12. How to interpret a CXR ?
• Heart failure
• Interstitial lung
disease
• Pulmonary mass
• Pulmonary abscess
• Pleural effusion
• Diaphragmatic hernia
• Hilar pathology
• LAP
13. A suggested form of tics
an inside-outside approach
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures
14. Inside to outside approach
• Technical adequacy
• Cardiothoracic ratio + CP
angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures
Normal ( clear CP angles )
For pl. effusion click button
24. pleural fluid and effusion
• Layering effusion
• Lamellated effusion
• Loculated effusion ( vanishing
tumor )
What is the clue ? What to do next ?
Take a lateral view
25. Lateral view CXR ( our best friend )
• On a normal lateral view the
contours of the heart are
visible and the IVC is seen
entering the right atrium.
• The retrosternal space should
be radiolucent, since it only
contains air. Any radiopacity in
this area is suspective of a
proces in the anterior
mediastinum or upper lobes of
the lung.
26. Lateral view CXR ( our best friend )
• As you go from superior to
inferior over the vertebral
bodies they should get darker,
because usually there will be
less soft tissue and more
radiolucent lung tissue (red
arrow).
• If this is not the case, look carefully for
pathology in the lower lobes.
27. Lateral view CXR ( our best friend )
What additional information can be
obtained by lateral view ?
In our field lateral view is for
localization
28. Lateral view CXR ( our best friend )
•The right diaphragm should be
visible all the way to the anterior
chest wall (red arrow).
•The left diaphragm can only be
seen to a point where it borders the
heart (blue arrow).
29. Lateral view CXR ( our best friend )
•From lateral view we can differentiate between hilar
masses ( LN or vascular lesions
30. Lateral view CXR ( our best friend )
From lateral view we can differentiate between hilar masses ( LN or vascular
lesions
Hilar LAPPulm. HTN
31. Lateral view CXR ( our best friend )
• On the Paview the superior mediastinum is widened.
• The lateral view is helpful in this case because it demonstrates a density in the retrosternal
space.
• Now the differential diagnosis is limited to a mass in the anterior mediastinum (4 T's).
32. Lateral view CXR ( our best friend )
• 4 T s :
• Thymoma
• Teratoma
• Thyroid ( retrosternal )
• Terrible lymphoma
33. Let’s go back to where we skipped
• Technical adequacy
• Cardiothoracic ratio + CP angles
• Mediastinal contour and para
vertebral lines
• Lung zones
• Hidden areas
• Bony stuctures