!t upper lo#e )ass causing fissure

#ulging 6 arro9 7
/i!gt upper and left lo#e consolidation
C.stic and ca;itar. disease
C,/ s!o9ing rig!t )id @one t!ic( 9alled ca;it. 9it! ad5acent satellite
lesions a#scess
/ig!t lo9er @one costop!erenic angle ca;it. 9it! fluid
le;el . Dr.Na#il Pa(tin,MD.FACC
PA and lateral s!o9ing a large c.st 9it! air fluid le;el and unifor) t!ic( 9all
Bilateral lo9er lo#e conglo)erate c.st 9it! fe9 c.sts
s!o9ing fluid le;els "case of infected #ronc!iectasis
Left upper lo#e ca;it. 9it! fungal #all-classical case of air crescent sign of fungal #all.
Solitar. pul)onar. )ass
C,/ s!o9ing rig!t )id @one opacit.

Left lo9er lo#e soft tissue opacit.

/ig!t upper lo#e calcified nodule

/ig!t )id and lo9er @one )ultiple calcified

nodules
Bilateral )ultiple lung nodules " t.pical

features of )etastasis
Diffuse disease 9it! a predo)inantl. air-space pattern
A/DS C,/ in a patient 9it! !istor. of to0ic gas

in!alation s!o9ing #ilateral diffuse parenc!.)al
opacities .
Diffuse parenc!.)al opacit. in a patient 9it! acute
interstitial pneu)onia
Pul)onar. ede)a 9it! classical #at s9ing appearance
Fi#roca;itar. disease
pattern of tu#erculosis
Bilateral upper lo#e Fi#roca;itar. disease . More e;ident on t!e left

side
Bilateral upper lo#e ca;itar. consolidation Dr.Na#il Pa(tin,MD.FACC

Bilateral upper lo#e fi#rosis 9it! se4uelae
Left upper lo#e fi#rosis 9it! collapse , note ele;ated left

!e)idiap!rag)
/ig!t upper lo#e ca;it. 9it! fungal #all . Note t!e )anacles sign 6 air
crescent 7
% ' 199


How To Read A CXR

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

How To Read A CXR

Diunggah oleh

Hak Cipta:

Format Tersedia

The Chest X-Ray Basics

How to read A CXR ?

Nor)al * #asics Concepts

&- assess t!e lung e0pansion

1- assess t!e pleura

2- loo( for infiltrate

3- loo( at t!e )ediastinu)

+-Assess t!e a#do)en

8olu)e of P and 9!et!er it:s

Sensiti;e )et!od for detecting

if t!e la.ering fluid is & c)

T!e patient s!ould #e

T!e diap!rag) fount

=n t!e lateral ;ie9 ,

T!e patient )ust

See t!e rotation !eads of t!e cla;icles

A#out &' posterior ri#s ;isi#le is an

In )an. Cospitali@ed patient D posterior

Co9 to tell t!e difference #et9een t!e

Ten posterior ri#s s!o9ing is an e0cellent inspiration

Poor inspiration 9ill cro9d lung )ar(ing and )a(e it

Better Inspiration and t!e disease at t!e lung #ases !as

Se;ere rotation )a. )a(e t!e pul)onar. arteries

If t!e ,- ra. #ea) is angle to9ard t!e

Anterior structure 6 li(e t!e cla;icles7 9ill

A fil) 9!ic! is apical lordotic 6 #ea) is angled up to9ard

T!e factors to e;aluate t!e 4ualit. of a

T!e i)age is apical

Bou )a. #e rig!t #ut .ou can:t tell fro)

T!e i)age is apical

T!e patient !as

T!e patient !as

Bou )a. #e rig!t #ut .ou can:t tell fro)

T!e pri)ar. tec!nical

nor)al frontal c!est ,-ra.A

+. /ig!t atriu) 6not

<. /ig!t costop!renic angle

I. /ig!t cardiop!renic angle

&'. Descending t!oracic

&&. Kastric air #u##le

&1. Left ;entricle

&2. Left lo9er lo#e

&3. Left upper lo#e

&+. Aortic arc!

nor)al lateral c!est

&. ascending t!oracic aorta,

<. gastric air #u##le,

D. rig!t upper lo#e #ronc!us,

&'. left upper lo#e #ronc!us,

<. Left !e)idiap!rag)

$. Posterior recess of lung

&&. Lung ape0

/ig!t upper lo#eA

/ig!t )iddle lo#eA

/ig!t lo9er lo#eA

Left lo9er lo#eA

Left upper lo#e 9it! LingulaA

Left upper lo#e - upper di;isionA

In al PA fil) t!e !eart is closer to t!e fil)

In a AP fil) , t!e !eart is fart!er fro) t!e

AP porta#le fil) )a(e t!e

=n t!is patient t!e PA fil)

Structures for)ing t!e )ediastnal