How read chest xr 3
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1. This document provides guidance on how to read chest x-rays and summarizes 5 case examples. 2. Key elements to evaluate on a CXR are described such as position, quality, lesions, mediastinal structures, and other findings. 3. The case examples demonstrate different pathologies such as pneumonia, pulmonary edema, and infiltrates. Each case provides the patient history and radiographic findings.
How read chest xr 3
- 1. HOW READ CHEST XR -3 ANAS SAHLE ,MD
- 2. POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION Homo Densityinfiltratio Heterogenous Centralperiph Silhouet n Wellill defined Zone eral Necrotic sign MEDIASTINAL Central deviasionwided COSTO-PHRENIC ANGEL Freeoblitern OTHER Bone soft tissuediaphragm
- 4. Consolidation Infection causes Non-infection causes Broncho- WEGNER Cardiac Pneumonia Lymphoma alveolar COP Sarcoid disease failure carcinoma
- 5. Case-1 A 35-year-old male presented with: 1. fever, 2. cough, 3. purulent sputum for one week.
- 6. POSITION •PA CXR QUALITY •GOOD Technical Quality Lower lobe •Homogenous density in the right lower LESION zone (with bronchogram) obscured hemidiaphragm •Central trachea? and mediasteinal. MEDIASTINAL •free left costo-phrenic angels ANGELS •NO OTHER
- 7. Case-2 This 75-year-old female presented with: acute respiratory failure. She had been sick for two weeks with: 1. fever, 2. cough, 3. purulent sputum
- 8. POSITION •AP CXR QUALITY •Poor Technical Quality •(HIGH penetration). •Tow homogenous opacification in both lung: •in the left and right (middle,lower ) zone LESION obscured aortic arc, and left border of heart extend to chest wall,(air bronchodram) •Central trachea and mediasteinal MEDIASTINAL •Free costo-phrenic angels ANGELS •NO OTHER
- 9. Case-3 • A 30-year-old male presented with cough, shortness of breath • and loss of weight over four months
- 10. POSITION •AP? CXR QUALITY •Good Technical Quality •Bilateral infiltrate at lower zone LESION •(air bronchogram??) •No kerley line. •No upper zone venous diversion •Central trachea and mediasteinal MEDIASTINAL •Free costo-phrenic angels ANGELS •NO OTHER
- 11. disscusion • The CXR shows bilateral infiltrates and air bronchograms with a perihilar distribution. • The heart size is normal. • There are no Kerley B lines or evidence of upper lobe venous diversion. • All these are typical features of PCP
- 12. Case-4 • This middle-aged male had low- grade fever of one month’s duration • associated with productive cough and loss of weight.
- 13. POSITION •PA CXR QUALITY •POOR Technical Quality •rotation •Hetero-genous density at right lower zone (bronchogram) obscured LESION hemidiaphragm •Central trachea and mediasteinal MEDIASTINAL •Free left costo-phrenic angels ANGELS •NO OTHER
- 14. Case-5 • This patient presented with stridor due to thyroid goiter. • was intubated (Fig. 1). • Repeat CXR was done six hours later (Fig.2). • What is the main radiological abnormality?
- 15. AFTER INTUBATED
- 16. POSITION •AP CXR QUALITY •ACCEPT Technical Quality •Bilateral perihilar patchy opaciteis LESION •Diffused but Most in middle zone . •Obscured aortic arc(bronchgram) •Central trachea and mediasteinal MEDIASTINAL •Free left costo-phrenic angels ANGELS •NO OTHER
- 17. AFTER SIX HOURS
- 18. discussion • The first CXR shows a normal cardiac shadow associated with bilateral perihilar alveolar infiltrates suggestive of acute pulmonary edema. • The development of pulmonary edema with a normal heart size is indicative of an acute event. • The rapid clearance of the pulmonary infiltrates here indicates that the process is rapidly corrected by positive pressure. • In this patient, an important consideration is negative pressure pulmonary edema due to upper airway obstruction from the thyroid Goiter