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X-RAYSX-RAYS
By
Prof Dr IBRAHIM DAWOUD
Prof of Surgery
Mansoura University
How to read
 Plain X-ray
 Plain x-ray (describe the region).
 View (PA, lat, oblique).
 Position (erect, supine).
 Qu...
Normal Chest X-ray
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view.
 Erect Position . Good Quality. Good Exposure.
 Ch...
Questions:Questions:
 CausesCauses
Artificial Spontaneous Traumatic
1- Therapeutic 1- Emphysem bullae 1- Open
2- Diagnos...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view
 Erect Position . Good Quality. Good Exposure.
 Che...
QuestionsQuestions
 CausesCauses
Postoperative Pathological Traumatic
1- Thoracotomy 1- Lung tumors 1- Open
2- Puncture ...
 Clinical PictureClinical Picture
 InvestigationInvestigation
 TreatmentTreatment
1- Systemic
{a} Aspiration {b} Bl Tra...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view.
 Erect Position . Good Quality. Good Exposure.
 Ch...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view
 Erect Position . Good Quality. Good Exposure.
 Che...
QuestionsQuestions
 CausesCauses
Direct Violence
Indirect Violence
Muscular Violence
 TypesTypes
1- Simple Fracture rib...
 Clinical PictureClinical Picture
 InvestigationInvestigation
 TreatmentTreatment
1- Simple Fracture
{a} Analgesic {b} ...
Conditions Requiring Urgent CorrectionConditions Requiring Urgent Correction
 Air Way ObstructionAir Way Obstruction
Rem...
Conditions Requiring Urgent ThoracotomyConditions Requiring Urgent Thoracotomy
 Continued Intrapleural BleedingContinued...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view (1) --- Lateral view (2)
 Erect Position . Good Qual...
QuestionsQuestions
 CausesCauses
1ry necrotizing pneumonia Aspiration pneumonia
Bronchial obstruction Systemic infection...
 TreatmentTreatment
1- Antibiotics and internal drainage
By {a} cough {b} bronchoscopy
2- External drainage
{a} Tube pneu...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view (1st
) lateral view (2nd
)
 Erect Position . Good Qu...
QuestionsQuestions
 PathologyPathology
1- Incidence ( age- sex- site )
2- Etiology (p.p) :(smoking- air pollution- adeno...
How to readHow to read
Plain x-ray chest.
 Postero-anterior view
 Erect Position . Good Quality. Good Exposure.
 Chest...
TYPESTYPES
 TansudateTansudate
1- Congestive HF 2- Nephrotic Syndrome
3- Cirrhosis 4- Hypoproteinemia
5- Myxedema 6- Per...
How to readHow to read
 Plain x-ray chest.
 Postero-anterior view
 Erect Position . Good Quality. Good Exposure.
 Che...
How to readHow to read
SOFT TISSUE MAMMOGRAPHY
A well defined rounded mass in the upper part of the
breast.
 It has a ro...
How to readHow to read
SOFT TISSUE MAMMOGRAPHY
 A dense shadow(s) in the breast with a very
irregular outline, and with ...
MAMMOGRAPHIC CRITERIA
OF CANCER BREAST
Malignant Benign
1ry
signs
High density Low density
Non-homogenous opacity Homogeno...
How to readHow to read
 Plain x-ray neck and thoracic inlet.
 Postero-anterior view.
 Good Quality. Good Exposure.
 P...
Postoperative
Postoperative
How to readHow to read
 Plain x-ray neck and thoracic inlet.
 Postero-anterior view.
 Good Quality. Good Exposure.
 P...
How to readHow to read
 Plain x-ray skull and mandible.
 Lateral view.
Presence of soft tissue shadow in the
saubmandib...
How to readHow to read
 Plain x-ray skull and mandible.
 Lateral view.
Presence of radio opaque shadow in the
submandib...
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(3) chest general

  1. 1. X-RAYSX-RAYS By Prof Dr IBRAHIM DAWOUD Prof of Surgery Mansoura University
  2. 2. How to read  Plain X-ray  Plain x-ray (describe the region).  View (PA, lat, oblique).  Position (erect, supine).  Quality.  Exposure.  Chest: Centralization, Bony frame work. Costophrenic angle, Soft tissue shadow.  Abdomen: well prepared or not, radio-opaque shadow, gas shadow.  Bone: Fracture, tumor, inflammation.  Soft tissue mammogram.
  3. 3. Normal Chest X-ray
  4. 4. How to readHow to read  Plain x-ray chest.  Postero-anterior view.  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : free .  Costophrenic angle : free on both sides,  Soft tissue shadow: Rt lung collapse with presence of air in the Rt pleural space.  Presence of chest tube in the Rt side of the chest.  Diagnosis most probably Rt Pneumothorax
  5. 5. Questions:Questions:  CausesCauses Artificial Spontaneous Traumatic 1- Therapeutic 1- Emphysem bullae 1- Open 2- Diagnostic 2- TB cavity 2- closed 3- Lung cyst  TypesTypes 1- Simple (closed) Pneumothorax 2- Open Pneumothorax 3- Tension Pneumothorax  TreatmentTreatment
  6. 6. How to readHow to read  Plain x-ray chest.  Postero-anterior view  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : fracture ribs on the Rt side .  Costophrenic angle : Obliterated on the Rt side with transverse air-fluid level and free on the left side.  Soft tissue shadow: Free  Diagnosis most probably Rt Hemo-pneumothorax
  7. 7. QuestionsQuestions  CausesCauses Postoperative Pathological Traumatic 1- Thoracotomy 1- Lung tumors 1- Open 2- Puncture 2- BL disease 2- Closed  Source of bleedingSource of bleeding 1- Systemic: Intercostal V, Heart and great V, Abd organs 2- Pulmonary: From lung parenchyma  PathologyPathology 1- Systemic bl is progressive, pulmon bl rapidly stopped 2- Bl at first defibrinated, then clotting occurs then organized into F.T.  then 2ry inf  Empyema
  8. 8.  Clinical PictureClinical Picture  InvestigationInvestigation  TreatmentTreatment 1- Systemic {a} Aspiration {b} Bl Transfusion {c} U.W.S. (site?) {d} Thoracotomy For major vessel injury 2- Pulmonary Conservative treatment 3- Clotted H Thoracotomy---- Decortication may be required 4- Infected H Early---- Aspiration Late------ Open drainage & Decortication
  9. 9. How to readHow to read  Plain x-ray chest.  Postero-anterior view.  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : Multiple simple Fracture ribs on the Rt side (2nd ,3rd , 4th , and 5th ribs).  Costophrenic angle : free on both sides,  Soft tissue shadow: Free on both sides. Diagnosis most probably Multiple Simple Fracture Ribs
  10. 10. How to readHow to read  Plain x-ray chest.  Postero-anterior view  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : Multiple segmented fracture ribs on the left side.  Costophrenic angle : Obliterated on the left side.  Soft tissue shadow: Lt lung collapse with presence of air in the lt pleural space. Diagnosis most probably Multiple Segmented Fracture Ribs (Flail Chest)
  11. 11. QuestionsQuestions  CausesCauses Direct Violence Indirect Violence Muscular Violence  TypesTypes 1- Simple Fracture ribs 2- Stove in Chest 3- Flail Chest
  12. 12.  Clinical PictureClinical Picture  InvestigationInvestigation  TreatmentTreatment 1- Simple Fracture {a} Analgesic {b} Adhesive strapping {d} Local Novocain Injection 2- Stove In Chest External Traction by Towel Clips for 2 w 3- Flail Chest {a} At the scene of the accident {b} At the casualty room {c} Definitive treatment
  13. 13. Conditions Requiring Urgent CorrectionConditions Requiring Urgent Correction  Air Way ObstructionAir Way Obstruction Removal of mechanical debris &Extension of the neck Tracheostomy or Catheter through the cricothyroid mem Endotracheal intubation  Tension PneumothoraxTension Pneumothorax Life-saving large-bore needle followed by UWS  Open PneumothoraxOpen Pneumothorax  Massive Flail ChestMassive Flail Chest  Massive HemothoraxMassive Hemothorax 1500 ml of bl or more
  14. 14. Conditions Requiring Urgent ThoracotomyConditions Requiring Urgent Thoracotomy  Continued Intrapleural BleedingContinued Intrapleural Bleeding Rate exceeding 100 ml/H or more for 6 H  Massive Air LeakMassive Air Leak Complete unilateral atelectasis in the face of a large air leak Symmetrical downward displacement of the bilateral hila  Acute pericardial tamponadeAcute pericardial tamponade  Acute Ht failure 2ry to valve or septal injuryAcute Ht failure 2ry to valve or septal injury  Widened or widening mediastinumWidened or widening mediastinum  Perforation of intrathoracic esophagusPerforation of intrathoracic esophagus
  15. 15. How to readHow to read  Plain x-ray chest.  Postero-anterior view (1) --- Lateral view (2)  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : free .  Costophrenic angle : free on both sides,  Soft tissue shadow: Consolidated area in the Rt lower segment with cavitations and air fluid level inside the cavity  Diagnosis most probably Rt Lung Abscess
  16. 16. QuestionsQuestions  CausesCauses 1ry necrotizing pneumonia Aspiration pneumonia Bronchial obstruction Systemic infection Pulmonary trauma Direct from surrounding  Clinical pictureClinical picture 1- stage of pneumonitis 2- stage of abscess 3- stage of chronicity  Investigations:Investigations: 1- Radiography 2- Sputum examination
  17. 17.  TreatmentTreatment 1- Antibiotics and internal drainage By {a} cough {b} bronchoscopy 2- External drainage {a} Tube pneumonostomy {b} Pneumonotomy through a generous incision with rib resection 3- Pulmonary resection: Indicated in {a} chronicity with symptoms {b} serious hemorrhage {c} Suspicion of associated carcinoma
  18. 18. How to readHow to read  Plain x-ray chest.  Postero-anterior view (1st ) lateral view (2nd )  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : free .  Costophrenic angle : free on both sides,  Soft tissue shadow: Apical opacity ( coin shadow) in the apex of the left lung.  Diagnosis most probably Bronchogenic Carcinoma Left lung (Pancoast tumor)
  19. 19. QuestionsQuestions  PathologyPathology 1- Incidence ( age- sex- site ) 2- Etiology (p.p) :(smoking- air pollution- adenoma…) 3- N/E: ( fungating- nodular- ulcer- infiltrating) 4- MP: (Sq CC- small CC- Adenocarcinoma- large CC- other) 5- Complications (including spread) 6- Staging  Clinical PictureClinical Picture  InvestigationsInvestigations  TreatmentTreatment
  20. 20. How to readHow to read Plain x-ray chest.  Postero-anterior view  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : free .  Costophrenic angle : Massive obliteration of the left side of the chest  Soft tissue shadow: Tracheal and mediastinal shift to the opposite side.  Diagnosis most probably Malignant pleural effusion
  21. 21. TYPESTYPES  TansudateTansudate 1- Congestive HF 2- Nephrotic Syndrome 3- Cirrhosis 4- Hypoproteinemia 5- Myxedema 6- Peritoneal dialysis  ExudateExudate 1- Malignancy (1ry or 2ry) 2- Infection 3- Infarction 4- Traumatic 5- Sympathetic ( Pancreatitis- Subphrenic abscess….) 6- Collagen disease
  22. 22. How to readHow to read  Plain x-ray chest.  Postero-anterior view  Erect Position . Good Quality. Good Exposure.  Chest: more or less Centralized.  Bony frame work : free .  Costophrenic angle : free on both sides,  Soft tissue shadow: Multiple opacities (coin shadows) occupying the whole of both lungs.  Diagnosis most probably Cannon-ball metastases of the lung
  23. 23. How to readHow to read SOFT TISSUE MAMMOGRAPHY A well defined rounded mass in the upper part of the breast.  It has a rounded border.  No pathological calcification.  Normal breast architecture.  Normal overlying skin.  No retraction of the nipple Mostly Benign Breast Disease Fibrodenoma
  24. 24. How to readHow to read SOFT TISSUE MAMMOGRAPHY  A dense shadow(s) in the breast with a very irregular outline, and with fine stippling of calcification .  Disturbed breast architecture.  Thickening of the overlying skin.  Retraction of the nipple Mostly Malignant in nature Biopsy is recommended
  25. 25. MAMMOGRAPHIC CRITERIA OF CANCER BREAST Malignant Benign 1ry signs High density Low density Non-homogenous opacity Homogenous opacity Irregular border Smooth outline Microcalcification No or macrocalcification 2ry signs Disturbed architecture Normal Increased vascularity Normal Perifocal haziness Rare Radiological size smaller than clinical size Same or larger Retracted nipple, thickened skin Normal
  26. 26. How to readHow to read  Plain x-ray neck and thoracic inlet.  Postero-anterior view.  Good Quality. Good Exposure.  Patient is more or less Centralized.  Bony frame work : Presence of bilateral extraribs on both sides of the neck connected to the 7th cervical vertebra and the first rib.  Diagnosis most probably BILATERAL CERVICAL RIBS
  27. 27. Postoperative
  28. 28. Postoperative
  29. 29. How to readHow to read  Plain x-ray neck and thoracic inlet.  Postero-anterior view.  Good Quality. Good Exposure.  Patient is more or less Centralized.  Bony frame work : Presence of extrarib on the Rt side of the neck connected to the 7th cervical vertebra and the first rib.  Diagnosis most probably RIGHT CERVICAL RIBS
  30. 30. How to readHow to read  Plain x-ray skull and mandible.  Lateral view. Presence of soft tissue shadow in the saubmandibular region with multiple radio opaque shadows.  Diagnosis most probably Chronic Submandibular Sialadenitis with Submandibular Stones
  31. 31. How to readHow to read  Plain x-ray skull and mandible.  Lateral view. Presence of radio opaque shadow in the submandibular region.  Diagnosis most probably Submandibular Stone

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