CXR

A-H

A- airway

B- bones

C- cardiac

D- diaphragm’s - liver on the right - diaphragm is higher than the left, stomach under the right - gastric bubble

E- expansion - need good expansion of chest for photo

F- fields and fissures

G- gadgets

H- hidden areas

Air is black - tissue fluid look white
Look for trachea

trachea = central or deviating very slightly to the right.

True tracheal deviation

  • Pushing of the trachea: large pleural effusion or tension pneumothorax.
  • Pulling of the trachea: consolidation with associated lobar collapse.

Apparent tracheal deviation

  • Rotation of the patient can give the appearance of apparent tracheal deviation (clavicle position)

Soft tissue

  • Breast shadows
  • skin folds and soft tissue density
  • surgical emphysema

right- 1/3rd
left- 2/3rds

Cardiac
Sail sign

  • wedge of collapsed tissue behind the heart boarder
  • left lower lung collapse
  • appears like sail boat

Diaphram

  • right hemidiaphram is higher than the left due to the liver
  • stomach underlies left hemidiaphram
  • if free gas is present (bowel perforation) air accumulates under diaphram causing it to lift and become visibly separate from the liver
  • The diaphragm should be indistinguishable from the underlying liver

Expansion

  • The diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clavicular line.
  • Less = incomplete inspiration
  • more = lung hyper-expansion

Fine grey lines that extend throughout the lung fields to within 2cm of the lung edge

field/fissures

  • fields - whiter than expected- increased density of lung markings or obscured by something else
  • fields darker than expected- Darker suggest air where it shouldn’t be and absent lung tissue

Horizontal fissure

  • Fluid = Pleural effusion
  • Opacity= infection of middle lobe
  • Movement- collapsed upper lobe

Gadgets

  1. Pacemaker
  2. ECG
  3. Tracheostmy
  4. Chest drain
  5. Nasogastric stomach tube
  6. Sternal wires
  7. Endotrachial tube
  8. Rods

Hilar

  • increased density around the hilar
  • bats wing pattern
  • pulmonary odema/ fluid overload/ heart failiure & increased blood flow to the area
  • The left hilum- slightly higher than right
  • anatomically it is where the descending pulmonary artery intersects the superior pulmonary vein.
  • When this is lost- lesion here (e.g. lung tumour or enlarged lymph nodes).

Hilar enlargement

  • Bilateral = sarcoidosis
  • Unilateral = underlying malignancy
  • pushed = soft tissue mass
  • pulled = lobar collapse

Pleural effusion

  • Concave - meniscus
  • blunting of costophrenic angles
  • uniform white appearance throughout a whole lung field with a defined line and meniscus
  • movement of structures away from this

Consolidation

  • refers to any pathological process that fills the alveoli with e.g. pus, blood, fluid
    Appearance
  • patchy ocacity
  • may affect one lobe up to both lungs
  • silhouette sign
  • Air brochiograms
  • all structures in expected positions

Atelectasis

  • uniform white appearance
  • localised to one lobe or whole lung
  • rib crowding
  • reduced expansion
  • movement of structures towards the area

Pulmonary Odema

  • bilateral increased lung markings- perihilar and shaped like bat wings
  • septal lines
  • effusions may be present

Bullae- common in COPD

  • areas of lung that appear more black within/adjacent to areas with lung markings in
  • due to emphysematous damage of the lung