CXR imaging  

outline

- CXR lung

- CXR heart

- CXR mediastinum

 

CXR interpretation

- ท่าของ CXR กับ special indication

- CXR interpretation

- normal CXR

- lateral view lesion ตาม lobe ปอดต่างๆ

- pleural effusion

 

CXR interpretation

ท่าของ CXR กับ special indication

- lateral decubitus film : pleural effusion

- lordotic view : lesion at lung apex

- oblique view : lesion at retrocardiac area, posterior costophrenic angles and chest wall

- inspiratory and expiratory views : air trapping and diaphragm movement, foreign body in child

 

CXR interpretation

- technical adequacy

** penetration or exposure

** inspiration

** rotation

normal CXR

- film CXR normal

- tube and line

normal chest CXR

PA upright lateral

normal CXR

- heart and mediastinum

- trachea

- hilar

- lung

- diaphragm

- thoracic cage

normal CXR

- retrosternal clear space

- hilar

- fissures

- thoracic spine

- diaphram and posterior costophrenic sulci

 

tube and line

- ETT tube ตำแหน่ง

- tracheostomy tube

- ICD

- nasogastric tube

- central venous catheter

- hemodialysis catheter

- pulmonary artery catheter

- pacemaker

ETT tube ตำแหน่ง

- คาง neutral

- คางก้ม

- คางเงย

- ศีรษะหันซ้ายขวา

 

tracheostomy tube

 

ICD

 

nasogastric tube

- ปลายสายอยู่ใน stomach

 

central venous catheter

 

hemodialysis catheter

- อาจลึกอยู่ใน right atrium

 

pulmonary artery catheter

 

pacemaker

- temporary pacemaker >> right ventricle

- permanent pacemaker >> right ventricle or right atrium

 

lateral view lesion ตาม lobe ปอดต่างๆ

- normal

- right lower lobe lesion

 

pleural effusion

- blunt of left posterior costophrenic angle

 

normal heart

cardiomegaly

- left atrial enlargement

- right atrial enlargement

- left ventricular enlargement

- right ventricular enlargement

cardiomegaly

left atrial enlargement

PA upright lateral film

- prominent left atrial appendage

- double contour right and left cardiac border

- large angle of carina angle

(left atrial enlargement)

- straight border

bulging posterior heart border

 

 

right atrial enlargement

- projection of the lower 2/3 of the right border of the heart

 

left ventricular enlargement

- obtuse cardio-phrenic angle

- the apex is displaced downward and outward

- obliteration of retrocardiac space in lateral view

 

right ventricular enlargement

- acute cardio-phrenic angle

- the apex is displaced outward.

- obliteration of retro-sternal space in lateral view.

congenital heart disease

- atrial septal defect

- ventricular septal defect

- patent ductus arteriosus

- total anomalous pulmonary venous return (TAPVR)

- transposition of great artery (TGA)

- tetralogy of fallot

 

atrial septal defect

- sinus venosus malformation

- scimitar syndrome

atrial septal defect

- enlarged main pulmonary artery

- right ventricular enlargement

- increased pulmonary vasculature

 

sinus venosus malformation

- right superior pulmonary vein

 

scimitar syndrome

- partial anomalous venous connection of right pulmonary vein to inferior vena cava

 

ventricular septal defect

- prominent left atrial appendage

- both ventricular enlargement

- increased pulmonary vasculature

 

patent ductus arteriosus

- prominent left atrial appendage

- left ventricular enlargement

- increased pulmonary vasculature

- prominent aortic knob

 

total anomalous pulmonary venous return (TAPVR)

- snowman appearance

 

transposition of great artery (TGA)

- egg on a string sign

 

tetralogy of fallot

- right ventricular enlargement

- concave main pulmonary (boot shape heart)

- lung oligemia

 

pulmonary hypertension

- enlarged pulmonary arteries and pruning of the distal pulmonary vasculature

PA upright lateral film

pulmonary hypertension

pericardial effusion

pericardial effusion

- flask or onion-shaped heart

- acute right and obtuse left cardiophrenic angles

valvular heart disease

- mitral stenosis

- aortic stenosis

 

 

 
 

mitral stenosis

- prominent left atrial appendage

- cephalization of pulmonary vessel

** prominent left ventricular enlargement with pulmonary interstitial edema (+ LAE)

- mitral annular calcification

 

 

 

aortic stenosis

- prominent descending aorta

mediastinum

- normal mediastinum

- mediastinal mass

- acute aortic dissection

- thoracic aortic aneurysm

normal mediastinum

** mediastinum area classification

+++ anatomic subdivision

+++ Felson's mediastinal division

mediastinal mass

- finding of mediastinal mass

- wide mediastinum เอาความกว้างเท่าไร

- anterior mediastinal mass

- middle mediastinal mass

- posterior mediastinal mass

- hilum overlay sign

- pericardial cyst

- tuberculous lymph node

- thyroid enlargement

- bronchogenic cyst

- thymoma

- hilar lesion

mediastinal mass

finding of mediastinal mass

 

wide mediastinum เอาความกว้างเท่าไร

- upright position > 6 cm

- supine position > 8 cm

 

anterior mediastinal mass

PA upright lateral

- no sihouette to descending aorta

(anterior mediastinal mass)

- density at retrosternal clear space

 

 

 

 

 

middle mediastinal mass

- mass at ascending thoracic aorta

PA upright supine

(middle mediastinal mass)

mass at mediastinum

- tracheal deviation at right side

 

posterior mediastinal mass

- no sihouette to heart and right hemidiaphragm

- cervicothorcic sign : mass above the clavicle

 

hilum overlay sign

- no discriminate right pulmonary artery and mass

 

pericardial cyst

- well-defined ovoid mass adjacent to the enlarged heart

 

tuberculous lymph node

- bilateral lobulated soft-tissue density masses caused by tuberculous lymph nodes

 

thyroid enlargement

- well-defined opacity in the upper mediastinum whose lateral margins can be traced in their entirely

 

bronchogenic cyst

- abnormal contour of the right heart border

infected bronchogenic cyst

- well-defined lesions in the right mid zone containing an air-fluid level

 

thymoma

Masaoka-Koga stage I

PA upright lateral

- slight hilar prominence on the right

- abnormally thickened anterior junction line secondary to an anterior mediastinal mass

(Masaoka Koga stage I)

- a sharply well-marginated retrosternal area of increased opacity with thin linear peripheral calcification

 

 

Masaoka-Koga stage IIb

PA upright lateral

- large left anterior mediastinal mass that produces an abnormal mediastinal contour

- obscure the upper part of the heart border

(Masaoka Koga stage IIb)

- well-defined, lobulate soft-tissue opacity in the retrosternal clear space that projects over the anterior mediastinum

 

 

hilar lesion

- sarcoidosis

- lymphoma

- tuberculosis

- lung cancer

sarcoidosis

- symmetrical hilar and right paratracheal nodal enlargement

 

 

lymphoma

- abnormal enlargement of lymph nodes in the aortopulmonary window in lymphoma

 

tuberculosis

- unilateral enlargement of right hilar and tracheobronchial lymph nodes in a young TB-contact

 

lung cancer

- hilar lymphadenopathy due to lung cancer

vascular disease

- acute aortic dissection

- thoracic aortic aneurysm

acute aortic dissection

- widening mediastinum with left pleural effusion and apical pleural cap

 

thoracic aortic aneurysm

**saccular aneurysm

- mediastinal mass adjacent to (but not obscuring) the aortic arch with well-defined lateral margins