Radiologic Images



X-ray


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How to Read X-ray

Normal Chest X-ray
Normal posteroanterior (PA) chest radiograph (X-ray)
Mikael Häggström, CC0, via Wikimedia Commons
Normal lateral chest radiograph (X-ray)
Mikael Häggström, CC0, via Wikimedia Commons
  • A – Airway
    • Ensure trachea is visible and in midline
    • Trachea gets pushed away from abnormality, eg pleural effusion or tension pneumothorax
    • Trachea gets pulled towards abnormality, eg atelectasis
    • Trachea normally narrows at the vocal cords
    • View the carina, angle should be between 60 –100 degrees
    • Beware of things that may increase this angle, eg left atrial enlargement, lymph node enlargement and left upper lobe atelectasis
    • Follow out both main stem bronchi
    • Check for tubes, pacemaker, wires, lines foreign bodies etc
    • If an endotracheal tube is in place, check the positioning, the distal tip of the tube should be 3-4cm above the carina
    • Check for a widened mediastinum
    • Mass lesions (eg tumour, lymph nodes)
    • Inflammation (eg mediastinitis, granulomatous inflammation)
    • Trauma and dissection (eg haematoma, aneurysm of the major mediastinal vessels)
  • B – Bones
    • Check for fractures, dislocation, subluxation, osteoblastic or osteolytic lesions in clavicles, ribs, thoracic
    • Spine and humerus including osteoarthritic changes
    • At this time also check the soft tissues for subcutaneous air, foreign bodies and surgical clips
    • Caution with nipple shadows, which may mimic intrapulmonary nodules
    • compare side to side, if on both sides the “nodules” in question are in the same position, then they are likely to be due to nipple shadows
  • C – Cardiac
    • Check heart size and heart borders
    • Appropriate or blunted
    • Thin rim of air around the heart, think of pneumomediastinum
    • Check aorta
    • Widening, tortuosity, calcification
    • Check heart valves
    • Calcification, valve replacements
    • Check SVC, IVC, azygos vein
    • Widening, tortuosity
  • D – Diaphragm
    • Right hemidiaphragm
    • Should be higher than the left
    • If much higher, think of effusion, lobar collapse, diaphragmatic paralysis
    • If you cannot see parts of the diaphragm, consider infiltrate or effusion
    • If film is taken in erect or upright position you may see free air under the diaphragm if intra-abdominal perforation is present
  • E – Effusion
    • Effusions
    • Look for blunting of the costophrenic angle
    • Identify the major fissures, if you can see them more obvious than usual, then this could mean that fluid is tracking along the fissure
    • Check out the pleura
    • Thickening, loculations, calcifications and pneumothorax
  • F – Fields (Lungfields)
    • Check for infiltrates
    • Identify the location of infiltrates by use of known radiological phenomena, eg loss of heart borders or of the contour of the diaphragm
    • Remember that right middle lobe abuts the heart, but the right lower lobe does not
    • The lingula abuts the left side of the heart
    • Identify the pattern of infiltration
    • Interstitial pattern (reticular) versus alveolar (patchy or nodular) pattern
    • Lobar collapse
    • Look for air bronchograms, tram tracking, nodules, Kerley B lines
    • Pay attention to the apices
    • Check for granulomas, tumour and pneumothorax
  • G – Gastric Air Bubble
    • Check correct position
    • Beware of hiatus hernia
    • Look for fee air
    • Look for bowel loops between diaphragm and liver
  • H – Hilum
    • Check the position and size bilaterally
    • Enlarged lymph nodes
    • Calcified nodules
    • Mass lesions
    • Pulmonary arteries, if greater than 1.5cm think about possible causes of enlargement

R Middle Lobar PNA
X-ray of lobar pneumonia
Mikael Häggström, M.D. , CC0, via Wikimedia Commons
R Influenza PNA patch consolidations
Chest radiograph in influensa and H influenzae, posteroanterior, annotated
Mikael Häggström, M.D., CC0, via Wikimedia Commons

Tuberculosis
Tuberculosis-x-ray-1
Unknown author, Public domain, via Wikimedia Commons

Ultrasound


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Pregnant woman receiving a ultrasound scan on the stomach in hospital

Fetus hartbeat
Fetus heartbeat
Marcel Berteler / Public domain

CT


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MRI


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