Chest X-ray

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Different shades

1. Black --> air density

2. Dark grey --> s/c tissue or fat

3. Light grey --> soft tissue (e.g. heart)

4. Off white --> bone (ribs, clavicle)

5. Bright white --> metal

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Interpretation of Chest X-ray

1. How was it taken?

AP --> makes the heart look bigger

PA +/- lateral view (view behind heart and localise objects better) --> provides a 3D visualisation

Exhalational film --> highlight pneumothorax more, atelectasis, air trapping

Check date and name of patient

2.

A -- trachea --> has it been shifted or another --> pleural effusion? atelectasis? tension pneumothorax? Intubated? is it 3-5cm away from Carina

B -- bony structres (site, size, shape and strucutre) --> clavicles, spinous processes, compression fractures? lytic lesions?

C -- cardiac silohette --> cardiothoraic ratio (1/2 distance of thoracic cage if greater consider CCF or cardiomegaly); looking at RA, LV; aortic arch; pulmonary artery

Aorta --> PA --> LA --> LV

IF right heart border becomes hazzy --> then it is a pneumonia in the right middle lobe

If hazy on the left heart border --> part of the lingula --> left upper lobe

D -- diaphragm :

right hemidiaphragm > left hemidiaphragam (loss of hemidiaphgram on right --> RLL pneumonia and on left (left lower lobe pneumonia)

Costophrenic angle (meniscus sign --> pleural efusion)

Cardiophrenic angle

Look for free air under diaphragm on both left and right --> free air --> bowel perforation --> surigcal abdomen (upright film)

E - Equal lung fields

Look all the way to the edge of the lung for lung markings --> all the way to the edge

Look at vasculature on left and right --> westmarks sign --> PE ->

Vascular markings -- in CCF (become more engorged (sephalisation) --> pulmonary vascular marking

Kerley B lines --> CCF

Air bronchograms --> infection, water density, air getting to the area and not limiting air flow to that region

G --> gastric bubble

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COPD findings on X-ray

Lung fields are visible more than 7th anterior rib

Loss of normal crescent shape of diaphragms

Hyperlucency of lung fields i.e. less vascular markings

Narrowing of the heart

Really large Bullae --> which could look like a pneumothorax

Barrel shaped lung on lateral view

Flattening of diaphragm on lateral view