1. Chest Radiographs Loyola University Stritch School of Medicine
Drs. Pierce and Demos
Loyola University Medical Center
Department of Radiology

2. Radiographs Free Intraperitoneal Gas Pneumothorax Pleural Effusion
Pulmonary Edema

3. Free Intraperitoneal Gas
Free Air

4. Free Intraperitoneal Gas
Upright chest
Left lateral decubitus abdomen

5. Free Intraperitoneal Gas Patient Supine

6. Free Intraperitoneal Gas
Neonate with distended abdomen Supine abdomen
58-year-old man with acute abdominal pain Supine abdomen
Free air under right hemidiaphragm Upright abdomen

7. Free Air in Supine Patient

8. Free Intraperitoneal Gas
When diagnosis is uncertain
If the patient can stand
Upright chest and abdomen
If the patient can not stand
Left lateral decubitus abdomen radiograph
Most sensitive
Computed tomography

9. Pneumothorax

10. Pneumothorax Displaced Visceral Pleura
Skin Fold
Skin fold extends outside ribs
Pneumothorax Displaced pleura (arrows)
Look for displaced Visceral Pleura

11. Tension Pneumothorax
TENSION PNEUMOTHORAX ** Examine patient * Look for deviated heart and mediastinum, depressed hemidiaphragm * Compare to previous radiographs

12. Supine Patient Medial Pneumothorax

13. Supine Patient Deep Sulcus Sign
Before….No pneumothorax
After….Pneumothorax

14. Is there a pneumothorax or isn’t there?
Order a Lateral Decubitus chest radiograph
With the side of the chest in question as the upside
Possible left pneumothorax get right lateral decubitus chest
Look for displaced visceral pleura along upside lateral chest wall
Order Upright Expiratory chest radiograph
Look for pneumothorax at lung apex

15. Pleural Effusion

16. Pleural Effusion Upright…Meniscus Supine…Unilateral increased density
Decubitus…Effusion layered on downside

17. Pleural Effusion Supine patient

18. Pleural Effusion Semiupright…..Lung base opacity fades superiorly
63-year-old man recovering from congestive heart failure…Effusion loculated in fissure

19. Massive Pleural Effusion or Total Lung Atelectasis
Total Atelectasis Heart and mediastinum shifted toward whited out hemithorax
Massive pleural effusion Heart and mediastinum shifted away from whited out hemithorax

20. Pleural Effusion Most sensitive way to show pleural effusion
Decubitus chest radiograph
Least sensitive way to show pleural effusion
Supine chest radiograph

21. Pulmonary Edema

22. Normal Chest PA and Lateral Radiographs

23. Pulmonary Edema
Normal pulmonary vessels
Interstitial pulmonary edema
Alveolar pulmonary edema
Septal (Kerley B) lines due to interstitial pulmonary edema are thickened interlobular septae

24. Pulmonary Edema Interstitial pulmonary edema Alveolar pulmonary edema
Poorly defined pulmonary vessels
Visible lung fissures
Septal lines
Thick bronchial walls
Alveolar pulmonary edema
Bilateral symmetric perihilar lung consolidation
Enlarged heart, Pleural effusion
COMPARE TO PREVIOUS RADIOGRAPHS

25. Left Upper Lobe Pneumonia
27-year-old man with productive cough, dyspnea, and fever

26. Monty Python
Gumbies