Wayang kulit, no 1 a fundamentals
- 1. CHEST RADIOGRAPHS, WAYANG KULITA REVISIONOF THE FUNDAMENTALSDr Ng Kian SengMBBS (Singapore) MCGP (Malaysia)Master Of Medicine (Internal Medicine, Singapore)FAFP (Malaysia) Cert In Occupational MedicinePh D (Theology, USA)
- 2. Hippocrates of Cos, Father of MedicineANATOMY IN THE CHEST RADIOGRAPH
- 3. A Chest Radiograph,Not A Chest X-RayA Normal Chest RadiographSome examiners like you to call x ray films radiographs; strictlyspeaking you can’t actually see the x rays themselves.
- 4. Anatomy in the Chest RadiographThe right main bronchus is slightly larger than the left & comesoff at a less acute angle than the left (hence septic material &foreign substances are more likely to be inhaled into the right lung than into the left).
- 5. Chest Radiograph, PA View, No 1Apex Of LungCarina Trachea Right para-tracheal stripeAortic archMainPulmonaryArteryLeft AtrialappendageDescending thoracic aortaLeft ventricleGastric Air Bubble
- 6. Chest Radiograph, PA View, No 2 Right upper lobe pulmonary vein Horizontal fissureRight hilumRight lower lobe pulmonary arteryRight atrium Right Cardiophrenic Angle Right Costophrenic Angle
- 7. Chest Radiograph, PA View, No 3Spinous processScapulaAnterior RibClaviclePosterior RibRight BronchusLeft BronchusDiaphragmBreast Soft TissueLung TissueSuperimposedOn diaphragmRetrocardiac vertebra
- 8. Chest Radiograph, PA View, No 4Anatomy Of the Heart In The Chest Radiograph
- 9. THE MEDIASTINAL STRUCTURES IN THE C-XRAY
- 10. AortoPulmonaryWindowAorto-pulmonary window. The aorto-pulmonary window lies between the arch of the aorta and the pulmonary arteries. It contains the ligamentum arteriosum, the recurrent laryngeal nerve, lymph nodes, and fatty tissue. ...
- 11. RIGHTPARA-TRACHEALSTRIPEFrom the level of the clavicles to the azygous vein the right edge of the trachea is seen as a thin white stripe. This appearance is created by air of low density (blacker) lying either side of the comparatively dense (whiter) tracheal wall. If this stripe is thickened (normally less than 5 mm) this may represent pathology such as a paratracheal mass or enlarged lymph node. The left side of the trachea is not so well defined because of the position of the aortic arch and great vessels.
- 12. Anatomy in theLateralChestX-ray1. Ascending thoracic Aorta2. Sternum3. Right ventricle4. Left ventricle5. Left atrium 6. Gastric air bubble7. Right Hemidiaphragm8. Left Hemidiaphragm9. Right upper lobe bronchus10. Left upper lobe bronchus11. Trachea.
- 13. NAME THE STRUCTURES IN THE LATERAL CHEST X-RAY1.Trachea2. Aortopulmonary window 3. Sternum4. Right ventricle 5. Right Hemidiaphragm 6. Left Hemidiaphragm 7. Left atrium 8. Scapula 9. Right Upper Lobe Bronchus10. Left upper Lobe Bronchus910
- 14. THE MEDIASTINUM The mediastinum is divided by a plane passing from the sternal angle to T4-T5 into: Superior mediastinum and The inferior mediastinum The inferior mediastinum is further subdivided into three regions namely:Anterior mediastinum Middle mediastinumPosterior mediastinumThese divisions are for descriptive purposes, theymerge into each other imperceptibly. There are no distinct boundaries between them.
- 15. ZONES OF THE CHEST RADIOGRAPHApex to a line drawn throughThe lower borders of theAnterior ends of the 2nd costalCartilage.UPPERZONEMIDDLEZONELOWERZONEFrom the 1st line to one drawnThrough the lower borders of the4th costal cartilage & includesThe Hila of the lungsFrom the 2nd line to theBases of the lungs.
- 16. THE FISSURES OF THE LUNGSOblique Fissure From 4 th Dorsal spine sweeping downObliquely to the 6th rib in mid mammary line or the 6th costo Chondral junction, anteriorly.Horizontal Fissure. Runs from the 4th costo chondral junction To meet Oblique Fissure at the mid axillary line.
- 17. THE LOBES & FISSURES OF THE LUNGSBase of the Lung: 6th costochondral junction, obliquely to the 10th rib in anterior Axillary line, then horizontally to 12th thoracic vertebra
- 18. OBLIQUE FISSURE , HORIZONTAL FISSUREOblique Fissure : From 4th Dorsal spine sweeping downObliquely to the 6th rib in mid mammary line or the 6th Costochondral junction, anteriorly.Horizontal Fissure. Runs from the 4th costochondral Junction to meet Oblique Fissure at the mid axillary line.
- 19. THE RIGHT & LEFT OBLIQUE FISSURESFrom 4th Dorsal spine sweeping down Obliquely to the 6th rib in midmammary line or the 6thCostochondral junction, anteriorly.
- 20. THE HORIZONTAL FISSUREHorizontal Fissure. Runs from the 4th costochondral junction to meet Oblique Fissure at the Mid Axillary Line.
- 21. WHAT IS THE ABNORMALITY HERE?
- 22. ACESSORY FISSURE, THE AZYGOS FISSURE.The azygos lobe appears starting in a teardrop shape at around the level of T5 to the right of the midline as a pale line curving outward and upward and then back in to meet the root of the neck, the line is the infolding of the pleura. Also described as a “curvilinear opacity,Inverted comma, tadpole.” (See Notes in “Companion”, J)
- 23. Louis PasteurNORMAL VARIANTS IN THE CHEST RADIOGRAPH
- 24. NIPPLE SHADOWS
- 25. NIPPLE SHADOWSRIGHT NIPPLELEFT NIPPLEConfirm these are indeed nippleShadows by using metal markers!
- 26. ASYMMETRY OF THE BREASTSBreast asymmetry is very common, even to the extent that no breast tissue is visible on one side. It should not be assumed that the patient has had a mastectomy, unless this is known from the history.
- 27. BONE ISLAND IN THE RIB
- 28. DROMEDARY HUMP IN THE DIAPHRAGM
- 29. EXAMINE THE FIRST & SECOND RIBS ON BOTH SIDES
- 30. FUSION OF FIRST & SECOND RIB ON THE LEFT
- 31. PSEUDO-ARTHROSIS OF THE FIRST TWO RIBS ON THE LEFT
- 32. BIFURCATED RIB
- 33. Soft tissue fat This close-up demonstrates a normal fat plane between layers of muscle. Fat is less dense than muscle and so appears blacker. Note that the edge of fat is smooth. Irregular areas of black within the soft tissues may represent air tracking in the subcutaneous layers. This is known as surgical emphesyma
- 34. What is the bony abnormality in this patient?Chest radiograph is showing well developed bilateral cervical ribs.
- 35. Cervical rib is an extra rib that arises from the 7th cervical vertebrae. How do you know these are cervical ribs? And not the 1st thoracic ribs?CervicalTransverseProcessesPoints Downwards=CDThoracicTransverseProcessesPoints Upwards =TULook at the transverse processes that articulate with these ribs. Cervical transverse processes points down while thoracic transverse processes points up.
- 36. Edward JennerTHE BLACK & WHITERADIOLOGICALTERMS
- 37. RADIODENSITY SCALERadiodensity : Physical quality of an object that determines how muchradiation it absorbs from the X-Ray beam. Radiodensity is determinedby composition ( atomic weight) and thicknessRADIOLUCENTINCREASING RADIODENSITYDECREASING RADIODENSITYAIRFATBLOODMUSCLEBONEBARIUMRADIOPAQUEradioLucent = bLack radiopaquE = whitE
- 40. Antonie von Leeuwenhoek “What is the student but a lover courting a fickle mistress who ever eludes his grasp?” Sir William OslerContact Me At : plusultra.ng@gmail.com
Editor's Notes
- #3: The Greek physician Hippocrates of Cos, born around 460 B.C. the Founding Father of Medicine
- #16: Note that the lower zones reach below the diaphragm. This is because the lungs pass behind the dome of the diaphragm into the posterior sulcus of each hemithorax. Normal lung markings can be seen below the well defined edges of the diaphragm.
- #21: costochondral junction
- #24: LouisPasteur: The Chemist Who Transformed Medicine. He debunk the theory that microbes appear by “spontaneous generation”, and demonstrated that they are instead produced from other microbes. Pasteur’s discoveries helped develop the “germ theory” of disease and the process of pasteurization that is used to this day.
- #37: This painting depicts the use of the first Western vaccine: the cowpox vaccine to protect against smallpox. Edward Jenner, a rural English doctor, is shown injecting his first patient, James Phipps, in 1796, using fluid obtained from scratches on the hand of dairymaid Sarah Nelmes. His observation that dairymaids seemed to gain immunity to smallpox from their exposure to cowpox led to Jenner’s experiments and the eventual widespread adoption of smallpox vaccination. In 1980, the disease of smallpox was declared eradicated from the world.
- #41: Antonie von Leeuwenhoek is shown exploring the microscopic world through handmade lenses. The 17th-century Dutch scientist was the first to report seeing what we now know as protozoa and bacteria (which he called “animacules”), and to document blood flow in small vessels called capillaries. He is considered a forefather of modern microbiology, and a key contributor to the development of the microscope, having ground hundreds of lenses that were mounted in metal frames such as the one he holds in the painting.