02.10 CHEST XRAY Normal and abnormal 2024.pdf

CHEST X Ray Normal & Abnormal A B D U L K A D E R A L - K E N AW I A S S I S TA N T P R O F E S S O R , K S A U C O N S U LTA N T I R , K I N G A B D U L A Z I Z M E D I C A L C I T Y 8/27/24...

CHEST X Ray Normal & Abnormal A B D U L K A D E R A L - K E N AW I A S S I S TA N T P R O F E S S O R , K S A U C O N S U LTA N T I R , K I N G A B D U L A Z I Z M E D I C A L C I T Y 8/27/24 1  WHY ORDER A CXR? SYMPTOMS: Bad or persistent cough Chest pain Chest injury Coughing up blood Fever Shortness of breath S/P fall 8/27/24 2  WHY ORDER A CXR? Pleural effusion Lung cancer Pneumothorax Chest pain (MI?) Hemothorax Hypertension Pulmonary embolus Screening Trauma Pneumonia Monitoring chest COPD drainage Asthma TB 8/27/24 3  INTERPRETING THE CHEST X-RAY -Technical assessment -Normal vs Abnormal -Search Pattern – Heart Size – Pulmonary Vessels / Hilum – Mediastinum – Lungs / Airways – Pleura / Fissures – Bones / Soft tissues – Tubes / Support devices -Comparison 8/27/24 4  CHEST FRONTAL &PA direction a pot a 8/27/24 5  CHEST LATERAL 8/27/24 6  LATERAL DECUBITUS POSITION 8/27/24 Evaluate pleural effusion7  POOR INSPIRATION Energ - A-P ICU PATIENT deep breath ↑ ex - instrated in O poline - e um du ↓ coste enter 8/27/24 8  TECHNICAL ASSESSMENT INSPIRATION PENETRATION ROTATION 8/27/24 9  TECHNICAL EVALUATION (i) INSPIRATION & if 1 2 3 1 1 4 2 5 6 3 2 potte 7 3 4 8 5 4 9 6 10 7 11 8 8/27/24 Anterior Posterior 10  TECHNICAL EVALUATION PENETRATION - EXPOSURE Over exposed Under exposed 8/27/24 11  claicaltri TECHNICAL EVALUATION ROTATION · clavicle 8/27/24 Rotated to Pt’s Right 12  PA and AP CHEST COMPARISON Cardiac size is magnified on an AP film PA AP 8/27/24 AP and PA on same patient same day 13  as · a g are ~ Magnification is exaggerated by: Ø The shorter distance between the X-ray source and the patient Ø The shorter distance between the X-ray source and the anatomical structure 8/27/24 14  INSPIRATION inflation DIFFERENCES Hyperexpansion of the lung 8/27/24 C.O.P.D 2 Poor inspiration 15  O Mande t X-ray O schest 8/27/24 16 8/27/24 17  & S ospe obce 8/27/24 18 8/27/24 19  IDENTIFICATION OF NORMAL AIRWAYS & LUNGS compare re a comp co m pa re On the lateral chest the vertebral bodies should become darker as you move from superior to inferior. Notice the sharpness of the costophrenic angles. 8/27/24 20 8/27/24 21  HEART FAILURE a pathly - cording - 1 in 2 3 i 23 gitig · 4 8/27/24 22  - 1 NORMAL VASCULARITY PULMONARY VENOUS HYPERTENSION C.H.F e 2 E 3 INTERSTITIAL 8/27/24 EDEMA ALVEOLAR EDEMA 23  KERLEY B LINES [15 : 10 O 8/27/24 24  MEDIASTINUM -panatomy 8/27/24 25  in siteriorposterior MEDIASTINUM 3 · normality common O g Vija 8/27/24 26  MEDIASTINUM ABNORMALITIES per MASS engine 8/27/24 27  MEDIASTINUM ABNORMALITIES MASS 8/27/24 28  MEDIASTINUM ANT MEDIASTINAL MASS 8/27/24 29  MEDIASTINUM ABNORMALITIES Dingman unt pus 8/27/24 30  MEDIASTINUM ABNORMALITIES AORTIC ANEURYSM 8/27/24 31 8/27/24 32  HILAR ENLARGEMENT urones sele e lgmt 8/27/24 33  MEDIASTINUM ABNORMALITIES BILATERAL HILAR MASSES symphoma 8/27/24 GLMPHADENOPATHY 34  induce HILAR ENLARGEMENT ↓ Asymmetric hilar enlargement. Both hila are larger and denser than normal. The right hilum is bigger than the left Multiple small lung nodules Missing right breast shadow (mastectomy) Clinical details Known breast cancer Increasing shortness of breath rente ↳ Diagnosis Metastatic disease Breast cancer 8/27/24 35 8/27/24 36  LUNG ABNORMALITIES e communi 8/27/24 37  remp LUNG ABNORMALITIES high 8/27/24 38  LUNG ABNORMALITIES a whitish once 8/27/24 39  LUNG ABNORMALITIES 8/27/24 40 8/27/24 41  PLEURAL DISEASE promothorat king - - Onworking 8/27/24 42  PLEURAL DISEASE ai PNEUMOTHORAX colle 8/27/24 43  PNEUMOTHORAX 8/27/24 44  PLEURAL DISEASE effusion 8/27/24 45  PLEURAL DISEASE PLEURAL EFFUSION 8/27/24 46  LARGE LEFT PLEURAL EFFUSION 8/27/24 47 8/27/24 48  LOBES FISSURES PLEURAL EFFUSION 8/27/24 49 8/27/24 50  DIAPHRAGMATIC 8/27/24 51  DIAPHRAGMATIC PNEUMOPERITONEUM - undertehrm h 8/27/24 52  DIAPHRAGMATIC - mal PHRENIC NERVE PALSY righ left- abnor 8/27/24 53 8/27/24 54 d BONE lunglood Fracturightomal ⑭ ↑ & 8/27/24 55  BONE RIB FRACTURES 8/27/24 56  BONE heued ~ OLD RIB FRACTURES 8/27/24 57