X- RAY CHEST

How To Read & Interpret

 X- RAY CHEST
 Keep the patient’s age, sex & clinical
information in mind.
 Follow your own systematic approach &
strict to it. You will never miss findings.
 See all four corners of the film.
 Always compare both sides.
 X- RAY CHEST

 See the Identification

number, name etc.
 Observe right & left
markers.
 See the date of
examination.
 X- RAY CHEST
 See the Exposure.
 Optimal exposure is that in which vertebral
bodies & intervertebral discs are just
visible behind the heart shadow.
 Avoid over or under exposed films.
 POSITION
 Observe the
position of the
patient.
 Medial ends of the
clavicles should be
equidistant from
spinous process
of dorsal vertebrae-
usually T4.
 TRACHEA
 Observe the Trachea
for narrowing,
displacement &
intraluminal lesions..
 It is usually central &
sometimes slightly
shifted to right.
 Deviation suggests
pathology.
 TRACHEA
 Right Para Tracheal Stripe:
 Seen in 60% of chest x rays.
 Normally less than 5 mm.
 Widening is caused by:
 Mediastinal lymphadenopathy.
 Tracheal malignancy.


Pleural effusion.

Mediastinitis.
 TRACHEA
 Carina is at T4 level.
 Carinal Angle is normally 60-75
degrees.
 Widening occurs in
• Enlarged left atrium.
• Enlarged carinal lymph nodes.
 LUNG FIELDS
 Compare corresponding lung fields in
both lungs
 Apices
 Upper zones
 Mid zones
 Lower zones
 LUNG FIELDS
 See for abnormal area of lucency.
 Uneven distribution of lung markings.
 The size of upper & lower zone vessels.
 Look for any abnormal opacity.
 Characterize the opacity by looking at location, extent,
specific features such as calcification or cavitation etc.
 HIDDEN AREAS
 Look again at apices.
 Look again behind heart shadow.
 Look bones esp at the overlapping
areas.
 Look the sharpness of cardiac,
mediastinal & diaphragmatic borders.
COSTOPHERENIC ANGLES

 Normally they are acute.

 Blunting indicates
• Effusion
• Fibrosis
• Pad of fat
• Overinflated lungs
PLEURA & DIAPHRAGM

 Right dome is usually higher than left.

 A difference of more than 3 cms is
significant.
 Raised dome indicate pathology.
 PLEURA & DIAPHRAGM
 Diaphragmatic border

Ill defined(Rt)
 Ill defined(Lt)
 Diaphragmatic position

Abnormal(Rt)

Abnormal(Lt)
 Free air under diaphragm
 Pleural border

Pneumothorax(Rt. or Lt)
 Pleural effusion(RT. or Lt)
 Pleural thickening
 THE HILUM
 Left hilum is 1-2 cms higher than
right.
 The hila are composed of
 Pulmonary artery and their main
branches.
 Upper lobe pulmonary veins.

 The major bronchi.


The lymph glands.
 THE HILUM
 Compare position of right & left hilum
 Size
a. Enlarged
b. Diminished
 HEART
 Usually 2/3rd of heart shadow lies to the
left of midline and 1/3rd to the right.
 Cardio-thoracic ratio:
It is the ratio between maximum
transverse cardiac diameter to the
maximum inner transverse diameter of
chest above CP angles.
 Normal C.T ratio is 0.5 or less. It is higher
in children.
RIGHT HEART BORDER

 It is formed by:
 Innominate vessels
 Superior vena cava

 Right atrium

 Small part of inferior vena cava

 LEFT HEART BORDER

 It is formed by:
 Subclavian artery
 Aortic knuckle

 Pulmonary bay

 Left arterial appendage

 Left ventricle
 MEDIASTINUM
 Mediastinum position
 Mid postion
 Shift to right
 Shift to left
 Mediastinal Air present or not
 Mediastinal enlargement
 Upper mediastinum
 Middle mediastinum
 Lower mediastinum
 SOFT TISSUES
 Chest Wall soft tissue, breast shadow etc.
 Increase
 Decrease
 Absence
 Soft tissue of Neck
 Asymmetry
 Shoulder area soft tissue
 Asymmetry
 Calcification
 Upper abdomen soft tissue
 Calcification
 Abnormal air ( GI tract, or Outside)
 BONES
 Ribs
 Count pair of ribs( compare right to left)
• Missing rib
• Asymmetric intercostals spaces
 Cervical ribs
 Trace rib outline
• Fractures
• Metastasis
 BONES
 Clavicles
• Fractures
• Metastasis
• Joints
 Scapulae
• Fractures
• Metastasis
• Joints
 Humerus
• Fractures
• Metastasis
 Shoulder Joint
• Calcification
• Widening
• Narrowing
• Dislocation
 BONES
 Spine.

PA View
• Pedicles
• Scoliosis

Lat. View
• Vertebral height
• Kyphosis