Chest X-Ray Interpretation: Bucky Boaz, ARNP-C
Chest X-Ray Interpretation: Bucky Boaz, ARNP-C
Interpretation
Introduction
Routinely obtained
Pulmonary specialist consultation
Inherent physical exam limitations
Chest x-ray limitations
Physical exam and chest x-ray provide
compliment
Exposure
Overexposure
Underexposure
Sex of Patient
Male
Female
Patient Position
Upright
Supine
Breath
Inspiration
Expiration
Systematic Approach
Bony Framework
Soft Tissues
Lung Fields and Hila
Diaphragm and Pleural Spaces
Mediastinum and Heart
Abdomen and Neck
Systematic Approach
Bony Fragments
Ribs
Sternum
Spine
Shoulder girdle
Clavicles
Systematic Approach
Soft Tissues
Breast shadows
Supraclavicular areas
Axillae
Tissues along side of
breasts
Systematic Approach
Pulmonary arteries
Pulmonary veins
Lungs
Blood vessels
40% obscured by other
tissue
Systematic Approach
Diaphragm and
Pleural Surfaces
Diaphragm
Dome-shaped
Costophrenic angles
visible
Interlobar fissures
Systematic Approach
Mediastinum and
Heart
Heart size on PA
Right side
Systematic Approach
Mediastinum and
Heart
Left side
Left ventricle
Left atrium
Pulmonary artery
Aortic arch
Subclavian artery and
vein
Systematic Approach
Gastric bubble
Air under diaphragm
Neck
Summary of Density
Air
Water
Bone
Tissue
Tissue
Poor inspiration
Over or under penetration
Rotation
Forgetting the path of the x-ray beam
Lung Anatomy
Trachea
Carina
Right and Left Pulmonary
Bronchi
Secondary Bronchi
Tertiary Bronchi
Bronchioles
Alveolar Duct
Alveoli
Lung Anatomy
Right Lung
Superior lobe
Middle lobe
Inferior lobe
Left Lung
Superior lobe
Inferior lobe
PA View:
Extensive overlap
Lower lobes extend
high
Lateral View:
Extent of lower lobes
PA View:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Aortic arch
Pulmonary trunk
Left atrial appendage
Left ventricle
Right ventricle
Superior vena cava
Right hemidiaphragm
Left hemidiaphragm
Horizontal fissure
Lateral View:
1. Oblique fissure
2. Horizontal fissure
retrocardiac space
4. Retrosternal space
Understanding Pathological
Changes
Liquid Density
Liquid density
Generalized
Localized
Infiltrate
Diffuse alveolar
Consolidation
Diffuse interstitial
Cavitation
Mixed
Mass
Vascular
Congestion
Atelectasis
Consolidation
Lobar consolidation:
Alveolar space filled with
inflammatory exudate
Interstitium and
architecture remain intact
The airway is patent
Radiologically:
A density corresponding to
a segment or lobe
Airbronchogram, and
No significant loss of lung
volume
Atelectasis
Loss of air
Obstructive atelectasis:
No ventilation to the lobe
beyond obstruction
Radiologically:
Density corresponding to a
segment or lobe
Significant loss of volume
Compensatory
hyperinflation of normal
lungs
Stages of Evaluating an
Abnormality
1.
2.
3.
4.
5.
Complex problems
Case 1
Case 2
Case 3
Case 4
Cavitation
Case 5
Tuberculosis
Case 6
Case 7
Pseudotumor: fluid has filled the minor fissure creating a density that
resembles a tumor (arrow). Recall that fluid and soft tissue are
indistinguishable on plain film. Further analysis, however, reveals a
classic pleural effusion in the right pleura. Note the right lateral gutter
is blunted and the right diaphram is obscurred.
Case 8
Case 9
Case 10
Chest wall lesion: arising off the chest wall and not the lung
Case 11
Case 12
Lung Mass
Case 13
Case 15
Case 16
Case 17
Case 18
Tuberculosis
Case 19
Case 20
Case 21
Questions?