Radiologic Images

X-ray

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How to Read X-ray

Normal Chest X-ray

Mikael Häggström, CC0, via Wikimedia Commons

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

Mikael Häggström, M.D. , CC0, via Wikimedia Commons

R Influenza PNA patch consolidations

Mikael Häggström, M.D., CC0, via Wikimedia Commons

Tuberculosis

Unknown author, Public domain, via Wikimedia Commons

Ultrasound

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Fetus heartbeat
Marcel Berteler / Public domain

CT

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Mikael Häggström / CC0

MRI

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