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To be able to identify the structures or your radio anatomy…To know how a normal chest x-ray appears…To interpret radio pathologic lesion…To put it in practice!
Learning ObjectivesCan anyone in here interpret this chest x-ray for me? (pause)What disease entity is this? Where is this lesion located? front? back? Is this a mass lesion? Consolidation? An atelectasis? How can I interpret this image?I am sure these are some of the few questions which you have in your head right now. Now lets move on to our first case.
This is a chest x-ray in PA view taken from a 36 year old male due to on and off non-productive cough.As you notice in the right paracardiac region, it shows some form of haziness. This was read as a mild inflammatory process. Patient was told take medications but did not complete the regimen.
Patient came back now with a follow-up x-ray done 3 weeks later showed an area of consolidation with air-bronchogram pattern in the right lower lung and right middle lung. Some infiltrates are also seen in the left upper. There is also beginning right pleural effusion.This time, patient took the medication seriously, but refused admission
Somehow the patient agreed to be admitted
Somehow the patient agreed to be admitted. But now presenting with this x-ray!Now we know that effusion progressed. It appears to have a well demarcated borders. We need to know is this fluid free or loculated?Supposing we did not have a previous film for comparison and just be presented with a film that is almost completely opacified hemithorax. It will be hard to know if there is a concomitant mass. Right? So we need to manipulate in order to determine if there is a underlying mass prior to doing a CTT
A right lateral decubitus film was taken showing a free flow of fluid.
Ultrasound showed a 257.23 ml of non loculated pleural effusion.
A lead-lined CTT was inserted with its tip at 5th left posterior rib and its sentinel eye at 6th rib.Now, the radiologist was able to help in the decision making of the AP whether it was safe to proceed with CTT. And was able to give an approximate amount of volume that could be drained.
As a follow-up 2 months after
As a follow-up 2 months after. An impressive clearing of the lungs were seen. So kudos to the clinician and radiologist
BASIC CONCEPTS DENSITIES SOFT TISSUES BONE WATER FAT AIR
Lets go back a little on basics.As you can see, bone or metal appears the most opacified or radioopaque; while air appears the most radiolucent or black. Water and soft tissues for most part, appears as an intermediate density.
BASIC CONCEPTSHere is a schematic of an xray tube. The cathode end which carries the negative charge is accelerated under a vacuum towards the tungsten anode end which is the positive side causing the release of Xray beam. It was named x-ray because during the time of Wilhelm Roentgen in the late 1800’s, such energy form was still unknown, thus the letter “X” in xray. This energy is known to penetrate materials which eventually then made its way in medicine.X-rays.
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Crash Course Interpretation of Chest X-Ray PDF Free Download
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