1. Introduction to Surgical Department CXR
Presented by
Dr.MOHAMMED MAREE
Surgical Department
Al- Makassed Hospital

2. CXR Interpretation CXR Views
Posteroanterior (PA) : Erect inspiratory is the preferred CXR view
Lateral CXR
Anteroposterior (AP) : performed in bed-bound patients unable to stand for a PA view, or those who require a portable CXR.
AP films magnify the size of the heart and mediastinum, and are more commonly associated with rotational artifact

3. PA

4. Lateral

5. Interpretation of Chest X-Ray A systematic approach
Name and Age and date of CXR
Projection (e.g. PA, AP, lateral).
Posture (e.g. supine or erect).
Adequacy of exposure, visible thoracic intervertebral spaces.
Degree of inspiration. Check if film is taken in full inspiration, with the diaphragm at the level of the 10th or 11th ribs posteriorly, and the 6th costal cartilage anteriorly
Degree of rotation. the spinous processes of the thoracic vertebrae located centrally

6. Identify the key components of the CXR

7. Interpretation of Chest X-Ray A systematic approach
Trachea :Should be central, with slight deviation to the right
Hila: are made up of the pulmonary arteries and veins.
The left hilum is usually higher (2cm) than the right hilum.
Hilar enlargement
lymph nodes
Vascular disease
Hilar malignancy
Heart: (fig)
Cardiothoracic ratio (CTR): Should be less than 0.5 (50%) on a PA CXR

11. Cardiothoracic ratio (CTR)

16. Interpretation of Chest X-Ray A systematic approach
Diaphragm : The right is usually higher than the left by 1–3 cm.
costophrenic angles
hemi diaphragms are flat in COPD
Free gas under a diaphragm on an erect film

17. Diaphragm

18. Free gas under a diaphragm

19. Lung outlines
Both lung fields should be equally translucent, and on the lateral view the lung lucency should increase towards the diaphragms
An abnormal increase in lucency occurs with vessel loss, as in emphysema or pneumothorax, and a decrease results from alveolar or interstitial fluid, effusion or consolidation.

20. lateral view the lung lucency should increase towards the diaphragms

21. An abnormal increase in lucency

22. Silhouette Sign
When examining the lung fields of a normal CXR, the outline (silhouette) of the heart borders; the ascending and descending aorta; the aortic knuckle and the hemi diaphragms should be clearly visible.
All of these silhouettes, or structures, are in contact with a specific portion of the lung.
Obliteration of any of these silhouettes by a water density e.g. infection in the lung, blood, pus, etc
Obliteration of this normal air-soft tissue interface is known as the silhouette sign (of Felson).
By determining exactly which silhouette/structure is obliterated, you can determine where the lung pathology is located.

23. Superior mediastinum Should have a width <8 cm on a PA CXR
A widened mediastinum
Look for evidence of mediastinal emphysema (abnormal air)

24. Superior mediastinum

25. A widened mediastinum