Chest X-Ray | A Short Review on X-Ray Chest. The chest X-Ray (CXR) is performed to evaluate the lungs, heart and chest wall. Normal CXR is taken with the patient in an upright position. Routine Chest X-Ray is taken in a frontal view which is referred to as posterior-anterior or PA view. The other views of CXR include lateral view, apical view and lateral decubitus views.
How to Interpret A Chest X-Ray
“Normal Chest X-Ray”
First look at the trachea whether it is shifted or not.
A well-centred x-ray. Medial ends of clavicles are equidistant from the spinous process
Divide The Lung Field into Three Zones
Assessment of the position of the Diaphragm
Normally anterior end of 6th rib touches the diaphragm and posterior end of 10th rib touches the diaphragm. The Diaphragm will be told low if 7th rib touches the anterior end and 11th rib touches posterior end.
Carefully examine each diaphragm
Assessment of Heart Size
Some Easy Clue to Reach the Diagnosis by Reading the Chest X-Ray
If you see in x-ray major portion of one side is White then it mostly likely pleural effusion . but exclude the consolidation
· milky and bright white than that of consolidation.
· Now look angle (costo and cardio phrenic ) it will be obliterate . This two are the more important point of pleural effusion .
· Now look at upper border it will concave upward.
· If trachea shifted 100% chance of pleural effusion. remember in p.E. trachea may not shift until massive
In case of consolidation
· hazy white / less white than PE
· Usually angle are clear unless it in lower ZONE
· Upper border usually irregular
· Trachea never shift
If in an x-ray u show one side is more black and another side is normal then maybe it is pneumothorax
· Now carefully look vascular marker with comparing the opposite u will see that it absent.
· If look medially to that pneumothorax side will see a small white things at near hilum it is collapsed lung
If u see in X-ray at one side upper half is black and lower portion is white as pleural effusion and these are separated by clear-cut horizontal line (fluid level )
If see any things like white egg (dim) in a X-ray. or rounded or circumscribed and margin may be irregular then it is
Look carefully rib destruction present or not
If you see anything like white egg (dim ) in that egg that mean rounded lesion air fluid level
Air fluid level (in that rounded lesion upper portion will be black and lower portion will b
White and separated by horizontal line )
If you see multiple egg (dim ) of variable size then it will
Secondaries in the lung
In a x-ray u may show both side more black than usual x-ray . to u this Xray seems to larger than as usual
It emphysema or COPD
Confirm it by counting that costophrenic end of diaphragm below the ant.end 6 rib or post end of 10 rib
If you see in x-ray that there is multiple dots of 1-2 mm are in both lung field
Skull it may be haemolytic or multiple myeloma
If u see multiple black dot of variable size no doubt it is MM
If black dot absent then it is haemolytic anemia . if u look upper border of skull u will see think double borders (hair on appearance)
If you see any X-ray of hand it will
Rheumatoid hand in your level
If you see any X-ray LS spine then the it may be
Pott’s or ankylosing spondylitis
First exclude ankylosing where your got
· White thick vertical line along mid vertebral body (calcification of ant longitudinal ligament )
· All the or most vertebral body are fused with each other laterally (syndesmophyte )
· X-ray film is contain lumber and sacral vertebra mainly
If not find these two then it pott,s . now find out the number of collapsed vertebra . at that vertebra level you don’t find and intervertebral disc
It mainly contain thoracic and lumbar vertebra
If see any X-ray where hear is pear or guava ) shape then it is pericardial effusion IN your level
Pear shape , lung is olgemic (slightly black and vascular marker are less prominent )
Multiple valvular heart disease
If lung is not olgemic rather plethoric (vascular marker are more prominent ) u have not remember this
If you show and patchy (soft 3-4 cm) over lungs usually upper or lower zone then it is
RADIOLOGY IN MEDICAL PRACTICE – ABM Abdullah
Dr. Shahidullah Shamol (FCPS in Medicine)
Assistant Professor, Department of Medicine
Mymensingh Medical College/tr (syndesmophyte )