4bc2radiology tutorials

8/12/2019 4bc2Radiology Tutorials

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Chest & AbdominalX-ray

Interpretation

Lt Col NK JainGd Spl (Radiology)

MH Jabalpur


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The Chest X-Ray


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Techniques - Projection

P-A (relation of x-ray beam to patient)


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Techniques - Projection (continued)

A-P Supine/Erect


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Techniques - Projection (continued)Lateral


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Techniques - Projection (continued)

Lateral Decubitus


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Technical Factors

Centering

Penetration

Inspiration


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Rotation


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Rotation (continued)


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Penetration


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Inspiration/Expiration


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DensitiesThe big two densities are:

(1) WHITE - Bone

(2) BLACK - Air

The others are:

(3) DARK GREY- Fat

(4) GREY- Soft tissue/water

And if anything Man-made is on the film,

it is:

(5) BRIGHT WHITE - Man-made


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Systematic Approach

Bony Framework

Soft Tissues

Lung Fields and Hila

Diaphragm and Pleural Spaces

Mediastinum and Heart Abdomen and Neck


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Systematic Approach

Bony Fragments

Ribs

Sternum Spine

Shoulder girdle

Clavicles


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Systematic Approach

Soft Tissues

Breast shadows

Supraclavicular areas Axillae

Tissues along side of

breasts


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Systematic Approach

Lung Fields and Hila

Hilum

Pulmonary arteries

Pulmonary veins

Lungs Linear and fine nodular

shadows of pulmonaryvessels

Blood vessels

40% obscured by othertissue


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Systematic Approach

Diaphragm and

Pleural Surfaces

Diaphragm Dome-shaped

Costophrenic angles

Normal pleura is not

visible Interlobar fissures


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Systematic Approach

Mediastinum and

Heart

Heart size on PA Right side

Inferior vena cava

Right atrium

Ascending aorta Superior vena cava


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Systematic Approach

Mediastinum and

Heart

Left side Left ventricle

Left atrium

Pulmonary artery

Aortic arch

Subclavian artery and

vein


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HeartSize:


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Systematic Approach

Abdomen and Neck

Abdomen

Gastric bubble Air under diaphragm

Neck

Soft tissue mass

Air bronchogram


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Anatomy


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LobesRight upper lobe:


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Lobes(continued)Right middle lobe:


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Lobes(continued)Right lower lobe:


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Lobes(continued)Left lower lobe:


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Lobes(continued)Left upper lobe with Lingula:

L b


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Lobes(continued)Lingula:

L b


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Lobes(continued)Left upper lobe - upper division:

Pl


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Pleura

Layers:

1. Visceral

2. Parietal

Angles:

1. Cardiophrenic

2. Costophrenic


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Hilum

Made of:

1. Pulmonary Art.+Veins

2. The Bronchi

Left Hilum higher (max 1-2.5 cm)

Identical: size, shape, density

Hilum


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Hilum


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The Normal Lateral Chest X-ray

Lateral View:

1. Oblique fissure2. Horizontal fissure

3. Thoracic spine and

retrocardiac space

4. Retrosternal space

Lateral CXR ( ti d)


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Lateral CXR(continued)

Lateral CXR ( ti d)


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Lateral CXR (continued)


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Identify the lesion localise the lesion describe the lesion give DD

Never stop looking, carry on with your

systematic approach!!


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Consolidation

Lobar consolidation:

Alveolar space filled withinflammatory exudate

Interstitium andarchitecture remain intact

The airway is patent

Radiologically:

A density corresponding toa segment or lobe

Airbronchogram, and

No significant loss of lungvolume


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Atelectasis

Loss of air

Obstructive atelectasis:

No ventilation to the lobebeyond obstruction

Radiologically:

Density corresponding to asegment or lobe

Significant loss of volume Compensatory

hyperinflation of normallungs


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Practice Time


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Right Middle and Left Upper Lobe Pneumonia


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Pseudotumor: fluid has filled the minor fissure creating a density that

resembles a tumor. Also seen is right pleural effusion


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Chest wall lesion: arising off the chest wall and not the lung


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Lung Mass


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Small Pneumothorax: LUL


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Metastatic Lung Cancer: multiple nodules seen


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Perihilar mass: Hodgkins disease


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Widened Mediastinum: Aortic Dissection


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Pulmonary artery stenosis with cardiomegally likely

secondary to stenosis.


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?


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Pneumothorax


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RUL collapse


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Air under the diaphragm


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Cavitating lesion


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Miliary shadowing


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Abdominal Xrays

The Abdominal X ray


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The Abdominal X ray

Not used in clinical diagnosis regularlyAn AXR uses 50x the radiation of a plain CXR

Can be plain or contrast study

Indications include:

Suspected bowel obstruction

Foreign body

Stones in the renal tractTo check position of stents etc

.

P iti f P ti t


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Position of Patient

Supine(lying on their back) with the plate (film)underneath themx rays from front to back

Unless otherwise labelled, the film will probably be supine

Erectmay be useful if looking for fluid levels

Decubitustaken with the patient in the lateralpositionmay be useful to detect intraperitoneal gas

Prone - patient lying on their front - occasionallyused in IVUs


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Interpreting

theAXR

Step by Step

Part 1 Patient Details


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Part 1Patient Details

Name of patientAge

Date of birth

Date the radiograph was taken/time

Brief info about patient

Part 2 Technical Details


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Part 2- Technical Details

TypeAP/PA

- supine/erect/L.decubitus/prone

Orientation of filmPenetration

Rotation

Adequate view

Part 3 Intraluminal gas


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Part 3Intraluminal gas

Stomach Small intestine (n= 2.5 cm)

Colon (n= 5 cm)

Caecum (n= 9 cm)

Rectum (sometimes visible)

Clinical Findings- Obstruction


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Clinical Findings Obstruction

Large bowel Small bowelPeripherally placed

dilated bowel

Centrally placed loops

dilated bowel

Haustra (do not cross

whole diameter of

colon; no more than 1/3

of the way across)

Valvulae conniventes

extend across whole

bowel lumen

Few loops Many loops


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EREC


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T

Note the multiple

fluid levels

Part 4 Extraluminal gas


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Part 4 Extraluminal gas

Gas under diaphragm

Gas present in the peritoneum - perforation


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Gas under diaphragm

Gas under diaphragm


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Perforation

PneumoperitoneumSupine AXR

Part 5 soft tissue structures


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Part 5 soft tissue structures

Liver Spleen

Pancreas

Kidneys

Ureters

Bladder

Psoas muscles

T12

b


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Kidney

Psoas

vertebra

Sacrum

Sacroiliac joints

Descending colon

faeces

Gas in

rectum

Part 6 Abnormal calcification


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Part 6 Abnormal calcification

Aorta Pancreas

Cystic Duct

Gall bladder

Kidneys

Ureter

Bladder

Urethra


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Bladder calculi


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Renal Stones


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Ureteric

Calculus


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Pancreatic Calcification


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Gallstones


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Aorta

Endovascularaortic

aneurysm stent

Walls ofAAA

Part 7 Look at bone structure


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Part 7 Look at bone structure

Fracturesvertebral bodies

Metastases

Changes in bone density

Shape


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Fracture


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Finally- Extra features


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y

Foreign objects ECG leads

Tubes/stents

Surgical clipsaid diagnosis

Then summarise the findings and give

possible diagnoses


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NORMAL


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Hepatomegaly


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Dilated Small Bowel


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Stag Horn Calculus


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Pneumobilia


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Toxic Megacolon


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Volvulus


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Pancreatic Calcification


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Gall Stones


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Vesical Calculus


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Renal Calculi


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