1. Chest x-ray interpretation

2. 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

3. The normal chest x-ray

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

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

8. Common conditions Right middle lobe pneumonia

9. Large simple pneumothoraxTension pneumothorax

10. Right middle lobe effusion Large left pleural effusion

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

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

13. Lung carcinoma

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

15. Surgical emphysema (underlying pneumothorax until proven otherwise)

16. Old right rib fractures

17. Large hiatus hernia

18. Diaphragmatic hernias

19. Fractured right humerus – remember to stick to the system

20. Oddities Dextrocardia

21. Breast implants

22. 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