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• Chest radiographs are common radiology exams providing information on lungs, soft tissue, bone, pleura, and mediastinum.
• Inappropriate exposure during chest radiographs may hide or mimic pathology.

Standard Chest Films

• Standard chest films include PA (Posterior-Anterior) and lateral views.
• Routine chest film examination includes tracing the diaphragms.
• Checking the heart and mediastinum position is part of a routine chest film.
• Assessing the size and shape of the heart on a chest film is crucial.
• Examining hilar shadows is part of chest film analysis.
• Checking ribs, clavicles, and spine is essential during chest film examination.
• Assessing the technical quality of the film is a standard practice.

Extra Chest Film Views

• Oblique views can better demonstrate intrathoracic shadows.

• Lordotic views demonstrate the apices of the lungs.

• Lateral decubitus views demonstrate fluid or free air in the chest.

• Expiration films demonstrate diaphragmatic movement, pneumothorax, and foreign bodies.

• Inspiration and expiration films might be performed for specific situations.

• Ribs, sternum, and thoracic spine enclose the thoracic cavity.

• Rib fractures may be seen with accompanying pneumothorax.

• Thymus Gland is fully developed around puberty age.

• Crying mimics the Valsalva maneuver, distorting the thymus and on an AP chest, it resembles a "sail sign".

• Pectus excavatum is a congenital anomaly with sternal depression, compressing the heart.

• Azygous Lobe Fissure results from failure of normal migration of the azygous vein.

• Dextrocardia indicates the heart is located on the right side of the chest.

Diaphragmatic Dysfunction

• It requires a sniff test.
• Diaphragmatic muscle weakness can impede respiratory function.
• It results in smaller inspiration and limited expansion of the thorax,.
• Diaphragmatic dysfunction most often involves the entire diaphragm.
• Paralysis is marked by absence of excursion during respiration.
• The affected hemi diaphragm loses its muscular power and cannot contract.
• Diaphragmatic dysfunction may be unilateral or bilateral.
• Bilateral dysfunction can result in disabling dyspnea.
• It may be caused by diaphragm degeneration or trauma and spinal cord injury.
• Eventration is an uncommon, permanent elevation of one hemi diaphragm.
• When unilateral, eventration often affects the left side.
• Eventration can result in acquired or congenital causes.

Imaging Modalities

• Computed Tomography is the method of choice for pulmonary adenopathy evaluation.
• A nodule less than 1cm is usually benign, while nodules larger than >1cm is usually malignant.
• Spiral or helical CT offers imaging of the entire chest with a single breath-hold.
• Nuclear medicine uses perfusion and ventilation scans to evaluate chest disease and pulmonary emboli.
• Injection of a radionuclide into the venous system causes it to become trapped in the pulmonary circulation.
• During a ventilation scan, a patient inhales radioactive Xenon, and an image of gas distribution is taken.
• PET captures information regarding metabolic activity.

Chest Tubes, Vascular Access Lines, and Catheters

• Exercise caution when moving a patient with these in place.
• It is important to have assistance when moving a patient with these in place.
• Always check with the nurse before moving a patient with these in place.
• Cover cassette.
• Endotracheal Tubes are large plastic tubes inserted into the trachea through the nose or mouth.
• It helps to manage the patient's airway.
• It allows suctioning and mechanical ventilation.
• The proper position is below the vocal cords and above the carina.
• Chest Tubes are large plastic tubes inserted into the chest wall between the ribs.
• It allows drainage of air (pneumothorax) from the thoracic cavity.
• It allows drainage of fluid (pleural effusion) from the thoracic cavity.
• It allows the lungs to inflate to help the patient breathe easier.
• Central Venous Lines are usually inserted into the subclavian.
• The tip of these lines should be in the distal SVC just above the right atrium.
• Provides alternate injection site to compensate for loss of peripheral infusion sites or to allow massive volumes of fluid.
• Allows for measurement of central venous pressure to indicate heart function.
• Chest radiographs check for proper placement and presence of pneumothorax or hemothorax.
• Pulmonary Artery Catheters are Swan Ganz catheters, usually inserted via the subclavian vein.
• It is a multiluminal catheter to evaluate cardiac function.
• It Measures pulmonary pressure, which reflects left atrial pressure, and is positioned in the pulmonary artery.
• Access Catheters such as Hickman or Port-a-Cath catheters are typically inserted via the subclavian vein.
• Hickman catheters are open to the outside with the tip placed in the SVC.
• Port-a-Cath devices are under the skin, with less chance of infection.
• It is used for chemotherapy in patients with poor peripheral venous access.

Congenital/Hereditary Disorders

• Cystic Fibrosis.
• Hyaline Membrane Disease/Respiratory Distress Syndrome in newborn infant, most often premature, due to a lack of surfactant.
• Radiographic findings: air bronchogram and widespread white opacities (ground glass appearance).

Inflammatory Disorders

• Croup is a viral infection in young children causing inflammatory obstructive swelling in the trachea.
• Epiglottitis is an acute infection of the epiglottis, most commonly by Haemophilus influenza in children; lateral neck view.
• It may result in sudden, complete airway obstruction.

Pneumonia

• It is generally acute inflammation that can be caused by a variety of organisms (mostly bacterial and viral)

• Lobar pneumonia involves 1 or more lobes of the lungs.

• Bronchopneumonia involves bronchioles with a patchy appearance.

• Alveolar or air space pneumonia is produced by an organism that replaces air sacs.

• This condition often produces an air bronchogram.

• Aspiration pneumonia is a result of reflux and esophageal or gastric contents.

• Some types of pneumonia occur secondary to diseases, malignancy, organ transplants, fractures, and surgery.

• Lung Abscess is a necrotic area with pus material, may occur due complications.

• Symptoms: fever, cough, and foul smelling sputum.

• A complication is the development of a brain abscess.

• Tuberculosis (TB): Caused by Mycobacterium tuberculosis.

• It spreads mainly by droplets in the air; it is killed by sunlight but survives in the dark.

• It can also be acquired by drinking the milk of an infected cow.

• It is primarily a disease of the lungs, but may spread to the GI, GU, and skeletal systems.

• TB grows in the apices of the lungs due to having more oxygen.

• High-risk individuals: homeless, alcoholics, diabetes mellitus, dehabilitation and arthritis.

• Primary TB may be seen as lobar consolidation.

• Miliary TB is dissemination of the disease via the bloodstream.

• Active TB is easy to penetrate, while latent TB is hard to penetrate.

• Bronchiectasis: Irreversible dilation of the bronchioles, leading to impairment of bronchial secretions.

• Radiographic findings: visible dilated bronchioles and persistent consolidation of areas affected.

• Bronchography is the definitive method of making the diagnosis.

Other Pathology

• Pneumoconiosis is a group of conditions caused by the inhalation of dust from occupational exposure.

• Silicosis: caused by silicon dust (mining and sandblasting).

• Asbestosis: exposure in asbestos workers.

• Anthracosis: exposure in coal miners (black lung).

• Bronchogenic Carcinoma: Linked to smoking and other carcinogens.

• May appear as a mass or only detectable as bronchial obstruction; malignant tumors.

• Pulmonary Embolus is potentially fatal.

• 95% arise from deep venous thrombosis in lower extremity.

• Most embolic occlusions occur in lower lobes of lungs.

• Symptoms include sudden onset of dyspnea and subtle pleuritic and hemoptysis".

• Predisposing conditions include recent fracture, surgery, heart disease, and obesity.

• Chest may be normal or inconclusive so, Nuclear Medicine lung scan is also used.

• Atelectasis is a complete or partial lung collapse resulting from obstruction an iatrogenic condition.

• Adult Respiratory Distress Syndrome (ARDS): Life threatening acute respiratory distress.

• It may result from trauma and aspiration.

• Empyema has Pus in pleural cavity.

• Pneumothorax: Is air in the potential space between the visceral and parietal pleura of the lung.

• Tension pneumothorax is a medical emergency where air continues to enter the pleural space.

• Spontaneous pneumothorax is air in the intrapleural space without preceding trauma.

• Iatrogenic pneumothorax is a medical procedure resulting in traumatic pneumothorax.

• Pleural Effusion: Accumulation of fluid in pleural cavity.

• Subcutaneous Emphysema: Air gets trapped under the skin, crackling sound.

• Covid origin and source of SARS-CoV-2 remains unknown.

• Declared a pandemic by the World Health Organization on March 11th, 2020.

• Symptoms: fever, cough, SOB, and fatigue.