Chest X-ray interpretation

Harindu Udapitiya,
Temporary Lecturer,
Division of Pharmacology.
Overview
 Before interpreting……

1. Proper labelling
2. Proper positioning
3. Veiw-PA? AP? Lateral?
4. Exposure
5. Rotation
6. Adequacy of inspiratory effort
Normal Anatomy
 Normal Chest X-ray

 Cardiac Structures
 Position
 More central in younger infants and children
 More on the L side in older infants and teens

 Size
 The cardiothoracic ratio should be less than 0.5
 A cardiothoracic ratio of greater than 0.5 (in a good
quality film) suggests cardiomegaly.
A/B<0.5
Cardiomegaly
 Trachea
 The trachea is placed usually just to the right of
the midline
 Mediastinum
 Lungs
 There are three lobes in the right lung and two in
the left.
 Right lung
1. Upper lobe
2. Middle lobe
3. Lower lobe.
 Left lung
1. Upper lobe; this contains the lingula
2. Lower lobe.
 Pleura
 There are two layers of pleura: the parietal
pleura and the visceral pleura.
 The parietal pleura lines the thoracic cage and
the visceral pleura surrounds the lung.
 Diaphragm
 Contour
 Rounded with sharp pointed costophrenic and
costocardiac angles. Blunting of costalphrenic or
costocardiac angles suggests plueral effusion.
 Right diaphragm is usually 1-2 cm higher
 Abnormal Chest X-ray
 Radiopacity (whiteness) means increased
density
 Radiotranslucency (blackness) means
decreased density
 Radiopacity can be of 3 causes
 Alveolar pattern – fluffy, soft, poorly demarcated
opacifications < 1 cm in diameter
 Possible causes:
 Pulmonary edema
 Viral pneumonia
 Pneumocystis
 Alveolar cell carcinoma
Pneumonia
 Abnormal Chest X-ray
 Interstitial pattern
 Consolidation of interstitial tissue (alveolar walls,
intralobular vessels, interlobar septa and
connective tissue)
 Looks like branching lines radiating toward the
periphery of the lung
 Possible causes:
 Interstitial
pneumonitis
 Pulmonary fibrosis
Pulmonary
Fibrosis
 Abnormal Chest X-ray
 Vascular pattern – assessment of the
pulmonary arteries and capillaries
 If there is an increase in the size of the
pulmonary arteries as they extend out into the
lung – pulmonary hypertension
 If there is a decrease in size, truncation, or
obliteration of a pulmonary artery – embolus
 Lack of vascular making in the periphery -
pneumothorax
Pulmonary Hypertension
Pulmonary
Embolism
 Lung pathologies

White Lung field Black lung Field

Well defined Ill defined

 Collapse  Consolidation
 Pleural Effusion  Fifrosis
 Pulmonary Edema
 Infiltration
 Pathological Conditions

1. Consolidation
2. Abscess
3. Bronchial Asthma
4. Bronchiectasis
5. COPD
6. Lung Collapse
7. Heart Failure
8. Pulmonary fibrosis
9. Hiatus hernia
10. Pleural Effusion
11. Pneumothorax
12. TB
13. Carcinoma
14. Lymphoma
15. Pericardial Effusion
16. Mitral Stenosis
 17. ASD
 1.Consolidation

 Causes
 Pneumonia
 Bronchialcarcinoma
 Lymphoma
 Inflammatory conditions
 Radiological features
 Airbronchogram
 Silhouette
sign
 Lower border
R.Middle lobe
Pneumonia
R.Lower Lobe pneumonia
2.Abscess
 3.Bronchial asthma

I. Hyperinflation
II. Diaphragmatic
flattening
III. Bronchial wall
thickening
IV. Hilar
enlargement
 4.Bronchiectasis

I. Tram line
opacification
II. “Bundle of graphes
appearance”
5.COPD
7.Lung Collapse
 DD
I. Lung collapse
II. Lower lobe consolidation
III. Pleural effusion
IV. Raised hemi diaphragm
8.Pulmonary fibrosis
9.Pleural Effusion
10.Pneumothorax
11.Hiatus hernia
12.TB
Miliary
TB
13.Bronchial carcinoma
14.Lymphoma
15.Pericardial effusion
16.Mitral Stenosis
17.ASD
 1.Basics on normal chest x ray
 2.Basics on Abnormal chest x ray
 3.Pathological conditions