Chest X-Rays

Question 1

Interpretation Normal

Answer 1

R - rotation
- sternal end of clavicles should be equidistant from centre of the sternum

I - inspiration

• count 6-8 anterior ribs
• count 8-10 posterior ribs

P - penetration
- want to just be able to see the intervertebral spaces behind the heart shadow

Airway

• trachea in the midline
• should be clearly open

Bones and soft tissues

• any fractures present?
• any obvious displacement?
• any disruption to the soft tissues

Cardiac Shadow

• heart size should take up 1/3 to half of the chest wall
• 2/3 of heart on left side, 1/3 of heart on right side
• have clear heart borders
• have clear cardiophrenic borders

Diaphragms

• roundish shape
• right hemidiaphragm should be higher than the left by 3cm
• have well defined costophrenic angles

Equal Volume
- able to count 6 ribs anteriorly on both and 9 ribs posteriorly on both

Fine Detail

• white lines in lungs indicate airways - should extend throughout majority of lungs
• check for any areas of excessive blackness or whiteness

Gastric Bubble
- should be located under the left hemidiaphragm

Hilum and Hardware

• whiteness accumulated around each hilum
• left hilum higher than the right

Question 2

Collapse

Answer 2

• surrounding structures are pulled towards the area of collapse
• fissures may be displaced
• hemidiaphragm on side of collapse is elevated
• trachea and mediastinum are shifted towards the collapsed side
• increased density of the collapsed lobe or segment
• increased aeration of the non-collapsed lung
• crowding of the ribs

Question 3

Consolidation

Answer 3

• homogenous shadowing - increased whiteness/patches of whiteness in a lobe, segment or whole lung
• no loss of lung volume
• air bronchogram - black tracks over white shadowing to indicate air filled airways over areas of increased density
• silhouette sign (may be seen, not always present)

Question 4

Pleural Effusion

Answer 4

• costophrenic angle is obscured when the patient is upright
• generalised opacity over the lungs when the patient is in supine
• fissures may become more prominent
  Small Effusion - blunting of the costophrenic angle
  Large Effusion - characteristic shadow with curved upper edge rising towards the axilla
• no pulling of structures towards the area
• no bronchograms

Question 5

Pneumothorax

Answer 5

• pneumothorax is visible as an area of complete radiolucency at the border of the lung (blackness)
• structures shift away from the pneumothorax towards the opposite side
• visible crescent line (lung border) beyond which no lung markings are visible

Question 6

Bilateral Infiltrates

Answer 6

• generalised increase in density
• affects both lungs and is global
• likely to have an enlarged cardiac shadow

Question 7

Subcutaneous/Surgical Emphysema

Answer 7

(not normal emphysema)

black streaks visible in soft tissues surrounding the lungs

Question 8

COPD

Answer 8

Hyperinflation

• large, long lung fields
• long, column shaped lungs
• horizontal ribs
• elongated and narrowed mediastinum
• increased vascular markings
• may have emphysemous bullae

Question 9

Bronchiectesis

Answer 9

can appear normal on an X-ray - need HRCT

• may have thickened bronchial walls
• dilatated airways
• cyst like shadows with fluid lines
• crowding of vessels with loss of volume
• hyperinflation characteristics