THORACIC_IMAGING (1)

1. Thoracic ImagingPlain Chest Radiography Prepared by Professor Abdulsalam Y Taha University of Sulaimani School of Medicine https://sulaimaniu.academia.edu/AbdulsalamTaha

2. Thoracic Imaging • Chest x-ray • Computerised tomography • Ultrasound • Magnetic resonance imaging • New advances

3. Background Chest X-ray • Most common radiological investigation – 40% of all investigations • Standard component of a pulmonary examination • Systematic review is vital in interpretation of chest x-rays

4. Limitations of a chest x-ray • 2 dimensional image of a 3 dimensional structure • X-ray findings may lag behind other clinical features • Normal x-ray does not rule out pathology • Dependent on good quality image

5. Chest x-ray views/types • Posteroanterior - PA • Anteroposterior - AP • Lateral • Decubitus

6. Views PA • Standard, radiology dept • X-rays posterior to anterior • Standing position

8. Normal PA

9. Lung Anatomy (1) aortic arch (2) pulmonary trunk (3) left atrial appendage (4) left ventricle (5) right atrium (6) superior vena cava (7 & 8) diaphragm (9) transverse fissure

10. Views AP • Cassette placed behind patient • X-rays anterior to posterior • Sitting in chair, semi-erect in bed, supine • AP marked on film • Heart enlarged, poorer inspiration

11. Normal AP

12. Views Lateral • Localises, shows posterior to heart • Side of interest placed against film Decubitus • PA on side • Small pleural effusions

13. vertebrae Heart Norm lateral

14. Lung Anatomy (1) oblique fissure (2) transverse fissure (3) retrocardiac space (4) retrosternal space

15. BASICS Air shows as black, solid structures white • Too white • Too black • Too large • In the wrong place (Corral et al 1997)

16. Chest x-ray viewing guide Correct CXR • Name • Date of birth • Date • Left and right, marker/stomach

17. Normal PA Stomach

18. Patient Position • PA, AP, lateral or decubitus view • Rotation – Sternal end clavicles equal from vertebral body • If AP what position

19. Exposure • How dark or light a film is • Should see vertebral bodies through heart

20. Soft Tissues • Breast shadows • Piercing • Air in tissues • Tissue folds in obese • Medical equipment

21. Breast shadows

22. Surgical emphysema

23. surgical emphysema

24. Heart valve Pacemaker

25. ECG ICD ETT

26. Bony Structures • Ribs • Scapulae • Clavicles • Vertebrae

27. #Clavicle

28. #ribs

29. Trachea • Deviated • Carina • Artificial airway

30. ETT #Ribs ICD

31. Mediastinum • Deviated • Hilar shadows • Aortic arch

32. Mediastinum - Heart Size • No larger than half width of chest Position • Two thirds on the left Borders • Clear

33. Diaphragm • Shape • Height: right –6rib ant, left – 7 ant • Cardiophrenic angle • Costophrenic angle

34. Lung Fields • Black with lung markings • Other opacity indicated pathology • Fissures • Zones • Air bronchograms • Consolidation

35. normal

36. Right upper lobe collapse

37. Right Lower lobe collapse

38. Pneumothorax

39. Pneumothorax

40. Consolidation

41. Pleural effusion

42. Pleural effusion

43. Right pneumonia

44. Air bronchogram

45. Emphysema

46. Other imaging Computerised tomography • Transverse images, cross section • Localises masses • High radiation dose

47. Other imaging cont Ultrasound • Useful for pleural effusions • Good images of heart and valves

48. Other imaging cont MRI • Malignancy • Vascular • Congenital abnormalities • Tuberculosis

49. New advances Patient archive communication system • Film free radiology • Computer use • Image enhancement

50. The cervicothoracic sign, a variant of the silhouette sign, helps to determine the anterior or posterior location of mass in the superior mediastinum on frontal chest radiographs. As the apical segments of the lungs extend superior to the clavicles, a posteriorly located mass demonstrates sharp lateral borders above the level of the clavicles. On the other hand, an anteriorly located mass demonstrates a faded lateral border above the level of the clavicles.