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The Complete Idiot’s Guide to Reading the X Ray PowerPoint PPT Presentation


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The Complete Idiot’s Guide to Reading the X Ray. By Sangwan. The PA view. Left chest appears on the right and Right chest on the left. The lateral view Receptor Film against left chest. Distinguishing Right from Left Lung in the Lateral View.

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The Complete Idiot’s Guide to Reading the X Ray

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The Complete Idiot’sGuide toReading the X Ray

By

Sangwan


The PA view

Left chest appears on the right and Right chest on the left.


The lateral viewReceptor Film against left chest.


Distinguishing Right from Left Lung in the Lateral View.

  • Right ribs are posterior and Larger than left ribs.

  • The left hemi-diaphragm is hidden anteriorly by the heart.

  • The Right hemi-diaphragm extends to the right ribs- more posteriorly.


DIVERGENCE & MAGNIFICATION.

The difference between the projector and the patient is 6 feet in the PA & 40 inches in the AP view.


The supine AP viewIn the AP supine film there is more equalization between the pulmonary vasculature of the upper and lower lobe & heart is enlarged.


The lateral decubitus

  • Pleural fluid volume.

  • Whether mobile / loculated.

  • Pneumothorax in a supine patient.


Inspiration

8-10 posterior ribs & 5-6 anterior ribs is adequate inspiration.


Penetration

  • In PA enough to just see disk spaces in thoracic spine, left hemi- diaphragm behind heart and vessels only up to 2/3 of lung area.

  • In lateral view 2 sets of ribs should be seen, sternum seen, spine appears clearer as it goes down.


Under and Over Exposure


RotationAssess by determining if clavicular heads are equidistant from spinous process of the thoracic vertebrae.


The Mediastinum


Fissures and lobes


Fissures and Lobes


Pleural Effusion extending into fissures


Lobes & Silhouette sign

  • Loss of lung/soft tissue interface.

  • Abnormality adjacent/anatomic contact.

  • Opacity in Posterior pleural cavity or posterior mediastinum or Right Lower lobe will cause OVERLAP but not an SILHOUTTE sign.


Air Bronchogram

  • A tubular outline of an airway visible due to alveolar filling/ collapse.

  • 6 causes- lung consolidation, pulmonary edema, non-obstructive pulmonary atelectasis, severe interstitial disease, neoplasm, and normal expiration.


The solitary nodule


Find the cancer


Atelectasis -Collapse/ incomplete expansion.

  • Endobronchial– mucus plug/ tumor.

  • Extrinsic compression– mass/ effusion/ ascites.

  • Scarring-- post TB/ Radiation/ inflammation.

  • Linear/curved/wedge(apex-hilum) density with hilar/tracheal/media-stinal/diaphragm deviation with volume loss +/- compensatory hyper- inflation.


Left Upper & Lower lobe atelectasis


Right upper and lower lobe atelectasis


Right middle lobe atelectasis


Pulmonary edema

Batwing Bronchogram

Cephalization Cardiomegaly

Septal lines Effusion

Cuffing


Kerley B lines


Major differentiating factors between atelectasis and pneumonia

Atelectasis Pneumonia

Volume Loss normal or increased volume

Associated Ipsilateral Shift no shift/ contralateral shift

Linear, Wedge-Shaped air space process

Apex at Hilum not centered at hilum

  • Air bronchograms can occur in both.


Type of pneumonia

  • Lobar - entire lobe consolidated and air bronchograms common

  • Lobular - multifocal, patchy.

  • Interstitial - starts perihilar ,can become confluent and/or patchy as disease progresses, no air bronchograms

  • Aspiration pneumonia

  • Diffuse pulmonary infections - nosocomial (Pseudomonas, debilitated, mechanical vent, high mortality rate, patchy opacities, cavitation, immuno-compromised host(bacterial, fungal, PCP)


Right middle lobe pneumonia


Right upper lobe pneumonia


Round Pneumonia


Pleural Effusion


Pneumothorax


Supine pneumo & hydropneumo


Interstitial Pulmonary Fibrosis


Emphysema


Hampton’s Hump

Westermark

Sign


Pericardial effusion


Pneumomediastinum


Diaphragmatic hernia


OPACIFIED HEMITHORAX 1)Atelectasis, 2) pleural effusion, 3) Pneumonia, 4) pneumonectomy.


Unilateral pulmonary edema

  • Re-expansion

  • Venous

    obstruction

  • Dependent

    position

  • Bronchial

    obstruction

  • PE on the

    other side


Aortic Aneurysm


Lung Masses

Causes of lung nodules-by frequency

Granulomas

Bronchogenic ca

Hamartoma

Metastases

Calcification

Doubling time


Cavitating nodule

Squamous cell most common

Adenocarcinoma

TB

Abscess

Mass with air bronchogram

Alveolar cell ca

Lymphoma

Pseudolymphoma

Inflammatory pseudotumor

Types of bronchogenic carcinoma

Squamous cell ca (30-35%)

Adenocarcinoma (25-35%)

Small cell or oat cell (25%)

Large cell undifferentiated (10%)


Squamous cell - Central Location (2/3), Atelectasis, Post-obstructive pneumonia, May cavitate.

Adenocarcinoma - Usually peripheral, Found in scars, Solitary nodule (52%), Upper lobe distribution (69%)

Small cell- Mediastinal adenopathy, Hilar mass, Small or invisible lung nodule, High metastatic potential, Rapid growth. May be associated with Hypoglycemia, Cushing's syndrome, Inappropriate secretion of ADH, excessive gonadotropin secretion

Large cell undifferentiated (10%) -Large peripheral mass, Pleural involvement


Roentgenographic findings

Airway obstruction – Atelectasis, No air bronchogram, postobstructive pneumonia

Hilar enlargement - From either the carcinoma itself or nodes, common in oat cell, uncommon in adenoca

Mediastinal node enlargement -Particularly anaplastic ca

Cavitation - 2-16% -Especially in squamous cell, mostly in upper lobes, Cavity is usually thick-walled with nodular inner margin

Pleural involvement - 10%- Hemorrhagic effusion denotes direct tumor invasion , Effusion carries a poor prognosis even if no malignant cells are found


Aspergilloma


Radiation Pneumonitis


The

Abdominal X Ray


Normal


Normal Gas Pattern

Stomach -Always

Small Bowel -Two or three loops of non-distended bowel with Normal diameter = 2.5 cm .

Large Bowel-In rectum or sigmoid – almost always

Normal Fluid Levels

Stomach -Always (except supine film)

Small Bowel - Two or three levels possible

Large Bowel -None normally


Large Vs Small Bowels

  • Large Bowel -Peripheral ; Haustral markings don't extend from wall to wall

  • Small Bowel – Central, Valvulae extend across lumen, Maximum diameter of 2“


Small Bowel Obstruction


Large Bowel Obstruction


Localized ileus


Adynamic ileus


Prone

Sentinel Loops


Gallstone ileus


Free Intraperitoneal AirCrescent Sign Rigler’s Sign


Ischemic Colitis


Ascites

  • Sorry , no image available


Thank you


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