CXR INTERPRETATION

MOHAMMAD IRFAN
KAUR R. ICVCU - IW
RSSA - MALANG
 PURPOSES
Interpret any structures inside of thorax cavity
Interpret of bone and soft tissue of the chest
Interpret any devices in the thorax cavity
 PROJECTION VIEW
Posterior-Anterior (PA):
Standard view & most reliable technique
Erect films detect air under the diaphragm

Lateral view:
Done at the same time as the PA film
Helps localize infiltrates
For specific purposes

Anterior-posterior (AP):
Portable- patient is too ill to go to X-ray, usually patient is
sitting upright in bed
Poor quality but may be the best you can do
Remember- AP films may cause the mediastinum & heart to
appear larger than they are
 DENSITY
How deep of structures to absorp the x rays
Gas low density radiolucent black in
film structures with air inside airway,
lung
Water more bright than gas
radioopaque white muscle, blood,
vasculer
Fat more bright fat layer in the heart or
lung
Bone high density more radioopaque
vertebrae, ribs, coin, marker of any devices
RULES FOR BASIC INTERPRETATION
SYSTEMATIC APPROACH
IDENTITY
PROJECTION VIEW
SIDE MARKER
CONTRAST OR BRIGHTNESS
SYMETRICALLY
ONE BY ONE STRUCTURES
 Rules
Read the label on the chest film
Assess the quality of the film
Check the Structures
Look at the heart and major vessels
Assess the Airways
Assess the Lung Tissues
Look for Line & Tube Placement
Normal Thoracic Anatomy
Normal CXR
NORMAL AP VIEW
Simetris
Iga Posterior : 8-10
Iga Anterior : 6-8
Diafragma Flat
Vaskularisasi paru terlihat
JANTUNG
 CTR
(Cardio Thorasic Ratio)

M CTR =
a + b x 100%
c
a N = < 50%
b

c
Dextrocardi
SNOWMAN
Gambaran Seperti
boneka salju, VCS
besar, Segmen Po
dilatasi
Terjadi pada
peningkatan volume
jantung kanan
Contoh : Anomali
total drainase vena
pulmonal
BOOT SHAPE
Gambaran seperti
sepatu boot, segmen
pulmonal lebih
cekung
Terjadi karena
penurunan aliran
darah pulmonal
Co : ToF, PS
EGG SHAPE
Gambaran seperti telur,
batas kanan jantung
membesar, apeks terangkat.
Terjadi karena peningkatan
beban jantung kanan
Co : TGA
PARU
PLEURAL EFFUSION
Gambaran Radiologis :
-Ada batas pleura,
gambaran pemb. darah
paru suram atau hilang
- Sudut costoprenikus
suram atau hilang
PLEURAL EFFUSION
Gambaran
Radiologis :
-Ada batas cairan yg
horizontal
-Sudut
costoprenikus
suram atau hilang
-Pada efusi masif yg
mengenai satu paru
akan mendorong
struktur
mediastinum ke sisi
yg berlawanan
ARDS
Gambaran Radiologis :
-Radioopasiti yg difus
diseluruh lapangan paru
-Cephalisasi pembuluh
darah paru
-Bisa diikuti udem paru
dan efusi pleura
PULMONARY EDEMA
Gambaran Radiologis :
-Cephalisasi
-Pelebaran hilus
tanda Bat-Wings
-Peningkatan Opasitas
lapangan paru
-Bisa diikuti atau tidak
dengan pembesaran
jantung
Pulmonary Edema
PNEUMOTHORAX
Gambaran Radiologis :
-Hiperlusensi paru
-Ada batas tegas
pleura
-Tidak ada
vaskularisasi paru
sebelah lateral dari
batas
-Diafragma pada sisi yg
sakit terdorong
kebawah
TENSION PNEUMOTHORAX
Gambaran Radiologis :
-Area hiperlusensi yg luas
paru tampak kolaps
-Trachea dan
mediastinum terdorong
kesisi yg berlawanan
ATELEKTASIS
Gambaran Radiologis :
-Area opaq di lapangan
paru
- bisa mengenai satu
segmen, lobus atau satu
lapangan paru
- Trachea dan
mediastinum tertarik
kesisi yg sakit
-Sela iga pada bagian yg
kolaps lebih sempit
ATELEKTASIS
FIBROSIS PARU Gambaran Radiologis :
-Paru kolaps peningkatan
opasitas di lapangan paru
- Vaskularisasi hilang
- Trachea tertarik kesisi yg sakit
TB MILIER
Gambaran Radiologis :
-Daerah hilus yang
melebar dan meluas
keseluruh lapangan
paru
- Peningkatan opasitas
dilapangan paru .
LINES AND TUBE ON
CXR
Lines & Tubes on CXR
ETT : Sela iga 2 3, diatas
arkus aorta, tepat
dipertemuan klavikula
dengan sternum

SG kateter : Sela iga ke 5-6,

Tips kateter terletak di 1/3
hemithoraks
IABP
Tips IABP terletak di
bawah arkus aorta
False Route CV Line
PERMANENT PACEMAKER
THANK YOU