Chest radiograph - Wikipedia

A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, ... Chestradiograph FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch ProjectionX-rayofthechest ChestradiographAnormalposteroanterior(PA)chestradiographofsomeonewithoutanysignsofinjury.DxandSinstandfor"right"and"left"respectively.ICD-9-CM87.3-87.4MeSHD013902MedlinePlus003804[editonWikidata] Achestradiograph,calledachestX-ray(CXR),orchestfilm,isaprojectionradiographofthechestusedtodiagnoseconditionsaffectingthechest,itscontents,andnearbystructures.Chestradiographsarethemostcommonfilmtakeninmedicine. Likeallmethodsofradiography,chestradiographyemploysionizingradiationintheformofX-raystogenerateimagesofthechest.Themeanradiationdosetoanadultfromachestradiographisaround0.02mSv(2mrem)forafrontview(PA,orposteroanterior)and0.08mSv(8mrem)forasideview(LL,orlatero-lateral).[1]Together,thiscorrespondstoabackgroundradiationequivalenttimeofabout10days.[2] Contents 1Medicaluses 2Views 2.1Typicalviews 2.2Additionalviews 3Landmarks 4Abnormalities 4.1Nodule 4.2Cavities 4.3Pleuralabnormalities 4.4Diffuseshadowing 4.5Signs 5Diseasemimics 6Limitations 7Gallery 8References 9Externallinks Medicaluses[edit] Dedicatedchestradiographyroom Conditionscommonlyidentifiedbychestradiography Pneumonia Pneumothorax Interstitiallungdisease Heartfailure Bonefracture Hiatalhernia Chestradiographsareusedtodiagnosemanyconditionsinvolvingthechestwall,includingitsbones,andalsostructurescontainedwithinthethoraciccavityincludingthelungs,heart,andgreatvessels.Pneumoniaandcongestiveheartfailureareverycommonlydiagnosedbychestradiograph.Chestradiographsarealsousedtoscreenforjob-relatedlungdiseaseinindustriessuchasminingwhereworkersareexposedtodust.[3] Forsomeconditionsofthechest,radiographyisgoodforscreeningbutpoorfordiagnosis.Whenaconditionissuspectedbasedonchestradiography,additionalimagingofthechestcanbeobtainedtodefinitivelydiagnosetheconditionortoprovideevidenceinfavorofthediagnosissuggestedbyinitialchestradiography. Unlessafracturedribissuspectedofbeingdisplaced,andthereforelikelytocausedamagetothelungsandothertissuestructures,x-rayofthechestisnotnecessaryasitwillnotalterpatientmanagement. ThemainregionswhereachestX-raymayidentifyproblemsmaybesummarizedasABCDEFbytheirfirstletters:[4] Airways,includinghilaradenopathyorenlargement Breastshadows Bones,e.g.ribfracturesandlyticbonelesions Cardiacsilhouette,detectingcardiacenlargement Costophrenicangles,includingpleuraleffusions Diaphragm,e.g.evidenceoffreeair,indicativeofperforationofanabdominalviscus Edges,e.g.apicesforfibrosis,pneumothorax,pleuralthickeningorplaques Extrathoracictissues Fields(lungparenchyma),beingevidenceofalveolarflooding Failure,e.g.alveolarairspacediseasewithprominentvascularitywithorwithoutpleuraleffusions Views[edit] PositioningforaPAchestx-ray Normallateralchestradiograph. Differentviews(alsoknownasprojections)ofthechestcanbeobtainedbychangingtherelativeorientationofthebodyandthedirectionofthex-raybeam.Themostcommonviewsareposteroanterior,anteroposterior,andlateral.Inaposteroanterior(PA)view,thex-raysourceispositionedsothatthex-raybeamentersthroughtheposterior(back)aspectofthechestandexitsoutoftheanterior(front)aspect,wherethebeamisdetected.Toobtainthisview,thepatientstandsfacingaflatsurfacebehindwhichisanx-raydetector.Aradiationsourceispositionedbehindthepatientatastandarddistance(mostoften6feet,1,8m),andthex-raybeamisfiredtowardthepatient. Inanteroposterior(AP)views,thepositionsofthex-raysourceanddetectorarereversed:thex-raybeamentersthroughtheanterioraspectandexitsthroughtheposterioraspectofthechest.APchestx-raysarehardertoreadthanPAx-raysandarethereforegenerallyreservedforsituationswhereitisdifficultforthepatienttogetanordinarychestx-ray,suchaswhenthepatientisbedridden.Inthissituation,mobileX-rayequipmentisusedtoobtainalyingdownchestx-ray(knownasa"supinefilm").Asaresult,mostsupinefilmsarealsoAP. Lateralviewsofthechestareobtainedinasimilarfashionastheposteroanteriorviews,exceptinthelateralview,thepatientstandswithbotharmsraisedandtheleftsideofthechestpressedagainstaflatsurface. Typicalviews[edit] Requiredprojectionscanvarybycountryandhospital,althoughanerectposteroanterior(PA)projectionistypicallythefirstpreference.Ifthisisnotpossible,thenananteroposteriorviewwillbetaken.Furtherimagingdependsonlocalprotocolswhichisdependentonthehospitalprotocols,theavailabilityofotherimagingmodalitiesandthepreferenceoftheimageinterpreter.IntheUK,thestandardchestradiographyprotocolistotakeanerectposteroanteriorviewonlyandalateraloneonlyonrequestbyaradiologist.[5]IntheUS,chestradiographyincludesaPAandLateralwiththepatientstandingorsittingup.SpecialprojectionsincludeanAPincaseswheretheimageneedstobeobtainedstatandwithaportabledevice,particularlywhenapatientcannotbesafelypositionedupright.Lateraldecubitusmaybeusedforvisualizationofair-fluidlevelsifanuprightimagecannotbeobtained.Anteroposterior(AP)AxialLordoticprojectstheclaviclesabovethelungfields,allowingbettervisualizationoftheapices(whichisextremelyusefulwhenlookingforevidenceofprimarytuberculosis). Additionalviews[edit] Decubitus–takenwhilethepatientislyingdown,typicallyontheirside.Usefulfordifferentiatingpleuraleffusionsfromconsolidation(e.g.pneumonia)andloculatedeffusionsfromfreefluidinthepleuralspace.Ineffusions,thefluidlayersout(bycomparisontoanup-rightview,whenitoftenaccumulatesinthecostophrenicangles). Lordoticview–usedtovisualizetheapexofthelung,topickupabnormalitiessuchasaPancoasttumour. Expiratoryview–helpfulforthediagnosisofpneumothorax. Obliqueview–usefulforthevisualizationoftheribsandsternum.Althoughit'snecessarytodotheappropriateadaptationstothex-raydosagetobeused. Landmarks[edit] Achestradiographwiththeanglepartsoftheribsandsomeotherlandmarkslabeled. Mediastinalstructuresonachestradiograph. Intheaverageperson,thediaphragmshouldbeintersectedbythe5thto7thanteriorribsatthemid-clavicularline,and9to10posteriorribsshouldbeviewableonanormalPAinspiratoryfilm.Anincreaseinthenumberofviewableribsimplieshyperinflation,ascanoccur,forexample,withobstructivelungdiseaseorforeignbodyaspiration.Adecreaseimplieshypoventilation,ascanoccurwithrestrictivelungdisease,pleuraleffusionsoratelectasis.Underexpansioncanalsocauseinterstitialmarkingsduetoparenchymalcrowding,whichcanmimictheappearanceofinterstitiallungdisease.Enlargementoftherightdescendingpulmonaryarterycanindirectlyreflectchangesofpulmonaryhypertension,withasizegreaterthan16 mmabnormalinmenand15 mminwomen.[6] Appropriatepenetrationofthefilmcanbeassessedbyfaintvisualizationofthethoracicspinesandlungmarkingsbehindtheheart.Therightdiaphragmisusuallyhigherthantheleft,withtheliverbeingsituatedbeneathitintheabdomen.Theminorfissurecansometimesbeseenontherightasathinhorizontallineatthelevelofthefifthorsixthrib.Splayingofthecarinacanalsosuggestatumororprocessinthemiddlemediastinumorenlargementoftheleftatrium,withanormalangleofapproximately60degrees.Therightparatrachealstripeisalsoimportanttoassess,asitcanreflectaprocessintheposteriormediastinum,inparticularthespineorparaspinalsofttissues;normallyitshouldmeasure3 mmorless.Theleftparatrachealstripeismorevariableandonlyseenin25%ofnormalpatientsonposteroanteriorviews.[7] Localizationoflesionsorinflammatoryandinfectiousprocessescanbedifficulttodiscernonchestradiograph,butcanbeinferencedbysilhouettingandthehilumoverlaysignwithadjacentstructures.Ifeitherhemidiaphragmisblurred,forexample,thissuggeststhelesiontobefromthecorrespondinglowerlobe.Iftherightheartborderisblurred,thanthepathologyislikelyintherightmiddlelobe,thoughacavumdeformitycanalsoblurtherightheardborderduetoindentationoftheadjacentsternum.Iftheleftheartborderisblurred,thisimpliesaprocessatthelingula.[8] Abnormalities[edit] Nodule[edit] Alungnoduleisadiscreteopacityinthelungwhichmaybecausedby: Neoplasm:benignormalignant Granuloma:tuberculosis Infection:roundpneumonia Vascular:infarct,varix,granulomatosiswithpolyangiitis,rheumatoidarthritis Thereareanumberoffeaturesthatarehelpfulinsuggestingthediagnosis: rateofgrowth Doublingtimeoflessthanonemonth:sarcoma/infection/infarction/vascular Doublingtimeofsixto18months:benigntumour/malignantgranuloma Doublingtimeofmorethan24months:benignnoduleneoplasm calcification margin smooth lobulated presenceofacoronaradiata shape site Ifthenodulesaremultiple,thedifferentialisthensmaller: infection:tuberculosis,fungalinfection,septicemboli neoplasm:e.g.,metastases,lymphoma,hamartoma sarcoidosis alveolitis auto-immunedisease:e.g.,granulomatosiswithpolyangiitis,rheumatoidarthritis inhalation(e.g.,pneumoconiosis) Cavities[edit] Acavityisawalledhollowstructurewithinthelungs.Diagnosisisaidedbynoting: wallthickness walloutline changesinthesurroundinglung Thecausesinclude: cancer infarct(usuallyfromapulmonaryembolus) infection:e.g.,Staphylococcusaureus,tuberculosis,Gramnegativebacteria(especiallyKlebsiellapneumoniae),anaerobicbacteria,andfungus Granulomatosiswithpolyangiitis Pleuralabnormalities[edit] Fluidinspacebetweenthelungandthechestwallistermedapleuraleffusion.Thereneedstobeatleast75mLofpleuralfluidinordertobluntthecostophrenicangleonthelateralchestradiographand200mLofpleuralfluidinordertobluntthecostophrenicangleontheposteroanteriorchestradiograph.Onalateraldecubitus,amountsassmallas50mloffluidarepossible.Pleuraleffusionstypicallyhaveameniscusvisibleonanerectchestradiograph,butloculatedeffusions(asoccurwithanempyema)mayhavealenticularshape(thefluidmakinganobtuseanglewiththechestwall). Pleuralthickeningmaycausebluntingofthecostophrenicangle,butisdistinguishedfrompleuralfluidbythefactthatitoccursasalinearshadowascendingverticallyandclingingtotheribs. Diffuseshadowing[edit] Thedifferentialfordiffuseshadowingisverybroadandcandefeateventhemostexperiencedradiologist.Itisseldompossibletoreachadiagnosisonthebasisofthechestradiographalone:high-resolutionCTofthechestisusuallyrequiredandsometimesalungbiopsy.Thefollowingfeaturesshouldbenoted: typeofshadowing(lines,dotsorrings) reticular(crisscrossinglines) companionshadow(linesparallelingbonylandmarks) nodular(manysmalldots) ringsorcysts groundglass consolidation(diffuseopacitywithairbronchograms) location(whereisthelesionworst?) upper(e.g.,sarcoid,tuberculosis,silicosis/pneumoconiosis,ankylosingspondylitis,Langerhanscellhistiocytosis) lower(e.g.,cryptogenicfibrosingalveolitis,connectivetissuedisease,asbestosis,drugreactions) central(e.g.,pulmonaryedema,alveolarproteinosis,lymphoma,Kaposi'ssarcoma,PCP) peripheral(e.g.,cryptogenicfibrosingalveolitis,connectivetissuedisease,chroniceosinophilicpneumonia,bronchiolitisobliteransorganizingpneumonia) lungvolume increased(e.g.,Langerhanscellhistiocytosis,lymphangioleiomyomatosis,cysticfibrosis,allergicbronchopulmonaryaspergillosis) decreased(e.g.,fibroticlungdisease,chronicsarcoidosis,chronicextrinsicallergicalveolitis) Pleuraleffusionsmayoccurwithcancer,sarcoid,connectivetissuediseasesandlymphangioleiomyomatosis.Thepresenceofapleuraleffusionarguesagainstpneumocystispneumonia. Reticular(linear)pattern (sometimescalled"reticulonodular"becauseoftheappearanceofnodulesattheintersectionofthelines,eventhoughtherearenotruenodulespresent) idiopathicpulmonaryfibrosis connectivetissuedisease sarcoidosis radiationfibrosis asbestosis lymphangitiscarcinomatosa PCP Nodularpattern sarcoidosis silicosis/pneumoconiosis extrinsicallergicalveolitis Langerhanscellhistiocytosis lymphangitiscarcinomatosa miliarytuberculosis metastases Cystic cryptogenicfibrosingalveolitis(latestage"honeycomblung") cysticbronchiectasis Langerhanscellhistiocytosis lymphangioleiomyomatosis AchestX-rayshowingaveryprominentwedge-shapeareaofairspaceconsolidationintherightlungcharacteristicofacutebacteriallobarpneumonia. Groundglass extrinsicallergicalveolitis desquamativeinterstitialpneumonia alveolarproteinosis infantrespiratorydistresssyndrome(RDS) Consolidation pneumonia alveolarhaemorrhage alveolarcellcarcinoma vasculitis Signs[edit] Thesilhouettesignisespeciallyhelpfulinlocalizinglunglesions.(e.g.,lossofrightheartborderinrightmiddlelobepneumonia),[9] Theairbronchogramsign,wherebranchingradiolucentcolumnsofaircorrespondingtobronchiisseen,usuallyindicatesair-space(alveolar)disease,asfromblood,pus,mucus,cells,proteinsurroundingtheairbronchograms.ThisisseeninRespiratorydistresssyndrome[9] Diseasemimics[edit] Diseasemimicsarevisualartifacts,normalanatomicstructuresorharmlessvariantsthatmaysimulatediseasesandabnormalities. Aprominentthymus,whichcangivetheimpressionofawidenedmediastinum.[10] Theinferiorskinfoldsofthesupraclavicularfossamaygivetheimpressionofaperiostealreactionoftheclavicle Limitations[edit] Whilechestradiographsarearelativelycheapandsafemethodofinvestigatingdiseasesofthechest,thereareanumberofseriouschestconditionsthatmaybeassociatedwithanormalchestradiographandothermeansofassessmentmaybenecessarytomakethediagnosis.Forexample,apatientwithanacutemyocardialinfarctionmayhaveacompletelynormalchestradiograph. Gallery[edit] ChestX-rayPAinvertedandenhanced. ProjectionallyrenderedCTscan,showingthetransitionofthoracicstructuresbetweentheanteroposteriorandlateralview Chestfilmshowingincreasedopacityinbothlungs,indicativeofpneumonia Achestradiographshowingbronchopulmonarydysplasia. Achestfilmafterinsertionofanimplantablecardioverter-defibrillator,showingtheshockgeneratorintheupperleftchestandtheelectricalleadinsidetherightheart.Notebothradio-opaquecoilsalongthedevicelead. References[edit] ^FredA.Mettler,WalterHuda,TerryT.Yoshizumi,MahadevappaMahesh:"EffectiveDosesinRadiologyandDiagnosticNuclearMedicine:ACatalog"–Radiology2008;248:254–263 ^"RadiationDoseinX-RayandCTExams".radiologyinfo.orgbytheRadiologicalSocietyofNorthAmerica.Retrieved2017-08-10. ^UsingDigitalChestImagestoMonitortheHealthofCoalMinersandOtherWorkersArchived2019-01-28attheWaybackMachine.NationalInstituteforOccupationalSafetyandHealth. ^medicalmnemonics.com>ChestX-rayinterpretationArchivedJanuary13,2010,attheWaybackMachine2002 ^"ChestX-rayquality–Projection".RadiologyMasterclass.Retrieved27January2016. ^Bush,A;Gray,H;Denison,DM(February1988)."Diagnosisofpulmonaryhypertensionfromradiographicestimatesofpulmonaryarterialsize".Thorax.43(2):127–31.doi:10.1136/thx.43.2.127.PMC 1020754.PMID 3353884. ^Gibbs,JM;Chandrasekhar,CA;Ferguson,EC;Oldham,SA(2007)."Linesandstripes:wheredidtheygo?--FromconventionalradiographytoCT".Radiographics.27(1):33–48.doi:10.1148/rg.271065073.PMID 17234997. ^Gandhi,Sanjay(December7,2013).ChestRadiology:ExamRevisionMadeEasy(1st ed.).JMDBooks.pp. 541pages. ^abChestX-Ray,OB-GYN101:IntroductoryObstetrics&Gynecology.©2003,2004,2005,2008MedicalEducationDivision,BrooksideAssociates,Ltd.Retrieved9February2010. ^Khan,Nausheen;Thebe,DimakatsoC.;Suleman,Farhanah;VandeWerke,Irma(2015)."Pitfallsandmimics:Themanyfacetsofnormalpaediatricthymus".SouthAfricanJournalofRadiology.19(1).doi:10.4102/sajr.v19i1.803.ISSN 2078-6778.(CCBY4.0) Externallinks[edit] WikimediaCommonshasmediarelatedtoX-raysofthechest. ChestX-rayAtlas USUHS:BasicChestX-RayReview eMedicineRadiology:Chestarticles DatabaseofchestradiologyrelatedtoemergencymedicineArchived2008-07-25attheWaybackMachine Introductiontochestradiology:atutorialforlearningtoreadachestx-ray ChestRadiologyTutorialsFreeWebTutorialsforChestAnatomyandLungMalignanciesinRadiology Yale:IntroductiontoCardiothoracicImaging vteMedicalimagingX-ray/Radiography2DMedical: Pneumoencephalography Dentalradiography Sialography Myelography CXR Bronchography AXR KUB DXA/DXR Uppergastrointestinalseries/Small-bowelfollow-through/Lowergastrointestinalseries Cholangiography/Cholecystography Mammography Pyelogram Cystography Arthrogram Hysterosalpingography Skeletalsurvey Angiography Angiocardiography Aortography Venography Lymphogram Orbitalx-ray Industrial: Radiographictesting CTscanTechniques: Generaloperation Quantitative High-resolution X-raymicrotomography Electronbeam Conebeam Targets Heart calciumscan angiography Abdominalandpelvis Virtualcolonoscopy Angiography Coronary Pulmonary Head Thyroid Wholebodyimaging Full-bodyCTscan Other Fluoroscopy Dentalpanoramicradiography X-raymotionanalysis MRI Brain functional Neurography Cardiac perfusion Angiography Cholangiopancreatography(MRCP) Breast Sequences diffusion restriction Tractography SyntheticMRI Ultrasound Techniques doppler contrast-enhanced 3D endoscopic duplex Echocardiography Dopplerechocardiography TTE TEE TranscranialDoppler Intravascular Gynecologic Obstetric Echoencephalography Abdominalultrasonography renal renaltract Rectal Breast Scrotal Carotid Emergencyultrasound FAST pre-hospital Radionuclide2D/scintigraphy Cholescintigraphy Scintimammography Ventilation/perfusionscan Radionuclideventriculography Radionuclideangiography Radioisotoperenography Sestamibiparathyroidscintigraphy Radioactiveiodineuptaketest Bonescintigraphy Immunoscintigraphy Dacryoscintigraphy DMSAscan Gastricemptyingscan Fullbody: Octreotidescan Gallium67scan Ga-68-DOTATOC Indium-111WBCscan 3D/ECTSPECT(gammaray): Myocardialperfusionimaging PET(positron): BrainPET CardiacPET PETmammography PET-CT PET-MRI Optical/Laser Opticaltomography Opticalcoherencetomography Confocalmicroscopy Endomicroscopy Orthogonalpolarizationspectralimaging Thermography non-contactthermography contactthermography dynamicangiothermography Targetconditions Acutestroke Pregnancy Category Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Chest_radiograph&oldid=1049059075" Categories:ProjectionalradiographyThorax(humananatomy)Hiddencategories:WebarchivetemplatewaybacklinksArticleswithshortdescriptionShortdescriptionmatchesWikidataCommonscategorylinkisonWikidata Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk Variants expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةCatalàDeutschEspañolفارسیFrançaisItalianoעבריתLatinaNederlandsPolskiPortuguêsРусскийSimpleEnglishSlovenčinaไทยTiếngViệt粵語中文 Editlinks