CHEST

RADIOLOGY
M.B. Barrameda-Delvo, MD
Medicine III
AMEC-BCCM

OBJECTIVES
At the end of the lecture, the student shall
be able to:
Identify the anatomic parts/important
landmarks in a chest radiograph
Recognize the different views by merely
looking at the radiographic image
Identify the commonly encountered
pathologic radiographic findings

LECTURE OUTLINE
RADIODENSITIES
NORMAL CHEST XRAY
RADIOLOGIC ANATOMY
INTERPRETATION OF CHEST XRAY
RADIOGRAPHIC FINDINGS AND SIGNS
IN COMMONLY ENCOUNTERED CHEST
DISEASES

PHYSICS
RADIODENSITIES

NORMAL CHEST XRAY

IDEAL CHEST
RADIOGRAPH
1. Upright
2. PA (PosteroAnterior view)
3. Full Inspiration
4. 6 ft. focus-tofilm distance

POSTERO-ANTERIOR (PA)

LATERAL VIEW

RADIOLOGIC ANATOMY
R

L
TRACHEA
AORTIC KNOB
R PULMO ART.
R ATRIUM

R HEMIDIAPHRAGM
R COSTOPHRENIC
SULCUS

L PULMO ART.
L VENTRICLE
L HEMIDIAPHRAGM
L COSTOPHRENIC
SULCUS

ANTERO-POSTERIOR (AP)

PA vs. AP

FISSURES (RIGHT LUNG)

RIGHT UPPER LOBE

RIGHT UPPER LOBE

RIGHT MIDDLE LOBE

RIGHT MIDDLE LOBE

RIGHT LOWER LOBE

RIGHT LOWER LOBE

LEFT LUNG

LEFT UPPER LOBE

LEFT UPPER LOBE

LEFT LOWER LOBE

LEFT LOWER LOBE

PATHOLOGIC FINDINGS

PULMONARY OPACITY

PNEUMONIA
RUL

With consolidation

CONSOLIDATION

CONSOLIDATION

AIR BRONCHOGRAM
Branching lucencies within opacified lung
Denotes air space disease:
Pneumonia
Pulmonary edema
Pulmonary hemorrhage

CONSOLIDATION

SILHOUETTE SIGN
Misnomer
Loss of silhouette
Any intrathoracic lesion obscuring the cardiac
border, aorta or diaphragm is anatomically
contiguous with that structure
Localize and detect lesions

INTERSTITIAL DISEASE

RETICULAR PATTERN

NODULAR PATTERN

RETICULO-NODULAR
PATTERN

LINEAR PATTERN
BLUE: Kerley B
lines
ORANGE: Kerley
A lines
GREEN: Kerley C
lines
Expansion of
interstitial
space by fluid

ATELECTASIS
DIRECT SIGNS
Deviation of fissure
Crowding of lung markings
Increased opacification

INDIRECT SIGNS
Shifting of mediastinal structures
Elevation of the diaphragm
Narrowing of rib interspaces
Compensatory hyperinflation of unaffected lung
Displacement of the hila

ATELECTASIS

ATELECTASIS

ATELECTASIS
Types:
OBSTRUCTIVE/RESORPTIVE
Complete endobronchial obstruction w/ resorption of gas
distally

PASSIVE/RELAXATION
Mass effect of an air or fluid collection within the pleural
space on the subadjacent lung
Compressive atelectasis

CICATRICIAL
Reduced alveolar volume due to parenchymal fibrosis

ADHESIVE
Diffuse alveolar collapse and volume loss due to increased
alveolar surface tension
Surfactant deficiency

HYDROTHORAX

HYDROTHORAX
Types:
TRANSUDATE
Excessive production of pleural fluid

EXUDATE
Damaged pleura

HYDROTHORAX

HYDROTHORAX

UNILATERALLY DENSE
HEMITHORAX

CONSOLIDATED
PNEUMONIA

MASSIVE
ATELECTASIS

MASSIVE PLEURAL
EFFUSION

UNILATERALLY DENSE
HEMITHORAX

CONSOLIDATED
PNEUMONIA

MASSIVE
ATELECTASIS

MASSIVE PLEURAL
EFFUSION

PNEUMOTHORAX

PNEUMOTHORAX
Due to terminal airway or alveolar
overdistention and subsequent rupture
Causes
Positive pressure ventilation
Resuscitative efforts
Pulmonary interstitial emphysema
Neonates initial inspiratory effort
Air-trapping

CYSTIC AND CAVITARY

LESIONS
CAVITY pulmonary mass undergoes
necrosis
irregular or lobulated; > 1mm

BULLA gas collection within pulmonary

parenchyma
> 1 cm diameter and thin wall < 1mm

BLEB collection of gas within the layers of

the visceral pleura
Usu. Apical
< 1 cm in size

CYSTIC AND CAVITARY

LESIONS

CYSTIC AND CAVITARY

LESIONS

BRONCHIECTASIS
Irreversible dilatation of the bronchial tree
Tram tracking
Thickened bronchial walls

PULMONARY
NODULES/MASSES
Nodule
Less than 3 cm

Mass
Greater than 3 cm

PULMONARY
NODULES/MASSES

GOLDEN S SIGN

GOLDEN S SIGN
Reverse S Sign
Central mass obstructing the upper
lobe

CANNON BALL MASSES

METASTASES

PULMONARY VASCULAR
PATTERN

NORMAL

PULMONARY VASCULAR
PATTERN

PULMONARY ARTERIAL
HYPERTENSION

QUICK REVIEW

CONSOLIDATED
PNEUMONIA

ATELECTASIS

MILIARY TB

ATELECTASIS

PLEURAL
EFFUSION/HYDROTHORAX

METASTASES

PULMONARY MASS

HYDROTHORAX

BRONCHIECTASIS