THE CHEST XRAY 2017 Dr Richard Beese Bsc(Hons) MRCP FRCR

The Chest x-ray What are we doing ?

We are examining Anatomy and pathology of the chest

Anatomy

Pathology

What makes a good chest x-ray?

Name DOB Label Projection Whole Image Penetration

PA Chest X-RAY The beam is posterior to anterior in relation to the patient

What is wrong with the CXR on the left ?

Why are the hemidiaphragms and heart borders clearly seen ?

The hemidiaphragms and heart borders are clearly demonstrated because this a soft tissue air interface. What is the name of this radiological sign ?

The silhouette sign. The chest x-ray is a silhouette of anatomy and pathology

Pathology Fluid There is loss of the silhouette of the left heart border and left hemidiaphragm.

Fluid is characterised as; Transudate Exudate There is loss of the silhouette sign of the left and right heart borders and left and right hemidiaphragms Fluid is characterised as; Transudate Exudate

Pleural effusions can be demonstrated with ultrasound

Describe what you see;

What complication of pneumothorax has occurred ?

How do you measure the heart size on a PA CXR ?

Air space shadowing The describes a pattern of shadowing with confluent increase in density in the lungs. The pathology is fluid in the air spaces or alveoli, the fluid may be a transudate or exudate

Describe what you see

Describe what you see There is a silhouette of a 6 cm mass in the left upper zone. This represents a tumour which can be begnin or malignant. If malignancy is suspected this may be a primary of secondary

QUIZ

What is the role of imaging in the unconscious patient?

What is the role of imaging in acute renal failure?

What is the role of imaging in the Jaundiced patient?

What is the role of Imaging in cancer patients ?

The answer to the last 4 questions is to differentiate between a surgical and medical cause.

What disease process can cause this appearance in a young man?

Cough and high temperature what is the cause ? Where is the abnormality ?

What is the most likely cause of the pleural effusion?

What is the diagnosis ? What are the causes ?

Virchoffs triad Stasis, vessel wall damage, increased coagubility of blood.

What one question would you ask this patient ?

I had this question in medical finals after 6 years at med school is got it wrong The answer the examiners wanted was, how does this abnormality effect the patients life as this will determine if the patient is for surgical or medical management.

Thank you END