Lung Disease Investigation: Chest X-Ray Analysis

Lung Disease Investigation

• Presentation title: Investigation of Lung Diseases
• Presenter: Dr Ramez M Othman, Pulmonary Consultant, PMAH
• Focuses on the interpretation of chest X-rays

Chest X-Ray Interpretation - Technical Aspects

• Identification: Includes name, file number, date, and time.
• Projection: PA (posteroanterior) or AP (anteroposterior).
• Position: Upright or supine (lying down).
• Inspiration/Exhalation: Assessment of the degree of inspiration/expiration, as this might affect interpretation.
• Exposure: Evaluation for overexposure or underexposure.
• Positioning: Clavicle heads should be equidistant from their corresponding spinous processes to ensure proper centering.
• Thoracic Intervtebral Disc Space: Should be visible, helping evaluate the appropriateness of the x-ray.

Chest X-Ray - Interpretative Approach

• Inside-Out approach: Systematic approach for interpretation
• Starts with heart, mediastinum, hili, lungs, thoracic wall, and abdomen.
• Systematic approach: Identify abnormalities, patterns, and differential diagnoses.

Expiratory View

• Air Obstruction: Useful in detecting unilateral obstructive emphysema, often from a blockage in one bronchus.
• Pneumothorax: Occasionally, a small pneumothorax is only detectable during exhalation.

Normal Standards (PA view only)

• Measurement of heart size
• Mediastinal width
• Diaphragm position
• Pleural effusion meniscus
• Vascular shadows measurement

Film Centering

• Critical for accurate interpretation and avoids misdiagnosis.

Mediastinum Anatomy

• Location: Area between the right and left pleural cavities.
• Superior: Thoracic inlet.
• Inferior: Thoracic outlet (diaphragm).
• Anterolateral: Sternum and ribs.
• Posterior: Thoracic vertebrae.
• Structures: Includes major structures like the ascending aorta, aortic knob, and others listed in the illustration.

Lung Anatomy - Lobes and Segments

• Right Lung: 3 lobes (upper, middle, and lower), 10 segments.
• Left Lung: 2 lobes (upper and lower), 8 segments.
• Fissures: oblique and horizontal in the right lung, oblique fissure in the left lung

Lung Regions (RUL, RML, RLL, LUL, LLL).

• Subdivisions of the lungs for precise anatomical location.

Lung Pathology Examples

• Consolidation, interstitial changes, nodules, masses, atelectasis.

Pleural Effusion

• Different fluid levels (200-300 ml, 2 liters, 5 liters) can be seen in the illustrations, showing the varying degrees of the condition.

Other Conditions

• Bronchiectasis, pulmonary edema, pleural effusion, pleural tuberculosis and malignancy

Indications for PFT (Pulmonary Function Tests)

• Medical Diagnosis: Presence and Extent of disease, pathology nature, and to evaluate therapeutic interventions
• Surgical Evaluation: Pre/post-op assessments for disease progression and disability evaluation.
• Rehab and Insurance: Rehabilitation needs, insurance claims
• Legal and Public health issues

Types of PFTs

• Spirometry (measures lung volumes and airflow)
• Flow Volume Loops (flow rate vs. volume)
• Bronchodilator response
• Lung volumes
• Diffusion capacity (DLCO)
• Bronchoprovocation testing (e.g., methacholine and exercise)
• Max respiratory pressures
• 6-minute walk testing
• Cardiopulmonary exercise test.

Spirometry Details

• Measures flow and volume
• Volume vs. Time
• Determines:
• Forced vital capacity (FVC)
• Forced expiratory volume (FEV₁) in one second
• FEV₁/FVC ratio
• Forced expiratory flow (FEF25-75) (maximum mid-expiratory flow rate).

Lung Volumes and Capacities

• Describes the different volumes of air within the lung during breathing cycles and their related capacities
• Important for understanding lung function.

Diffusing Capacity

• Measures the ability of the lungs to transport inhaled gases, such as carbon monoxide, through the alveolar and pulmonary capillary membrane.
• Depends on:
• Alveolar-capillary membrane
• Hemoglobin concentration
• Cardiac output.

PFT Results & Interpretation

• Interpretation of results from PFTs (pulmonary function tests), showing different results in regard to obstruction/restriction/mixed patterns.

CT Pulmonary Angiography (CTPA)

• Indicates pulmonary embolism.

High Resolution Chest CT (HRCT)

• Imaging to diagnosis pulmonary fibrotic conditions including Idiopathic Interstitial Pneumonias.

Thoracentesis technique - symptom explanation

• Symptoms during and after the medical procedure.
  • Chest pain
  • Cough
  • Vague chest discomfort

Pleural Biopsy

• Used to diagnose conditions like pleural tuberculosis and lung malignancies such as mesothelioma and adenocarcinoma

This quiz delves into the investigation of lung diseases with a focus on chest X-ray interpretation. It covers technical aspects, positioning, and systematic approaches vital for accurate diagnosis through X-rays. Enhance your understanding of the critical details involved in this essential medical practice.