Chest x-ray interpretation

Aims 1.To have a system to interpret chest x-rays (CXR) 2.To understand a normal CXR 3.To identify common abnormalities on a CXR

The normal chest x-ray

Initial guidance 1.Check it’s the right patient 2.Look for rotation 3.Look for penetration 4.AP vs PA

A systematic approach A - Airway B – Breathing (lungs) C – Circulation (heart and great vessels) D - Diaphragm E – Everything else (bones and soft tissue)

Common conditions Right middle lobe pneumonia

Large simple pneumothoraxTension pneumothorax

Right middle lobe effusion Large left pleural effusion

Cardiomegaly Heart is greater than 50% of the thorax ( remember need a PA film)

Pulmonary oedema/heart failure/acute cardiogenic pulmonary oedema/LVF

Lung carcinoma

1. Dual chamber pacemaker 2. Air beneath right diaphragm (perforation)

Surgical emphysema (underlying pneumothorax until proven otherwise)

Old right rib fractures

Large hiatus hernia

Diaphragmatic hernias

Fractured right humerus – remember to stick to the system

Oddities Dextrocardia

Breast implants

Summary 1.You should now have a system to interpret CXR’s 2.You should begin to recognise common conditions on x-ray It’s all about practice and pattern recognition However, Never forget the patient and they come before the x-ray. (Never fit the patient to the x-ray in front of you