An introduction to Chest X-ray

1. Chest X- Ray demonstration
Presented BY
DR Laith Fadhil Al hialy
P.G. C.R – MB.ch.B

2. Chest X-Ray procedure
Standing position /
View PA
cassette at chest stand
Film size 14 x 14, 14 x17 inch
Tube distance 1.5 m
Focus at T5 vertebra
KV 50 -- 75 KV
Mass 15 – 20 mil A
Other views
Lateral ( RT – LT )
Frontal projection ( AP )
Supine ( pediatric , disable patient )
Lordotic ( vitalized the lung apex )
Oblique ( RT – LT ) chest wall ,
medistainum

3. Other views
Lateral CXR
Lateral decubitus CXR

4. Lordotic view

5. Normal CXR
What can be found in CXR ?
A chest x-ray can detect:
1. Changes in the size and shape of
the heart & in the major blood
vessels
2. Abnormalities in the lungs such
as ( mass , consolidation ,
collapse , any shadows,
calcification, edema , and
cavities )
3. Any mediastinal abnormalities
, diaphragmatic abnormality
4. Any bone ( ribs , vertebra ,
clavicle ) abnormality
5. Both hialy shadows ( LN ,
bronco-vascular abnormality
6. X-Ray technique – look for (
clavicles , trachea, No of Ribs ,
aeration of pulmonary fields )
7. Pneumothorax

6. X-Ray markers

8. Different cases
Dextrocardia
Stomach bubble on left
Right diaphragm lower Position
of heart determines which
diaphragm is lower, not liver.

9. Single cavitary
lesion
Hydatid Cyst

10. Chest HC
Multiple
Multiple

11. Segmental Pneumonia
Superior segment of RLL
Patchy consolidation

12. Air Bronchogram
The term air Bronchogram is
used for signifies alveolar
disease.
Note the branching
radiolucent columns of air
corresponding to the bronchi,
in Right Upper Lobe
consolidation in the adjacent
CXR.

13. Bilateral Upper Lobe Disease
Tuberculosis
Sarcoidosis
Histoplasmosis
Silicosis
Ankylosing spondylitis
Eosinophilic granuloma
Tuberculosis
LUL cavities
RUL infiltrate

14. Sarcoidosis
Bilateral hilar LN
enlargement
( lobulated shape )

15. Silicosis
Bilateral upper lobe
disease

16. Butterfly Pattern
Indicative of bilateral diffuse
alveolar disease
Also called medullar
distribution
Also called Bat wing
appearance
This case is alveolar
proteinosis. Also in
(Pulmonary - edema)
CT

17. Solitary Pulmonary
Nodule
On steroids develops solitary
pulmonary nodule in one
month
FNAB: Aspergillus
Resolved with discontinuation
of steroids

18. Solitary Pulmonary
Nodule
Left infra hilar region
Adenocarcinoma lung

19. Polycyclic Margin
The wavy shape of the
mediastinal mass margin
indicates that it is made up
of multiple masses, usually
lymph nodes.
This is a case of
lymphoma.

20. Cannon Balls – Lung
Metastasis
Recto sigmoid Cancer
Multiple
Bilateral
Round mass densities
Sharp margins

21. Popcorn Calcification
Solitary pulmonary nodule
Popcorn calcification
Hamartoma

22. Cavitating Metastasis
Multiple Thin Walled Cavities
Metastases from
Cervix Ca

23. Honeycombing
Seen in end stage lung
disease
Indicative of diffuse interstitial
fibrosis
Due to bronchiolectasia
Most of the time in bases
Upper lobe distribution seen
in Eosinophilic granuloma
Close up and gross lung
specimens below.

24. Lung Cancer
Large cell type
Mass
Round or oval
Sharp margin
Homogenous