Chest X-ray interpretation

Julee Waldrop, MS, PNP

School of Nursing

UNC

Chest X-ray

• Generally get AP and Lateral views

• Fullest inspiration if possible (see example of difference in expiration and inspiration in module)

• Dimensions– A:P < 2 years – 1:1– > 2 years – 2:1

Normal Chest X-ray

• Cardiac Structures– Position

• More central in younger infants and children• More on the L side in older infants and teens

– Size• In AP view if < 2 years – take up to ~ 65%• If > 2 years - ~ 50%

Normal Chest X-ray

• 1. Soft tissue structures– Shadows, most commonly, breast

• 2. Bony structures– Count the ribs– ~ 8 – 9 ribs should be visible on inspiration– Clavicle placement at ~ 2-3 intercostal space

(if not, may be malrotated)

Normal Chest X-ray

• 3. Diaphragm– Contour– Rounded with sharp pointed costophrenic and

costocardiac angles– Right diaphragm is usually 1-2 cm higher

Normal Chest X-ray

• 4. Lungs– Start at the top and compare the R and L– Trachea should be midline over the thoracic

vertebrae and air filled– Lung parenchyma becomes lighter as you go

down the lung. If not, it may indicate a lower lobe or pleural effusion

Abnormal Chest X-ray

• Radiopacity (whiteness) means increased density

• Radiotranslucency (blackness) means decreased density

• Radiopacity can be of 3 causes– Alveolar pattern – fluffy, soft, poorly demarcated

opacifications < 1 cm in diameter– Possible causes:

• Pulmonary edema• Viral pneumonia• Pneumocystis• Alveolar cell carcinoma

Note: ground glass appearance of the lungs here

Tracheal deviation to the Right caused by posterior tumor

Posterior chest wall tumor

Abnormal Chest X-ray

• Interstitial pattern– Consolidation of interstitial tissue (alveolar

walls, intralobular vessels, interlobar septa and connective tissue)

– Looks like branching lines radiating toward the periphery of the lung

– Possible causes:• Interstitial pneumonitis • Pulmonary fibrosis

Middle lobe infiltration

Boot shaped heart: enlarged heart

Abnormal Chest X-ray

• Vascular pattern – assessment of the pulmonary arteries and capillaries– If there is an increase in the size of the

pulmonary arteries as they extend out into the lung – pulmonary hypertension

– If there is a decrease in size, truncation, or obliteration of a pulmonary artery – embolus

– Lack of vascular making in the periphery - pneumothorax

Trace the lung vascular markings out to the border of the rib cage. When the lung markings stop short of the rib cage and thrre is increased radiolucency in the pleural space, the patient has a pneumothorax.