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Monday, January 16, 2017

Simplified Approach To Reading Chest X- Rays.

A good understanding of normal anatomy and variations is essential for the interpretation of chest
radiographs.Here is given a simplified approach to reading chest x -rays.
Most commonly the chest x rays are in a PA (posterio anterior) view in which the X-ray beam first
enters the patient from the back and then passes through the patient to the film that is placed anterior to the patient‘s chest. It uses 80–120 kV and focus film distance of 6 feet.

                                                 A Normal Chest X-Ray (PA view)



                                     A Chest X-Ray (PA view) showing Mediastinal Borders


On a PA film, lung is divided radiologically into three zones:

                                             X- ray chest (PA view) showing lung zones

1. Upper zone extends from apices to lower border of 2nd rib anteriorly.
2. Middle zone extends from the lower border of 2nd rib anteriorly to lower border of 4th rib anteriorly.
3. Lower zone extends from the lower border of 4th rib anteriorly to lung bases.
Radiological division does not depict anatomical lobes of the lung.

In a well-centered chest X-ray, medial ends of clavicles are equidistant from vertebral spinous process. Lung fields are of equal transradiance.

Apices are visualized free of ribs and clavicles on apicogram shown below:
                                                     X- Ray Chest - Apicogram

The normal length of trachea is 10 cm, it is central in position and bifurcates at T4–T5 vertebral level. Left atrial enlargement increases the tracheal bifurcation angle (normal is 60°). An inhaled foreign body is likely to lodge in the right lung due to the fact that the right main bronchus is shorter, straighter and wider than left main bronchus

Normal heart shadow is uniformly white with maximum transverse diameter less than half of the maximum transthoracic diameter.
Cardiothoracic ratio is estimated from the PA view of chest. It is the ratio between the maximum transverse diameter of the heart and the maximum width of thorax above the costophrenic angles:
a = right heart border tomidline,
b = left heart border to midline,
C = maximum thoracic diameter above costophrenic angles from inner borders of ribs. Cardiothoracic ratio = a + b: c. Normal cardiothoracic ratio is 1:2

                          Chest x-ray (Pa view) showing Measurement of Cardiothoracic ratio

To detect any pulmonary pathology, it is important to remember the normal thoracic architecture, both lungs are compared for areas of abnormal opacities, translucency or uneven bronchovascular distribution in the lungs.
An abnormal opacity should be closely studied to ensure that it is not amalgamated opacity formed by superimposed normal structures such as bones, costal cartilages, vessels, muscles or nipple. Any opacity is evaluated by its extent, margins and location with presence or absence of calcification or cavitation. A general assessment survey is made to look for any other lesion or displacement of adjacent structures.

                                                   Chest X ray Lateral view


                                  X-ray chest Pa view (negative) to help visualize bony thorax

10 comments:


  1. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
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  3. Good news this is to everyone out there with different health challenges, as I know there are still a lot of people suffering from different health issues and are therefore looking for solutions. I bring you Good news. There is a man called Dr ehiaguna a herbal practitioner who helped cure me from HSV (2), i had suffered from this diseases for the past 5 years and i have spent so much money trying to survive from it. I got my healing by taking the herbal medicine Dr ehiaguna sent to me to drink for about 14 days . 3 days after completion of the dosage, I went for a medical checkup and I was tested free from HSV. all thanks to God for leading me to Dr ehiaguna who was able to cure me completely from this deadly diseases, I’m sharing this so that other people can know of this great healer called Dr ehiaguna because I got to know him through elizabeth who he cured from HIV. I was made to understand that he can cure several other deadly diseases and infections. Don’t die in ignorance or silent and don’t let that illness take your life. Contact Dr ehiaguna through his email  drehiaguna@gmail.com You can also whatsapp/call him on:+2348073908953 .He cure all forms of disease {1}HIV/AIDS {2}DIABETES {3}EPILEPSY {4} BLOOD CANCER {5} HPV {6} BRAIN TUMOR {7} HEPATITIS {8}COPD{9} SICKLE AND ANAEMIA.etc Be kind enough to share as you received.  

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  4. God bless Dr Ebacol for his marvelous work in my life, I was diagnosed of HERPES since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched out some possible cure for HERPES i saw a comment about Dr Ebacol, how he cured HERPES,DIABETES,HIV,and CANCER with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine I took the medicine as prescribed by him and 14 days later i was cured from HERPES, Dr Ebacol truly you are great, do you need his help also? Why don’t you contact him through his EMAIL:    drebacolherbalhome1@gmail.com  call or whatsApp him on +2348159042641      

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  7. My name is Thomas White, from United states, i have been Herpes positive and it is just like been through hell; well special thanks to God almighty for using Dr Twaha, the greatest Herbal doctor in curing my herpes disease. I was diagnosed of this disease in the year 2004. Although I was taking my medications I was not myself. Until a few weeks ago. My friend came to me and told me that he saw many testimonies on how Dr. Twaha  cured people Herpes disease. Although I never believe in herbs, I said to myself "seeing is believing" I took his name and searched it on GOOGLE, I saw many testimonies myself. Quickly, I copied his email: drlregbeyen10000@gmail.com I emailed him, he gave me a form to fill which I did, then he sent me a message  and told me that he required some items in which he will use in preparing the cure for me and he told me that it will cost me some money which i sent to him because I need the cure urgent,  He bought the items and prepared a cure for me, then he sent the parcel to me through courier delivery service. I paid the courier services, I got my parcel, it was a bottle of ointment as described by Dr,Twaha After taking the ointment he told me to do, the herpes test and the result came out negative. Quickly I messaged him and told him what happened he congratulated me. I promised to tell the world about him. You can contact him with any problem  via email: ( drlregbeyen10000@gmail.com ) or contant him on whatspp +2349038518881 thank you Dr Twaha

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