Chest X-Ray

Prepared by Supervised by

Dr. Salem Alhadid Pro. Hussein shaaban

Postgraduate Studies Professor of

Thoracic surgery Thoracic surgery

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Systematic Approach
•Name /marker /rotation/ penetration
•Lines /metal work
•Heart
•Mediastinum
•Lungs
Zones (upper/middle/lower)
•Bones
•Diaphragm
•Soft Tissues
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•Name /marker /rotation/ penetration

clavicles
equidistant from
spinous processes
of thoracic spine

can just see lower

thoracic spine

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Lines / metal work

Tip of central
venous lines at
origin of superior
vena cava. See
tubes and lines
presentation.

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Heart
•Occupies up to 50%
of the maximum
internal thoracic
diameter on a
standard PA erect view

•Cannot comment on
heart size on AP view
because of
magnification of heart

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Mediastinum
•Hilar vascular
structures should
be crisply defined

•No widening of
mediastinum

•Trachea should
be central
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Lungs
•Compare upper,
mid and lower
upper zone
zones
middle zone

•Look between ribs

lower zone for lung detail
•Remember to look
“behind” the heart

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Bones

•Look at each rib in

turn

•Clavicles
•Scapulae and
humeri if visible

•Lower cervical and

thoracic spine
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Diaphragm
•Both diaphragms
should form a sharp
margin with the
lateral chest wall

•Both diaphragm
contours should be
clearly visible
medially to the spine

Position of stomach
gas bubble (not
present on this CXR)

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Soft Tissues
•Supraclavicular
fossae (enlarged
nodes)

•Lateral chest wall

(surgical emphysema)

•Under diaphragm
(pneumoperitoneum)

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Summary

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Dr. Salem Alhadid
 Pericardial effusion
 Hemorrhagic
 Infectious
HIV
Tuberculous
Syphilitic
 Radiation therapy
 Myxedema
 Severe pulmonary
hypertension

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Mediastinum

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Windened mediastinum

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Focal Lesions

 Nodales

 Masses

 Patches

 Cavity

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Nodules

 3 cm or less

 Tuberculoma
 Hamartoma
 Bronchogenic ca.
 Metastases
 Avm
 Hydatid cyst

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 Masses

 More than 3 cm

 Bronchogenic carcinoma

 Metastases deposit

 Hydatid cyst

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Patch

 Lesion with air

bronchogram

 Pneumonia
 Infarction

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Cavities
 Lesion partially or totally contains air

 Abscess
 Tumor breakdown
 Emphysmatous bulla
 Penumatocele
 Ruptured hydatid cyst
 Necrotic tumor
 Fungel baal

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Pancoast tumour

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Atelectasis

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Bronchiectasis

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White Hemithorax

 Large effusion

 Lung collapse

 Lung mass

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Emphysema

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Pleural effusion

 Transudate
 Exudate

Pus
Blood
Chyle
Cholesterol
urine
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 Causes of Pleural effusion

 CHF
 Para pneumonic
 Trauma
 Pulmonary embolism
 Tumores of lung & pleura
 Autoimmune disease
 Renal failure

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 Pneumothorax

 Spontaneous

 Asthma
 COPD
 Pulmonary infection
 Neoplasm
 Marfanas syndrome
 Smoking cocaine

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Tension pneumothorax

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Pleural mass

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Metastatic deposits

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Fractures

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Diaphragmatic hernias

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Diaphragmatic Paralysis

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Soft tissues

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 Surgical emphysma

 Trauma
 Obstructive lung disease
Asthma
 Latrogenic
Surgery
 Oesophageal injury
 Gas gangrene

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 Tumors

 Desmoids tumor
 Malignant fibrous
histocytoma
 Rabdo myosarcoma
 Lipo sarcoma
 Neuro fibro sarcoma
 Lieomyo sarcoma

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Thank You

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