The complete idiot s guide to reading the x ray
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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 l.jpg

The Complete Idiot’sGuide toReading the X Ray



The pa view l.jpg
The PA view

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

The lateral view receptor film against left chest l.jpg
The lateral viewReceptor Film against left chest.

Distinguishing right from left lung in the lateral view l.jpg
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 l.jpg

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

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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 l.jpg
The lateral decubitus

  • Pleural fluid volume.

  • Whether mobile / loculated.

  • Pneumothorax in a supine patient.

Inspiration l.jpg

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

Penetration l.jpg

  • 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.

Slide11 l.jpg
RotationAssess by determining if clavicular heads are equidistant from spinous process of the thoracic vertebrae.

Lobes silhouette sign l.jpg
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 l.jpg
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.

Atelectasis collapse incomplete expansion l.jpg
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.

Pulmonary edema l.jpg
Pulmonary edema

Batwing Bronchogram

Cephalization Cardiomegaly

Septal lines Effusion


Major differentiating factors between atelectasis and pneumonia l.jpg
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 l.jpg
Type of pneumonia 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)

Round pneumonia l.jpg
Round Pneumonia pneumonia

Pleural effusion l.jpg
Pleural Effusion pneumonia

Pneumothorax l.jpg
Pneumothorax pneumonia

Emphysema l.jpg
Emphysema pneumonia

Hampton s hump l.jpg
Hampton’s Hump pneumonia



Opacified hemithorax 1 atelectasis 2 pleural effusion 3 pneumonia 4 pneumonectomy l.jpg
OPACIFIED HEMITHORAX pneumonia 1)Atelectasis, 2) pleural effusion, 3) Pneumonia, 4) pneumonectomy.

Unilateral pulmonary edema l.jpg
Unilateral pulmonary edema pneumonia

  • Re-expansion

  • Venous


  • Dependent


  • Bronchial


  • PE on the

    other side

Aortic aneurysm l.jpg
Aortic Aneurysm pneumonia

Slide44 l.jpg

Lung Masses pneumonia

Causes of lung nodules-by frequency


Bronchogenic ca




Doubling time

Slide45 l.jpg

Cavitating nodule pneumonia

Squamous cell most common




Mass with air bronchogram

Alveolar cell ca



Inflammatory pseudotumor

Types of bronchogenic carcinoma

Squamous cell ca (30-35%)

Adenocarcinoma (25-35%)

Small cell or oat cell (25%)

Large cell undifferentiated (10%)

Slide46 l.jpg

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

Slide47 l.jpg

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

Aspergilloma l.jpg
Aspergilloma pneumonia

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The pneumonia

Abdominal X Ray

Normal l.jpg
Normal pneumonia

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Normal Gas Pattern pneumonia

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 l.jpg
Large Vs Small Bowels pneumonia

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

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

Localized ileus l.jpg
Localized ileus pneumonia

Adynamic ileus l.jpg
Adynamic ileus pneumonia

Sentinel loops l.jpg

Prone pneumonia

Sentinel Loops

Gallstone ileus l.jpg
Gallstone ileus pneumonia

Free intraperitoneal air crescent sign rigler s sign l.jpg
Free Intraperitoneal Air pneumoniaCrescent Sign Rigler’s Sign

Ischemic colitis l.jpg
Ischemic Colitis pneumonia

Ascites l.jpg
Ascites pneumonia

  • Sorry , no image available

Thank you l.jpg

Thank you pneumonia