Interpretation of Lung chest X ray.doc - 4medstudents by pengxuebo

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									                                                                                     Respiratory module
                                                                                   Chest X-ray made easy

                        Interpretation of Lung chest X-ray

1. THE WHITE LUNG FIELD:
        Pleural effusion
    Causes:
    Transudes: heart failure, liver failure, protein loss, iatrogenic
    Exudates: infection, malignancy, RA , SLE, pancreatitis, subphrenic absecess, trauma

    Appearance of pleural effusion:
        Looking at the upper border of the shadowing, fluid will have meniscus so the upper
         border of an effusion will be concave
        To differentiate an effusion from a raised hemidiaphragm, the upper border of an
         effusion will peak mush more laterally
        To confirm the pleural effusion look for the signs of HF, hilar node enlargement
         ( malignancy ) or TB.




        Collapse of the lung
       It leads to a loss of volume of that part of the lung and so the normal radiological
       landmarks will be distorted.
On the PA film:
        Normally, the right lung is larger than the left - if not, collapse an area of right lung.
        Normally, the right diaphragm is higher than the left – if not, collapse of left lung.
        The horizontal fissure in the right lung run from the center of the right hilum to the
           level of the 6th rib at the axillary line. If pulled up, right upper lobe collapse. If pulled
           down, right lower lope collapse
        The heart straddles the midline with 1/3 to the right and 2/3 to the left. The heart
           shadow will be deviated to the side of collapse.
        Heart borders are distinct. If the lung adjacent to the heart collapse, the heart border
           will appear blurred.
        Trachea pulled towards the area of collapse
       
On lateral film look for the horizontal fissure




                                                                                           Al Dhufair AM
                                                                         Respiratory module
                                                                       Chest X-ray made easy
 Consolidation
More associated with signs of infections
 Acute condition, there is no similar abnormality when look to previous x ray – if there
  is, it if most likely to be fibrosis not consolidation.
 Look closely to the area of consolidation, you will see the small airways as black
  against a white background – so called bronchogram.
 The shadowing in consolidation will be denser and more clearly demarcated at its lower
  border




   Fibrosis
   causes shrinkage of the lung, pull the mediastinum to the side of the fibrosis
   Reticularnodular Shadowing, means a meshwork of lines.
   Heart and diaphragm borders appear blurred
   Vascular markings become less distinct




                                                                               Al Dhufair AM
                                                                           Respiratory module
                                                                         Chest X-ray made easy
 Asbestos plaques
 Pleural thickening which is easy to identify at the periphery as a thickened line around
  the edge of the lung
 The position of the whiteness follows intrapulmonary structure; very commonly found
  running along the line of the anterior portions of the ribs.
 Patches usually bilateral
 Steaks of dense white material ( calcium) running along the giaphragm
 Chronic, present in previous x ray


    Coin lesions
   Speculated, irregular or lobulated edge is suggestive of malignancy
   Calcification would be dense white ( same as bone).
   Present of more than one suggests metastasic disease.
   Malignant tumors associate with mediastinal lymphoadenopathy
   Cavitating lesions are darker in the center than the circumference, moreover , there
    will be a horizontal line within the lesion, whiteness (fluid) below the line with an area
    of black (air) above.
         o Easier to see on a lateral of the film especially posterior or inferior
         o Abscess, neoplasm, around pneumonia, infarction, TB




                                                                                 Al Dhufair AM
                                                                          Respiratory module
                                                                        Chest X-ray made easy

2. THE BLACK LUNG FIELD:

     COPD
     Count the number of ribs, in lung enlarged ( emphysema) you will be abe to count
       more than seven ribs interiorly
     Diaphragm is flat or scallop shaped
     Elongate and narrow the heart
     There are densely black area ,usually round, surrounded by hairline shadows




     Pneumothorax
     The edge of the lung can be seen
     In tension pneumothorax, the midiastinal shift away from the black lung




     Pulmonary embolism
     The area of blackness is confined to segments of the lung and not widespread.
       Embolus within an artery will only affect the segments supply by the artery
     There will be a compensatory over perfusion in the rest of the lung and increase the
       density of vascular shadow.



                                                                                Al Dhufair AM
                                                                    Respiratory module
                                                                  Chest X-ray made easy


3. HILAR ENLARGMENT

   Unilateral:
       Causes: Lymphoadenopathy: neoplastic, TB, sarcoidosis
              Vascular enlargement: pulmonary artery aneurysm
                     One hilum is bigger than the other
                     One hilum is denser than the other
                     Loss of the hila normal cobcave shape
                     Presence of calcium suggests lymphadenopathy

   Bilateral:
       Causes: Lymphoadenopathy: neoplastic, TB, berylliosis
              Vascular enlargement: COPD , asthma, LVF, pulmonary hypertension
                     Hila convex on shape
                     Signs of associated diseases ( TB, COPB..)




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                        Prepared by Al Dhufair, AM
                        CHEST X-RAY made easy
                                  OSC 1
                                   2006




                                                                         Al Dhufair AM

								
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