Interpretation of Chest X-Ray: An Illustrated Companion

Description

This book is a quick reference guide to chest X-Ray interpretation. Beginning with an introduction to basic chest radiology the following section describes `normal' chest X-Ray. The next chapters cover more than 100 lung and heart disorders, each beginning with a clinical description, followed by an image of the symptoms in a chest radiograph which is accompanied by a corresponding line diagram to help illustrate the salient features. This practical manual is a useful reference for both postgraduates and clinicians. More than 225 radiological images, diagrams and tables enhance learning. Key points Quick reference guide to chest X-Ray interpretation Explains basic radiology and `normal' chest X-Ray Covers more than 100 lung and heart disorders Each topic illustrated by radiographic image and corresponding line diagram CHEST X-RAY An Illustrated Companion JAYPEE BROTHERS MEDICAL P U B LISHERS ( P ) L TD P reface G Balachandran Contents 1. Introduction 2. Normal Chest X-Ray 3. Lung Opacity and Lung Lucency 4. Diseases of the Heart viii 5. Miscellaneous Lesions Index CHAPTER Introduction GENERAL INTRODUCTION B ASIC RADIOGRAPHY Black and White Principles Basic Chest X-ray Views P osteroanterior ( P A ) View vs A nteroposterior ( A P ) View T echnical Factors of Viewing for Chest Radiographs P enetration Respiration P atient Rotation P atient Movement B ASIC PRINCIPLES OF C HEST X- RAY I NTERPRETATION Radiographic Density Radiographic Contrast CHAPTER Normal Chest X-ray Normal Structure S See N I N c he S t X- r a y— a Br I ef De S cr I pt I Introduct I on t he Lungs and F I ssures Pleural c o v ering r ibs d iaphragm Heart K e y Points for Interpretation T r achea/Bronchi/Alveoli Heart and Great Vessels Mediastinum Diaphragm Bone Structures Soft Tissues Others a , B, c ’ s of c hest X-ray Interpretation so M e use F u L s I gns I n chest X- ra Y I nter P retat I on s ilhouette s ign Uses of Silhouette Sign a ir Bronchogram s igns Air Bronchogram C auses of Air Bronchogram Common Rare t r am Lines e xtrapleural s ign Lung Opacity and Lung Lucency L UNG OPACITY  INTRODUCTION  UNILATERAL LUNG OPACITY Unilateral Lung Opacity Involving Whole Lung Massive Pleural Eff usion Massive Lung Collapse Massive Consolidation P ost-pneumonectomy (Fig. 3.4) Unilateral Lung Opacity Involving Part of Lung W ell-defi ned Series L obar Consolidation (Fig. 3.5) P neumonia Upper Lobe Consolidation (Fig. 3.6) C omplication of Pneumonic Consolidation Seen in Chest X-ray  L OBAR COLLAPSE SERIES  C OLLAPSE/ATELECTASIS Summary of the Radiographic Signs of Collapse Direct Signs of Collapse Indirect Signs of Collapse C auses of Collapse T ypes of Collapse Special Forms of Collapse Golden’s “S“ Sign L uftsichel Sign  C OLLAPSE OF INDIVIDUAL LOBES (TABLE 3.6) Right Upper Lobe Right Middle Lobe Right Lower Lobe Pleural Eff usion Pleural Eff usion Hemothorax L ung Mass Single Large L ung Masses P ancoast Tumor (Fig. 3.14) Radiologic Features Clinical Features P eripheral Lung Carcinoma (Fig. 3.15) L ung Mass—Multiple and Large L ung Secondaries Metastatic disease—hematogenous spread Metastatic disease—lymphangitic spread Metastatic disease – endobronchial metastases Metastatic disease – intrathoracic adenopathy Metastases other characteristics Different radiological features L ung Carcinoma L ung Nodule—Single Small T uberculoma L ung Nodule—Multiple Tiny Miliary Mottling P neumoconiosis Characteristics Clinical Features Radiological Features Unilateral “ILL Defi ned” Lung Opacity Involving Part of Lung ILL Defi ned Fibrosis in TB T uberculosis P rimary Complex—Childhood TB  HILUM BASED OPACITY C auses of Enlarged HILA Hilar Lymphadenopathy T uberculous Lymphadenopathy Sarcoidosis L ymphoma Hodgkin’s Disease Clinical features Radiographic features  BILATERAL LUNG OPACITY C ongestive Cardiac Failure (CCF) C ongestive Cardiac Failure—Kerley B Lines K erley Lines A Lines C auses of Kerley Lines C ongestive Cardiac Failure—Pulmonary Edema L UNG LUCENC Y  L UNG LUCENCY—UNILATERAL INVOLVING WHOLE LUNG P neumothorax F indings in Chest X-ray in Tension Pneumothorax (Fig. 3.29)  L UNG LUCENCY—UNILATERAL INVOLVING PART OF LUNG Radiological Appearances C auses of Unilateral Hyperlucency F ibrous-Cavernous Tuberculosis L ung Abscess P neumatocele  BULLOUS EMPHYSEMA  BRONCHIECTASIS C auses C omplications of Bronchiectasis T ypes of Bronchiectasis Radiological Features  L UNG LUCENCY—BILATERAL COPD C OPD—Emphysema Diseases of the Hear t  CRITERIA FOR A NORMAL HEART IN CHEST X-RAY  METHOD OF MEASURING CTR IN CHEST X-RAY (FIG. 4.2) Right Sided Cardiac Structures L eft Sided Cardiac Structures  HOW TO READ X-RAY CHEST IN CARDIOLOGY? Site Size C ontour A tria Great Vessels P ulmonary Vascularity P ulmonary Oligemia P ulmonary Plethora P ulmonary Venous Hypertension (PVH) P ulmonary Edema Other Abnormalities  CARDIAC SHAPE—A GUIDE TO CONGENITAL HEART DISEASE T otal Anomalous Pulmonary Venous Drainage (TAPVD) F allot’s Tetralogy Ebstein’s Anomaly Dextrocardia  CARDIAC SITUS—A GUIDE TO CHD Kartagener Syndrome Characteristics Clinical Features Radiological Features Diff erential Diagnosis  C O ARCTATION OF AORTA  P A TENT DUCTUS ARTERIOSUS (PDA) Roentgenogram Staging  VENTRICULAR SEPTAL DEFECT (VSD)  A TRIAL SEPTAL DEFECT (ASD)  PRIMARY PULMONARY HYPERTENSION Diff erential Diagnosis  BICUSPID AORTIC VALVE A ortic Stenosis C alcifi c Aortic Stenosis Chest Radiography A ortic Regurgitation C auses of Aortic Regurgitation in Mneumonics  MITRAL REGURGITATION  RHEUMATIC MITRAL STENOSIS  LEFT ATRIAL ENLARGEMENT  PERICARDIAL EFFUSION  CALCIFIC PERICARDITIS C auses of Pericarditis in Mnemonic CARDIAC RIND  DILATED CARDIOMYOPATHY Mneumonic for Dilated Hearts (Extrinsic Heart Diseases) Dilated Hearts End In Terrible In fi ltration  C ONGESTIVE HEART FAILURE—CHF/CCF  PULMONARY EDEMA Heart Failure—Chest X-ray Signs in Mneumonics ABCDE  A ORTIC ANEURYSM A neurysm—Causes in Mneumonic A TTIC CHAPTER Miscellaneous Lesions RIB FRACTURE (F I g . 5 . 1 ) CERVICAL RIB C omp LETE E VE n TRATI on o F T h E R I gh T hE m I d IA ph RA gm dIA ph RA gm R U p TURE d IA ph RA gm A TIC h ER n IA I n A C h IL d Unilateral Elevation of the h emidiaphragm g AS U nd ER d IA ph RA gm C h ILAI d ITI SY nd R om E Subcutaneous Emphysema (Fig. 5.10) Index