Diagnostic Imaging - 8 - Radiological Pathology - Lung Pathologies and Radiology in Specific Cases - Prof - Dr.i̇smet TAMER
Diagnostic Imaging - 8 - Radiological Pathology - Lung Pathologies and Radiology in Specific Cases - Prof - Dr.i̇smet TAMER
Diagnostic Imaging - 8 - Radiological Pathology - Lung Pathologies and Radiology in Specific Cases - Prof - Dr.i̇smet TAMER
Rotation
The medial aspect of each clavicle should be
equidistant from the spinous processes.
The spinous processes should also be in
vertically orientated against the vertebral bodies.
Inspiration
The 5-6 anterior ribs, lung apices, both
costophrenic angles and the lateral rib edges
should be visible.
Projection
Note if the film is AP or PA: if there is no label,
then assume it’s a PA film (if the scapulae are
not projected within the chest, it’s PA).
Exposure
The left hemidiaphragm should be visible to the
spine and the vertebrae should be visible behind
the heart.
Normal chest X-ray (Female) Normal chest X-ray (3-year-old child)
ABCDE approach
The ABCDE approach can be used to carry out a structured interpretation of a
chest X-ray:
• Airway: trachea, carina, bronchi and hilar structures.
• Breathing: lungs and pleura.
• Cardiac: heart size and borders.
• Diaphragm: including assessment of costophrenic angles.
• Everything else: mediastinal contours, bones, soft tissues, tubes, valves,
pacemakers and review areas.
Airway: Trachea
Inspect the trachea for evidence of deviation:
• The trachea is normally located centrally or deviating very slightly to the right.
• If the trachea appears significantly deviated, inspect for anything that could be pushing or pulling the
trachea.
• Make sure to inspect for any paratracheal masses and/or lymphadenopathy.
L
Diaphragm
• The diaphragm should
be indistinguishable from
the underlying liver in healthy individuals on
an erect chest X-ray.
• However, if free gas is present (often as a
result of bowel perforation), air accumulates
under the diaphragm causing it to lift and
become visibly separate from the liver
(Pneumoperitoneum).
• If free gas under the diaphragm is seen,
urgent senior review is required, as further
imaging (e.g. CT abdomen) will likely be
required to identify the source of free gas.
Everything else
• Mediastinal contours
• The mediastinum contains
the heart, great vessels, lymphoid tissue and a number
of potential spaces where pathology can develop. The
exact boundaries of the mediastinum aren’t particularly
visible on a chest X-ray, however, there are some
important structures to be assessed.
Aortic knuckle
• The aortic knuckle is located at the left lateral edge of
the aorta as it arches back over the left main bronchus.
Reduced definition of the aortic knuckle contours can
occur in the context of an aneurysm.
Aortopulmonary window
• The aortopulmonary window is a space
located between the arch of the aorta and the
pulmonary arteries. This space can be lost as a result
of mediastinal lymphadenopathy (e.g. malignancy).
Normal vascularity / aortic knuckle Coarctation of aorta
Aorta
Heart