Chest X-Ray: Basics

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-Introduction
-Technical Aspects
-Cardiac Shaddow
-Mediastinum
-Hila
-Lungs
-Plural Spaces
-Bones
-Soft Tissues

• Please click on any of the images below to enlarge •

Interpreting the CXR

General format:

Check the technical aspects
-Name, date, projection, rotation, penetration, inspiration
Cardiac shadow
-Size, shape, calcification
Mediastinum
-Position, width, outline, density, tracheobronchial tree
Hila
-Position, size, density, concave
Lungs
-Size, transradiancy, fissures, focal or generalised pulmonary infiltration
Pleural spaces
-Effusions, soft tissue masses, calcification, pneumothorax
Bones
-Fractures, lytic or sclerotic lesions
Soft tissues
-Masses, calcification

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Technical Aspects

Check the side markers

Have you got L and R the right way around?

Assessment of rotation

Distance between medial ends of the clavicles and the spinous processes

Penetration

• Intervertebral disc spaces just visible through mid-cardiac shadow
• Pulmonary structures visible with clarity
• Few vessels in outer third

Inspiration

Full inspiration:
• 6-7 anterior ribs
• 10-11 posterior ribs

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Cardiac shadow

Heart Size

• Cardiac Transverse Diameter (CTD) = a+b
< 15.5cm (males)
< 15.0cm (females)

• Cardio-Thoracic Ratio (CTR) =a+b÷c+d
< 0.5

Cardiac configuration

• Dilated left ventricle:
-Ischaemic/dilated cardiomyopathy
-Aortic reflux
-Mitral reflux
-VSD, PDA
-Anaemia, hyperthyroid, Paget’s, AVF

• Failing left ventricle:
-AS, HTN, Coarctation

• Cardiomegaly (CTR > 0.5)

• Large third “mogul”

• Double density right heart border

• Displaced descending aorta

• Dilated left atrium:
-Mitral stenosis or myxoma
-Mitral reflux, VSD, PDA,
-ASD (late)