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.
Left chest appears on the right and Right chest on the left.
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.
8-10 posterior ribs & 5-6 anterior ribs is adequate inspiration.
Septal lines Effusion
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
Lung Masses pneumonia
Causes of lung nodules-by frequency
Cavitating nodule pneumonia
Squamous cell most common
Mass with air bronchogram
Alveolar cell ca
Types of bronchogenic carcinoma
Squamous cell ca (30-35%)
Small cell or oat cell (25%)
Large cell undifferentiated (10%)
Squamous cell - pneumoniaCentral 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 pneumonia
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
Abdominal X Ray
Normal Gas Pattern pneumonia
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
Prone pneumoniaSentinel Loops