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Lateral Decu#itus
Dr.Na#il Pa(tin,MD.FACC
Dr.Na#il Pa(tin,MD.FACC
Dr.Na#il Pa(tin,MD.FACC
Tec!ni4ues
Nondependent !e)it!ora0 to
confir) a pneu)ot!ora0 in a
patient 9!o could not #e
e0a)ined erect .
S!o9s #etter
intrapul)onar.
a#nor)alities
=n a good PA fil) ,
t!e t!oracic spine
dis( spaces s!ould
#e #arel. ;isi#le
t!roug! t!e !eart
#ut #on. details of
t!e spine are not
usuall. #e seen
t!roug! t!e !eart .
?nderpenetrated
o;erpenetrated
T!ere is no
ade4uate
lung detail
A#sence of
perip!eral
;asculature
See
;erte#rae
e0tending
do9n into
t!e
a#do)inal
region.
Dr.Na#il Pa(tin,MD.FACC
/otation
Cla;icular !eads
9!et!er t!e. are
in e4ual distance
fro) t!e spinous
process of t!e
t!oracic ;erte#ral
#odies .
Dr.Na#il Pa(tin,MD.FACC
/otation cont>
Factors to e;aluate A
&- Penetration
1- Inspiration
2- /otation
3- Angulation
Dr.Na#il Pa(tin,MD.FACC
Penetration
Bou s!ould #e
a#le to 5ust see t!e
t!oracic spine
t!roug! t!e Ceart .
Dr.Na#il Pa(tin,MD.FACC
Pitfalls Due to o;er penetration
Dr.Na#il Pa(tin,MD.FACC
Inspiration
Posterior
ri#s are
t!ose t!at
are )ost
apparent on
t!e c!est 0
ra. .t!e.
ru) )ore or
less
!ori@ontall..
Anterior ri#s
9ill #e
;isi#le #ut
are !arder
to see .
T!e. run
)ore or less
at a 3+
degree
angle
do9n9ard
to 9ard t!e
feet ,
If t!e spinous
process of
t!e ;erte#ral
#od. is
e4uidistant
fro) t!e
)edial ends
of eac!
cla;icle.
T!ere is no
rotation
Dr.Na#il Pa(tin,MD.FACC
Dr.Na#il Pa(tin,MD.FACC
Dr.Na#il Pa(tin,MD.FACC
Pitfall due to )ar(ed rotation
Penetration
Inspiration
/otation
Angulation
Dr.Na#il Pa(tin,MD.FACC
Correct
Penetration
Inspiration
/otation
Angulation
Dr.Na#il Pa(tin,MD.FACC
Grong
Dr.Na#il Pa(tin,MD.FACC
Correct
Penetration
Inspiration
/otation
Angulation
Dr.Na#il Pa(tin,MD.FACC
Correct
T!e fil) is
underpenetrated ..ou
can:t see t!e !eart
t!roug! t!e spine .
T!e degree of
inspiration is
pro#a#l. ade4uate .
/otation can not #e
e;aluated and t!ere
is a slig!t a)ount of
Angulation
.incidentall. t!ere is
a large #rong!ogenic
ca in t!e left lung .
Dr.Na#il Pa(tin,MD.FACC
Grong
Dr.Na#il Pa(tin,MD.FACC
Can:t tell
Penetration
Inspiration
/otation
Angulation
Dr.Na#il Pa(tin,MD.FACC
Correct
&. Trac!ea
1. Lung ape0
2. /ig!t para-trac!eal
stripe
3. /ig!t !ilu)
$. A@.go-oesop!ageal
stripe
D. Carina
,-ra.A
1. sternu),
2. rig!t ;entricle,
3. left ;entricle,
+. left atriu),
I. rig!t !e)idiap!rag),
$. left !e)idiap!rag),
&. Trac!ea
1. Aortopul)onar. 9indo9
2. Sternu)
3. /ig!t ;entricle
+. /ig!t !e)idiap!rag)
I. Left ;entricle
D. Left atriu)
&'. Scapula
Nor)al Anato).
Dr.Na#il Pa(tin,MD.FACC
Dr.Na#il Pa(tin,MD.FACC
Lateral C,/ 6continued7
Dr.Na#il Pa(tin,MD.FACC
Lateral C,/ 6continued7
Dr.Na#il Pa(tin,MD.FACC
Lateral C,/ 6continued7
Dr.Na#il Pa(tin,MD.FACC
Lateral C,/ 6continued7
Dr.Na#il Pa(tin,MD.FACC
Anato).
Dr.Na#il Pa(tin,MD.FACC
Lo#es
LingulaA
Dr.Na#il Pa(tin,MD.FACC
Lo#es 6continued7
If t!e fil)s is
underpenetrated , t!e left
!e)idiap!rag) 7 and left
lung #ase 7 9ill not #e
;isi#le and t!e.
pul)onar. )ar(ing 9ill
appear )ore pro)inent
t!an t!e. actuall. are .
Dr.Na#il Pa(tin,MD.FACC
AP 8ersus PA
t!e effect of )agnification
T!e lo#es of
t!e lungs
for)ing t!e
)argins of
t!e lungs
along t!e
)ediastinu)
and c!est
9all .
Mediastinu) Cont>
Dr.Na#il Pa(tin,MD.FACC
Cila
Co)posed of
pul)onar. arter.
and it:s #ranc!es ,
and ad5acent and
pul)onar. ;eins .
T!e pul)onar.
arteries and upper
lo#e ;eins
significantl.
contri#ute to t!e
!ilar s!ado9 on
plain C!est ,-ra. .
Nor)all. rig!t
!e)idiap!rag) is
&.+-2.+c) !ig!er
t!an t!e left
difference of )ore
t!an 2 c) is
considered
a#nor)al .
In 2L of population .
Left !e)idiap!rag)
is at a !ig!er le;el
t!an t!e rig!t .
Dr.Na#il Pa(tin,MD.FACC
Diap!rag) cont>
C!ec( for do)ing of diap!rag) #. dra9ing a line prependicular fro) t!e )id
point of t!e do)e to a line 5oining costop!erenic and cardiop!renic angles .
I- !eart si@e , s!ape A t!e 9idt! of t!e !eart s!ould #e no greater t!an +'L
of t!e 9idt! of t!e cage .
$-/e;ie9 !ila A
A- nor)al relations!ips
B- si@e
D- parenc!.)a A no9 finall. read. to e0a)ine t!e lungsJJ Mentall. di;ide t!e
entire c!est into upper , )iddle and lo9er t!irds . T!en , )et!odicall.
co)pare t!e rig!t and left sides of eac! lung section loo(ing for as.))etr. .
T!e easiest 9a. to identif. an a#nor)alit. is to confir) t!at it does not e0ist
on t!e ot!er side J .
For e0a)ple . If an
intrat!oracic opacit. is in
anato)ic contact 9it! t!e
!eart #order , t!en t!e opacit.
9ill o#scure t!at #order .
Disease Patterns
Dr.Na#il Pa(tin,MD.FACC
Air #ronc!ogra)
Air #ronc!ogra) is a
tu#ular outline of an
air9a. )ade ;isi#le #.
filling of t!e surrounding
al;eoli #. fluid or
infla))ator. e0udates .
Consolidation , pul.ede)a
, nono#strucuti;e
pul)onar. atelectasis ,
se;ere interstitial
disease , neoplas) and
nor)al e0piration .
Dr.Na#il Pa(tin,MD.FACC
Consolidation
Defined as a process
in 9!ic! air in t!e
al;eoli is replaced #.
products of disease .
In )ost instances ,
al;eolar filling is
patc!.,i.e. not all acini
are in;ol;ed .
T!e radiograp!ic
opacit. is t!erefore
non!o)ogeneous ,
so)eti)es 9it! are
#ronc!ogra) .
Dr.Na#il Pa(tin,MD.FACC
Collapse 6 atelectasis 7
T.pes
-
=#structi;e
-
Co)pressi;e
-
Cicatri@ation
-
Ad!esi;e
-
Passi;e
Dr.Na#il Pa(tin,MD.FACC
Keneral features of lo#ar collapse
S!ift of fissures
Cro9ding of ;essels
Trac!eal displace)ent
to9ard t!e side of t!e
collapse
Cilar s!ift
le;ation of t!e
!e)idiap!rag)
=t!er signs A
T!e presence of an
endotrac!eal tu#e , is it
sited too lo9 H
=t!er e;idence of
)alignant disease 6 e.g.
ri# )etastases , effusion 7
.
Dr.Na#il Pa(tin,MD.FACC
Collapse of indi;idual lo#es
/ig!t lo9er
lo#e collapse.
Loss of ;olu)e
in t!e rig!t
lung, t!e rig!t
!e)it!ora0 is
!.per
translucent.
Dr.Na#il Pa(tin,MD.FACC
Left upper lo#e collapse
T!e left lung lac(s a )iddle lo#e and t!ere fore a )inor fissure ,
so left upper lo#e atelectasis presents a different picture fro)
t!at of t!e rig!t upper lo#e collapse .
;entration
it:s caused due to a#sence of a
part of )uscle in t!e
diap!rag) 9!ic! is replaced
#. a t!in la.er of connecti;e
tissue .
It is usuall. associated 9it!
triso)ies &2,&$, pul)onar.
!.poplasia , congenital
CM8 .
;entration is )ore co))on on
t!e left side .
/adiological features includeA
-
Ce)idiap!rag) not
;isuali@ed .
-
Multic.stic )ass in t!e
c!est .
-
Mediastnal s!ift to opposite .
Dr.Na#il Pa(tin,MD.FACC
H
Medicine is notorious for t!ro9ing surprises especiall. for non curious and not
e0perienced doctors JJJ
Dr.Na#il Pa(tin,MD.FACC
Pneu)o)ediastinu)
Dr.Na#il Pa(tin,MD.FACC
Basics of cardiac dia#nosis fro! chest X-ray
HEART SIZE
=#esit.
Pregnanc. or
Ascites
=r a#nor)alities of t!e
c!est t!at co)press t!e
!eart suc! as
Ascending aorta
Dou#le densit. of
left atrial
enlarge)ent
/ig!t atriu)
Aortic (no#
Main or undi;ided
seg)ent of t!e
pul)onar. arter.
Left ;entricle
Dr.Na#il Pa(tin,MD.FACC
=#literation of retrosternal
space .
Dr.Na#il Pa(tin,MD.FACC
Pericardial Calcification
Dr.Na#il Pa(tin,MD.FACC
Disease Pattern
A s!ado9
rese)#ling a line N
!ence an.
elongated opacit.
of appro0i)atel.
unifor)- linear
atelectasis
Dr.Na#il Pa(tin,MD.FACC
C,/ s!o9ing rig!t )id @one t!ic( 9alled ca;it. 9it! ad5acent satellite
lesions a#scess
Dr.Na#il Pa(tin,MD.FACC
/ig!t lo9er @one costop!erenic angle ca;it. 9it! fluid
le;el . Dr.Na#il Pa(tin,MD.FACC
PA and lateral s!o9ing a large c.st 9it! air fluid le;el and unifor) t!ic( 9all
Dr.Na#il Pa(tin,MD.FACC
Bilateral lo9er lo#e conglo)erate c.st 9it! fe9 c.sts
s!o9ing fluid le;els "case of infected #ronc!iectasis
Dr.Na#il Pa(tin,MD.FACC
Left upper lo#e ca;it. 9it! fungal #all-classical case of air crescent sign of fungal #all.
Dr.Na#il Pa(tin,MD.FACC
Solitar. pul)onar. )ass
/ig!t upper lo#e ca;it. 9it! fungal #all . Note t!e )anacles sign 6 air
crescent 7
Dr.Na#il Pa(tin,MD.FACC
% ' 199
Dr.Na#il Pa(tin,MD.FACC