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1. Normal Chest Radiology
A Quiz Based Review
Ver. 1.0
For Undergraduate Medical
Students
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2. Radiological Anatomy Review
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16. • The Trachea
• Normally the upper part is
Central in position then it
becomes slightly deviated
to the right.
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Check for:
-Displacement (Mediastinal shift)
-Narrowing
-Intraluminal Lesions
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17. • The Heart & Mediastinum
• Normal heart (refer to
cardiac imaging section)
R
Check for:
- Cardiac size
- Any abnormal densities
- Fluid levels
- Calcifications
- Spinal Abnormalities
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18. • The Diaphragm:
• Usually the right
hemidiaphragm is higher than
the left.
• On inspiration the level of the
diaphragm is at (6th Rib
anteriorly or below the 10th R
posteriorly)
Check for:
-Loss of outline (adjacent pathology)
-Look under the diaphragm (Intraperitoneal air)
-Level of the diaphragm (Abnormal elevation or
depression)
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19. • The Costophernic Angles:
• Normally they are acute
and well defined.
R
Check for:
-Obliteration (Fluid accumulation)
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20. • The Lung Fields:
• Both lung fields must be
examined and compared to
each other.
• On PA views the lung fields
could be divided in to 3 R
zones
-Upper (Apex - 2nd rib) - Middle (2nd rib –
4th Rib)– Lower (4th Rib down)
*(Mistake to define a lung lobes on basis of PA
view only you must have a Lateral film)
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21. • The Lung Fields:
• Check for:
– Abnormal Shadows or opacities.
– Abnormal Areas of translucency.
– Abnormal distribution of lung markings
Upper Zone
Middle Zone
Lower Zone
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22. Diagram illustrating the approximate positions of the pulmonary
segments as seen on the PA & Lateral radiographs
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23. • The Lung Apices:
• The lung apices are
partially obscured on PA
views by the ribs, costal
cartilages, clavicles and soft
tissues. (Considered one of
the hidden areas in chest) R
Check for:
-Apical Shadowing (Normal in 7% of patients due to pleural
thickening)
-More Important: It’s the site for certain pathology:
-T.B. -Fungal Infections
-PANCOAST TUMOUR
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24. • The Lung Hila:
• Normally the left is higher
than the right by 2.5 cm.
• Both must be equal in
density and similar in size
with clearly defined R
concave lateral borders.
•(Considered one of the hidden areas in chest)
Check for:
-Hilar position, Size and density
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25. • The Gastric Air bubble:
Checking the below the
diaphragm area
• (Considered one of the hidden
areas in chest)
• Normally seen under the left
hemidiaphragm
R
Check for:
-Any other abnormal gas shadow (Free intrperitoneal
air – abcess – dilated bowel).
-Displaced gastric bubble.
-Calcified lesions.
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26. • The Breast Shadows:
Checking the soft tissue
shadows of the chest
• Breast shadows may obscure
the costophernic angles.
• Nipple shadows may be seen
and resemble a pulmonary
R
lesion.
• Skin folds may overly the lung fields and resemble
pathology.
Check for:
-Absent breast shadow (Mastectomy)
-Any normal skin shadow which may give impression
of a pathology.
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27. • The Ribs: Bony Chest
• Check for:
-Extra Number
(Cervical rib)
R
-Destruction.
-Rib notching.
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28. How to count Ribs
1
2
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Now you
try
counting
the rest of
them!!!

29. • The Clavicles: Bony
Chest
• Check for:
-Destruction.
-Erosion. R
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30. • The Scapula and
Humeral Heads:
• Both scapula must be projected
away from the chest during
taking the chest X-ray
(Technical consideration)
• Check for: R
-Destruction.
-Osteolytic lesions
(metastasis).
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31. Thank you for taking the time to review this presentation. For any comments or
suggestions I would be glad if you post it on the Radiology forum at
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