general surgery

1. CHEST x ray
by
Abdelaziz ragab sakrAbdelaziz ragab sakr
M.B.B.Ch ,M.B.B.Ch ,m.chm.ch ,, mrcsmrcs

2. What is an x ray?
An X-ray machine is basically like a
camera.It uses
X-rays to expose the film, instead of visible
light.

3. appearnce of different tissue

4. chest radiology

8. view
PA view
• Scapula is seen in
periphery of thorax
• Clavicles project
over
lung fields
• Posterior ribs are
distinct
• Position of markers
AP view
• Scapulae are over
lung fields
• Clavicles are above
the apex of lung
fields
• Anterior ribs are
distinct
• Position of markers

9. Penetration
With correct exposure you
should barely see
the intervertebral disc
through the heart
• If you see them very
clearly
the film is overpenetrated
• If you do not see them it is
underpenetrated

10. Rotation

11. Normal Chest X-ray
• Cardiac Structures
– Position
• More central in younger infants and children
• More on the L side in older infants and teens
– Size
• CARDIO-THORACIC RATIO!
• Cardiac diameter :
– normal individuals < 15.5 cm in males; <14.5 cm in
females.
– A change in diameter of greater than 1.5 cm between
two
X-rays is significant.

13. !!!!!!

14. Pneumothorax
Radiological features
● Simple:Visceral pleural edge visible.
● Tension: THIS IS A CLINICAL AND NOT A
RADIOLOGICAL DIAGNOSIS!
Associated mediastinal shift to the opposite side is
seen.

16. !!!!!!

17. Haemothorax
Radiological features
● Erect CXR is more sensitive than a
supine film.
– Blunting of the costophrenic angles –
seen with approximately 250 ml
of blood.
– General increased opacification of the
hemithorax is seen on a supine
film.

19. !!!!!!

21. !!!!!!

22. Aortic rupture
Widened mediastinum (8cm on a supine AP Chest
radiograph (CXR)).
● Blurred aortic outline with loss of aortic knuckle.
● Left apical pleural cap.
● Left sided haemothorax.
● Depressed left/raised right main stem bronchus.
● Tracheal displacement to the right.
● Oesophageal NG tube displacement to the right.

23. !!!!!

24. Diaphragmatic rupture/hernia
● CXR:
– Air filled or solid appearing viscus
above the diaphragm.This may only
be recognised following passage of
an NG tube.
– Other features include mediastinal
shift away from the affected side,
diaphragmatic elevation, apparent
unilateral pleural thickening or
suspicious
areas of atelectasis.
.

25. !!!!

26. Oesophageal perforation/rupture
● CXR: Classic signs are
subcutaneous emphysema,
pneumomediastinum,
left sided pleural effusion,
hydropneumothorax and
mediastinal widening.
● Water soluble contrast studies
are of benefit to demonstrate
perforations.
If no perforation is seen a barium
swallow will show better mucosal
detail.These studies can be
repeated over time.

27. !!!!!

28. Flail chest
• Multiple rib
fractures.
• Costochondral
separation may not
be evident.
• Air space
shadowing may be
seen with
pulmonary
contusions

29. !!!!!

30. pneumo_mediastinum

31. THANK YOU